Obesity Treatment Gliwice

In the International Classification of Diseases ICD-10 obesity has a code of its own, E66, and in its 2024 recommendations the Polish Society for the Treatment of Obesity describes it as a chronic disease: it lasts for years, it needs continuous treatment, and once treatment stops body weight goes back up. An example from the clinic: a man who lost more than ten kilograms three times over a decade now weighs more than he did before the first of those attempts. Once body fat has gone, the body uses less energy than its new weight would suggest, it releases more ghrelin, the hormone that drives appetite, and along with the fat it loses leptin, which tells the brain how much energy is stored. After the same lunch, hunger then comes back sooner than it did before the diet.

Several things outside the diet also affect body weight. Anti-inflammatory steroid tablets, for example Encorton, some psychiatric drugs, an untreated underactive thyroid and alcohol, whose calories almost nobody counts, all push it up. In men there is also the fat that gathers around the abdomen, which lowers testosterone, and with lower testosterone muscle is lost, resting energy expenditure falls and further kilograms go on more easily. The fat surrounding the abdominal organs releases substances that keep inflammation going and makes the tissues less sensitive to insulin, so the pancreas produces more and more of it. That is where the link between obesity and type 2 diabetes, high blood pressure, fatty liver disease and coronary artery disease comes from.

We therefore treat obesity the way a physician treats high blood pressure or diabetes. The doctor makes the diagnosis, chooses the drug, checks how well the patient tolerates it and, after a few months, judges whether it is working. Alongside the doctor there is a dietitian, who builds a meal plan around the patient's working hours, and a specialist in the psychology of eating for when food becomes a way of releasing tension. We plan treatment in years, and at the first appointment we say plainly that there will be months in it with no weight loss.

We start with the scales and a tape measure. BMI is body weight in kilograms divided by the square of height in metres, so a man who is 178 cm tall and weighs 106 kg has a BMI of 33.5. The World Health Organization set the same thresholds for both sexes: 25 for overweight, 30 for class I obesity, 35 for class II and 40 for class III. The index has a drawback, though, and it shows up more often in men than in women: it does not tell muscle from fat. In a man who does physical work or trains with weights, BMI comes out high with relatively little body fat, and on its own it settles nothing.

That is why we measure waist circumference, halfway between the lowest rib and the top of the hip bone, at the end of a relaxed breath out. The International Diabetes Federation takes 94 cm as the threshold for abdominal obesity in men of European descent, whatever the BMI, and above 102 cm the risk of metabolic complications rises more sharply. In women the thresholds are 80 and 88 cm, because body size and the distribution of body fat differ. In men, fat is laid down mainly inside the abdomen, and it is that fat which drives metabolic complications. Separately we take the history of the patient's weight: what he weighed at secondary school and around the age of twenty, when his weight started to climb, what treatments he has been through and how much of the weight he lost he managed to keep off. We also ask about how he feels, about his sex drive and about morning erections, because what we investigate next depends on those answers.

When BMI alone is enough for a prescription and when a coexisting illness is needed

From a BMI of 30 the index alone is enough for a prescription. Between 27 and 29.9 the patient also needs a weight-related illness listed in the summary of product characteristics, that is the official description of the drug: prediabetes or type 2 diabetes, high blood pressure, lipid disorders, obstructive sleep apnoea or cardiovascular disease. Below a BMI of 27 we do not offer drug treatment, whatever the waist circumference and the test results. Low testosterone on its own is not grounds for prescribing an obesity drug either, although many patients come to us for exactly that reason. Age does not rule treatment out, but it does affect the choice of drug: from the age of 75 we do not use liraglutide, and there is little data on the other drugs in people of that age.

Treatment is run by physicians certified by the Polish Society for the Treatment of Obesity, and the first consultation, at our practice at ul. Toszecka 18 or by video call, lasts about an hour and costs PLN 250. It has four parts. First we go through the medicines and supplements the patient takes; in men past forty that list usually holds a blood pressure drug, a statin and sometimes an over-the-counter product for erections. Then we measure weight, waist circumference and blood pressure, and take the history of the patient's weight. The third part is going through the test results and ordering the ones that are missing, and the fourth is the decision about treatment. A patient with a full set of results who meets the criteria leaves with an e-prescription (Poland's electronic prescription) for the starting dose and an appointment with the dietitian, and we teach him how to use the injection pen at that same appointment, in person or over the camera.

Reaching the target dose of semaglutide takes 16 weeks: we start with the lowest of five doses and raise it four times, at four-week intervals. Tirzepatide is also raised every 4 weeks, but it has more dose steps and reaching the highest of them takes about 20 weeks. The liraglutide dose goes up every week, because that is the schedule written into its summary of product characteristics. Before every dose change we see the patient by video: he reports the weight and blood pressure he has measured at home and describes how he is tolerating the drug, and the doctor sets the dose and sends the prescription code. Strength training goes into the plan in the very first week, because weight falls fastest at the start and that is when muscle is easiest to lose along with the fat. In the fourth month we repeat the blood tests.

We judge how well the drug is working after three months on the full dose, so roughly in the seventh month of treatment. Treatment counts as effective when body weight has fallen by at least 5 percent; that threshold is written into the summaries of product characteristics and the Polish Society for the Treatment of Obesity applies it too. If the fall is smaller we change the drug, for example to another injectable or to an oral one. After that review the patient stays on a fixed dose, and we check on him remotely every 4 to 8 weeks and once a quarter at the practice. After a year we decide together whether the drug stays or whether we start bringing the dose down.

What we do not do at Nasz Gabinet Gliwice in the treatment of obesity

• We do not prescribe testosterone and we do not run hormone treatment in men. An andrologist or an endocrinologist decides who is eligible for it, while we deal with body weight, which largely determines the level of that hormone.
• We do not treat erectile dysfunction and we do not prescribe drugs for erections. We do check blood pressure, cholesterol and blood glucose, because in some men trouble with erections is the first sign coming from the blood vessels.
• We do not change cardiac treatment or the doses of blood pressure drugs on our own. When blood pressure starts to drop too low as the patient loses weight, we write to the doctor in charge with a proposed adjustment, and until that doctor decides the patient does not change the doses himself and keeps a record of his readings at home.

Before the first prescription we want to see a full blood count, fasting glucose or glycated haemoglobin, a lipid profile, liver enzymes, creatinine and TSH, the hormone that steers the thyroid; results more than six months old we ask the patient to repeat. A GP can order the whole set on the National Health Fund (NFZ), free of charge, and a photograph of the results taken on a phone is enough for us. In the BMI range from 27 to 29.9, eligibility usually turns on the glucose or the lipid profile, although any other illness from the list in the summary of product characteristics will do. Liver enzymes point to a fatty liver, creatinine with a calculated eGFR tells us how the kidneys are working, and a normal TSH rules out the underactive thyroid that almost every patient asks about. In the lipid profile of a man with abdominal obesity, triglycerides are the first to rise and HDL cholesterol the first to fall, so we look at those two items more closely than at total cholesterol.

When we order a testosterone test and how it has to be done

We do not measure testosterone in everyone. We do it when the patient reports a drop in sex drive, no morning erections, marked fatigue or a loss of muscle despite training. The result only means something if the sample is taken under the right conditions: blood in the morning, between seven and eleven, fasting, and always two measurements on different days, because a single reading after a sleepless night or during an infection can come out too low. If the result is low we also measure luteinising hormone and prolactin, because those two tests help us separate a deficiency caused by the obesity itself from disease of the pituitary or the testes, which needs specialist treatment. Patients who come with a result from a test package bought online are usually asked to repeat the measurement under proper conditions before we draw any conclusion from it.

In Poland excess weight is more common in men than in women: according to a 2019 survey by the Polish statistical office GUS, 65 percent of men and 49 percent of women are overweight or obese, while in drug trials, for example in STEP 1, women made up three quarters of the participants. Men come forward later and rarely because of the weight itself. They come with a blood glucose result from an occupational health check, with blood pressure picked up by chance, after a heart attack, or because of erectile dysfunction, which they mention only at the end of the appointment.

What lowers testosterone when there is too much body fat

Adipose tissue contains aromatase, the enzyme that converts testosterone into oestradiol, a typically female hormone. The more body fat there is, the lower the testosterone level in the blood. Excess insulin and chronic inflammation further dampen the signal that the hypothalamus and the pituitary send to the testes. A deficiency of this kind is called functional hypogonadism, as distinct from damage to the testes or the pituitary. A 2026 review of the literature puts it at 35 to 50 percent of men with obesity and type 2 diabetes, and the symptoms overlap with what patients put down to age: less sex drive, poorer sleep, less strength, loss of muscle. In its 2020 guidelines the European Academy of Andrology recommends diagnosing it only when the symptoms come with two morning fasting measurements below the cut-off, which is taken at around 12 nmol/l, and when organic causes have been ruled out.

Why we start with weight loss rather than testosterone injections

Under the same guidelines, the first step in every man with overweight and obesity is a change of lifestyle and weight loss, and testosterone treatment is considered only after that. As body fat goes down, so does aromatase, insulin sensitivity improves and testosterone rises on its own, without the hormone being given from outside. A 2026 systematic review covering work on GLP-1 analogues in men with obesity, diabetes or functional hypogonadism describes a moderate rise in testosterone and better erections. In the only randomised trial, carried out in men with a normal hormone level, no difference from placebo was shown. How large the effect is therefore depends on the patient's metabolic state.

Testosterone treatment has contraindications of its own and, before it starts, requires a PSA test, an examination of the prostate and a check of the haematocrit, because thickening of the blood is its commonest complication; it also suppresses sperm production, which matters for a man planning a child. An andrologist or an endocrinologist decides who is eligible for it, not us.

What the T4DM trial showed and what we do not conclude from it

The argument for the hormone that comes up most often is the Australian T4DM trial, in which testosterone given alongside a lifestyle programme reduced the risk of diabetes in men with low testosterone, but thickened the blood too much in one in five of the men treated. That result is about preventing diabetes, not about treating obesity. Testosterone holds no marketing authorisation in Poland either in obesity or in the prevention of diabetes, which is why a patient will not get it from us.

The measurements and thresholds we look at in men

The table below brings together the measurements and tests we ask for most often, along with the cut-off values that the treatment decision depends on.

Erectile dysfunction as the first sign of atherosclerosis and what obesity treatment does for the heart

An erection depends on the small arteries of the penis staying open, and those arteries are narrower than the coronary arteries, so atherosclerosis shows itself in them earlier. In large observational studies, men with erectile dysfunction had a 44 percent higher risk of cardiovascular events and a 62 percent higher risk of heart attack than other men. So in a patient who reports this problem we measure blood pressure and check the lipid profile along with the glucose, instead of sending him straight off for tablets. Weight loss on its own improves erections: in an Italian randomised trial in which men with obesity took part in a diet and exercise programme for two years, 17 of the 55 participants regained normal sexual function against 3 of the 55 in the control group. The data on GLP-1 analogues here comes from small trials and we treat it as preliminary.

With men who have had a heart attack we talk about the heart separately, because in them the risk of a second heart attack depends on how the obesity is treated. The SELECT trial enrolled 17,604 people aged 45 and over with cardiovascular disease and a BMI of 27 or more, without diabetes; men made up 72 percent of the participants and more than three quarters had already had a heart attack. After almost four years of follow-up, cardiac death, heart attack or stroke occurred in 6.5 percent of those taking semaglutide and in 8.0 percent of those taking placebo, which means a fifth less risk. Tolerance of the treatment came off worse: side effects led 16.6 percent of the semaglutide group to stop it, against 8.2 percent of the placebo group. We show a patient who has had a heart attack both of those figures, and we agree the treatment plan with his cardiologist.

GLP-1 is a hormone that the gut releases after a meal. It suppresses appetite, slows the emptying of the stomach and prompts the pancreas to release insulin, after which enzymes in the blood break it down within a minute. The molecules used in treatment have been modified so that the enzymes break them down far more slowly, which is why they act for a full day or for a week. Patients describe this in two ways: a smaller portion fills them up, and between meals the constant thinking about food goes away. Tirzepatide is not an analogue of GLP-1 alone, because it also acts on the receptor for a second gut hormone, GIP, and it lowers body weight more strongly than semaglutide. Semaglutide and tirzepatide are injected once a week into the skin of the abdomen, the thigh or the upper arm, liraglutide once a day.

How many kilograms a man weighing 106 kg loses on the drug

Trials report their results as a percentage of body weight, while the patient is interested in kilograms, so at the appointment we convert the percentages into kilograms together with him. At 106 kg, semaglutide gives roughly 16 kg of weight loss over 68 weeks, and tirzepatide about 22 kg over 72 weeks, although part of that comes from the change in eating alone, because both trials ran one alongside the drug. These figures come from the registration trials. In the STEP 1 trial body weight fell by 14.9 percent against 2.4 percent on placebo, so the drug itself gave an advantage of 12.5 percentage points, and in the SURMOUNT-1 trial tirzepatide at 15 mg gave 20.9 percent against 3.1 percent. Liraglutide in the SCALE trial does less well, because after 56 weeks the loss came to 8.4 kg against 2.8 kg on placebo, that is roughly 8 percent of body weight. The average also hides large differences between participants, and nobody can predict in advance how much a given man will lose.

Weight coming back once treatment ends

What happens after the drug is stopped is known from the further follow-up of the participants in the STEP 1 trial: the drug was taken away and their care ended, and a year later two thirds of the lost weight had returned, along with their starting blood glucose and blood pressure. The drug can be stopped, but we spread the stopping over months. We bring the dose down gradually and care carries on, although even then some of the weight returns. We start reducing the dose only once body weight has stood still for several months, eating has a regular rhythm and strength training happens on fixed days of the week. For the next six months after the last injection we keep seeing the patient for follow-up appointments, and a gain of more than 5 percent of the weight reached on treatment is a signal for us to go back to the drug.

The first question usually concerns a name heard at work or at the gym, and it is whether that is an obesity drug. Five products are approved in Poland for treating obesity: Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. Of these, only the orlistat in Xenical has cheaper generic versions; the other substances remain under patent. The names patients bring up most often belong to a completely different group. Ozempic and Rybelsus contain semaglutide and Victoza contains liraglutide, the same substances as in Wegovy and Saxenda. Ozempic, Rybelsus and Victoza, however, hold a marketing authorisation for type 2 diabetes only. Whether a product is an obesity drug is therefore decided by the indication written into the summary of product characteristics.

How a product licensed in diabetes differs from an obesity product

The dose settles the division, along with who the product was tested in. Semaglutide in Wegovy goes up to 2.4 mg and went through the STEP trial programme in people with obesity, whereas Ozempic goes no higher than 2 mg, and Rybelsus is the same semaglutide in a tablet for people with diabetes. Liraglutide at 3 mg is Saxenda and obesity treatment; at doses up to 1.8 mg it is Victoza and diabetes treatment. The only product approved in both diseases is Mounjaro with tirzepatide. A man without diabetes who has bought Ozempic on a prescription issued for another indication is therefore left on a dose that was not the target dose in the obesity trials, and the doctor who issues him a reimbursed prescription risks being asked to pay the reimbursement back. So we start with Wegovy or Mounjaro; we reach for the other products when injections are contraindicated, and where type 2 diabetes is present as well we agree the choice with a diabetes specialist.

The monthly cost of treatment with each of the products

In September 2026 a month of treatment at the pharmacy costs: Wegovy from PLN 550 to 890, Mounjaro from PLN 800 to 1,900, Saxenda from PLN 500 to 1,250, Mysimba from PLN 370 to 600, and Xenical together with the orlistat generics from PLN 160 to 350. With the pen products the lower figure is the starting dose and the higher one the target dose, so we advise planning the household budget on the higher figure from the outset, because the patient reaches the target dose within a few months. With Mysimba the difference comes from working up gradually to the full dose, that is four tablets a day, and with orlistat from competition between the makers of the generics. The same dose in two pharmacies in Gliwice can differ by several dozen złoty, so we ask patients to compare prices before the first purchase and then stay with one pharmacy.

Where tablets belong in the treatment of obesity

Oral products work less strongly than injected ones, but some patients tolerate them better or prefer a tablet. Mysimba contains naltrexone and bupropion, which act on the reward system in the brain, that is they blunt the pleasure of eating, and we consider it in patients who reach for food under the influence of emotion. In the COR-I trial body weight fell after 56 weeks by 6.1 percent against 1.3 percent on placebo, and the summary of product characteristics requires treatment to be stopped if the loss does not reach 5 percent after 16 weeks. We do not use the product in uncontrolled high blood pressure, epilepsy or bipolar disorder, after bulimia or anorexia, in people taking opioids or monoamine oxidase inhibitors, or during alcohol withdrawal. With this one we also ask about stop-smoking medicines, because bupropion is an ingredient of one of them and must not be taken in two products at the same time. Xenical with orlistat blocks the absorption of roughly a third of the fat in a meal, gives about 3 kg more weight loss than placebo after a year and requires the fat in the diet to be limited, because otherwise fatty stools appear.

The summary of product characteristics for semaglutide gives one absolute contraindication: hypersensitivity to the active substance. In practice there are far more situations in which we do not start the drug. We do not use it in pregnancy or while breastfeeding, and we advise women of childbearing age to use effective contraception and to stop semaglutide at least two months before a planned pregnancy. We also do not start the drug in gastroparesis, that is markedly slowed emptying of the stomach, or in end-stage kidney failure, where safety data is simply missing; after an episode of pancreatitis we take the decision with particular care. The American label additionally lists medullary thyroid cancer in the patient's own or family history and multiple endocrine neoplasia type 2. The European summary of product characteristics carries no such entry, but even so we do not offer the drug to those patients. We ask separately about two groups of medicines: insulin and sulfonylureas, whose doses we lower together with a diabetes specialist so that hypoglycaemia does not occur, and steroid tablets taken long term, because they raise body weight themselves and make it harder to judge whether treatment is working.

Nausea, diarrhoea and gallstones in the figures from the trials

Most of the phone calls in the first weeks are about the stomach and the bowels, and we know the scale of these complaints from a pooled analysis of the STEP 1 to 3 trials. Nausea was reported by 43.9 percent of those taking semaglutide against 16.1 percent on placebo, diarrhoea by 29.7 percent, vomiting by 24.5 percent and constipation by 24.2 percent; diarrhoea, vomiting and constipation were also reported by participants on placebo, only less often. In half of the patients the nausea settled within eight days. Gastrointestinal complaints led to treatment being stopped in the STEP 1 trial in 4.5 percent of those taking the drug and in 0.8 percent of those taking placebo. Every dose increase makes them worse for a while, which is why we keep to four-week intervals and, if tolerance is poor, leave the current dose in place for another month; smaller portions, eating more slowly and a break from fatty food also help. We watch the gall bladder separately, because rapid weight loss encourages stones to form: in the treated group gallstones were recorded in 1.6 percent of participants, inflammation of the gall bladder in 0.6 percent and acute pancreatitis in about 0.2 percent.

When to phone us and when to go to the emergency department

A few situations call for a phone call the same day. The first is vomiting that lasts more than a day, with the patient unable to keep down even fluids. The second is yellowing of the whites of the eyes or of the skin. The third is a loss of more than 2 kg in a week despite eating normally. The fourth concerns men treated for high blood pressure: dizziness on standing up usually means that after more than ten kilograms have come off the dose of their drug has turned out to be too high. Severe abdominal pain radiating to the back needs urgent assessment in hospital; we ask the patient to go to the emergency department then and not to wait for our reply. Patients with diabetes also phone if their eyesight gets worse quickly, because a sharp improvement in blood glucose control temporarily worsens the changes at the back of the eye. We answer the phone every day from 8am to 8pm. Outside those hours, non-urgent matters are taken over by the out-of-hours health service, while for the warning signs described above the right place remains the emergency department, at any time of day.

How to avoid counterfeit semaglutide pens

In 2023 counterfeit semaglutide pens reached legally operating pharmacies in several European countries, because they entered the market outside the official supply chain. The European medicines verification system catches them: on dispensing, the pharmacist scans the two-dimensional code on the pack and checks the batch number. So we ask patients not to buy the product from small ads, from auction sites or from friends at the gym, even when the price is half as much. The same goes for testosterone ampoules, which reach the same channels. Our prescription comes to the patient as a four-digit code in a text message and can be dispensed at any pharmacy in the country.

The drug reduces appetite, but it does not settle what the patient eats or at what time. The dietitian therefore starts with a dietary history and with the shape of the day, including the question of whether the patient has his main meal in the canteen at his break or only in the evening once he is home. We set the deficit at 500 to 750 kcal a day, and we count protein at 1 to 1.5 g per kilogram of ideal body weight, that is the weight that suits the patient's height, and spread it across all his meals. Protein is the most important item on such a meal plan in men, because when body weight falls quickly muscle goes along with the fat, and a low testosterone level makes it harder to rebuild. At a height of 180 cm the ideal body weight is about 75 kg, which works out at 75 to 110 g of protein a day. Beyond that we watch the fibre from vegetables, grains and wholegrain products, which protects against constipation while the bowels are working slowly, and at least one and a half litres of fluid a day, and more on days with nausea.

We plan exercise separately, and its main job is to keep muscle. The energy the training itself uses up is smaller than most patients assume. The more muscle that stays, the higher the resting metabolic rate, including after the drug is stopped. We suggest strength training twice a week, at home or at the gym, using body weight and a load matched to what the patient can manage, with a daily walk between sessions. For a patient who has not moved for years we set one goal to begin with: a quarter of an hour of walking a day, at a pace that still lets him speak in full sentences.

Some men past fifty want at this point to go back to the sport of their youth and start with running. We then suggest putting the running off until more than ten kilograms have gone, to spare the knees.

What we do when the patient eats in the evening without being hungry

Men rarely talk about eating out of emotion. They say that in the evening they simply keep going to the fridge, that after a day at work they deserve something, or that they eat out of boredom in front of the television. In each of these cases the GLP-1 analogue quietens hunger but does not remove a habit built up over more than ten years. The specialist in the psychology of eating teaches the patient to catch the moment just before the fridge door opens, and to rearrange the day so that he does not come home after eight hours without a meal, because after a day like that there is no such thing as a considered choice of supper. We work separately with the men whose evening eating goes together with alcohol, because eating and drinking cannot then be treated apart. If the history includes repeated episodes of eating very large portions with a sense of losing control, that is binge eating disorder, we suggest a psychiatric consultation alongside.

The body burns the calories from alcohol first, so as long as the liver is breaking it down, the fat from the same supper goes into store. A gram of alcohol holds 7 kcal, closer to fat at 9 kcal than to sugar at 4 kcal. Half a litre of beer is 200 to 250 kcal, depending on its strength, and 50 ml of vodka about 110 kcal, so four beers on a Saturday evening come to close to a thousand calories, roughly a day and a half of the planned deficit. Regular drinking also raises blood pressure and lowers testosterone, and in men with obesity both of those effects add to the effects of the abdominal obesity itself. On top of that comes broken sleep in the second half of the night, especially when alcohol serves as a way of getting to sleep.

During treatment with a GLP-1 analogue alcohol behaves differently than before. Slower emptying of the stomach delays its absorption, so alcohol starts to work later than usual and it is easy to drink more than intended. Alcohol also makes worse the nausea that appears in the first days after an injection anyway. In people taking insulin or sulfonylureas the risk of hypoglycaemia in the early morning goes up. We do not set abstinence as a condition, but we do ask for the true number of glasses and beers, because without it we cannot explain why the weight is standing still. One symptom we warn about separately: severe pain that bands around the abdomen after alcohol during this treatment needs urgent assessment in hospital, because that is how acute pancreatitis starts.

It happens that a conversation about weight turns into a conversation about alcohol, and the drinking turns out to be the more urgent matter. When the evening beer has become an everyday habit, no meal plan will bring body weight down, so we suggest starting with treatment for the drinking. At the same address we run alcoholism treatment in Gliwice, so the patient does not have to look any further. We do not treat alcohol addiction in passing with an obesity drug: that is a separate assessment, separate doses and a separate plan, which we draw up as part of addiction therapy.

The first consultation can start remotely and some patients do exactly that, but we complete the examination at the practice within the first weeks of treatment. The doctor then looks at the results, goes through the history of the patient's weight and his chronic illnesses, and reads the blood pressure from measurements taken at home, while the patient measures his waist himself, following the instructions given at the appointment. Over video it is impossible to examine the thyroid by touch, to listen to the heart or to look at the skin in the armpits and the groin, where dark, velvety patches appear when blood glucose handling is disturbed; if the patient has noticed them on himself, we ask him to mention it at the appointment, because it is a sign of insulin resistance. For those examinations we ask him to come in. We measure blood pressure in both arms with a cuff matched to their circumference, because one that is too narrow gives a falsely high reading in a person with obesity.

Follow-up appointments while the dose is going up are run remotely, because they come down to a conversation about how the drug is tolerated and a reading of the measurements taken at home; they fall every 4 weeks, and once the target dose is reached every 4 to 8 weeks. The patient comes to the practice once a quarter and whenever something needs examining. He gives blood at the laboratory nearest home and sends us the result before the time of the call, and he gets the prescription code by text message whatever form the appointment takes.

The NFZ covers the diagnostic work; the patient funds the drug treatment of obesity himself. A GP working on the NFZ will diagnose obesity, order blood tests and write a referral to a specialist clinic. There is also a separate cardiovascular prevention programme, run by the patient's own GP, with no referral and once every five years, between the ages of 35 and 65 and provided that cardiovascular disease, diabetes or chronic kidney disease has not been diagnosed before. The programme covers measurement of blood pressure, weight and waist circumference, a lipid profile, glucose and an assessment of risk. For a man who has not seen a doctor for years this is the simplest way to arrive at his first appointment with his blood pressure measured and his lipid profile and glucose results in hand; a full blood count, liver enzymes, creatinine and TSH the GP orders separately. A broader health review comes from the Moje Zdrowie programme, available in primary care from the age of 20. What the NFZ will not provide is month-by-month management of obesity treatment, because an appointment at a GP surgery lasts little more than ten minutes, and there are few clinics in the country dealing with metabolic diseases.

With a referral, an abdominal ultrasound scan, which is used to assess fatty liver disease, is free as well, and so is bariatric surgery itself once the criteria are met. The patient does pay for consultations with us, for the drug at the pharmacy and for appointments with the dietitian and the specialist in the psychology of eating, according to our price list. No product licensed in obesity is reimbursed, so we ask about the monthly outlay the patient can manage at the very first appointment, because sometimes it is that which decides between the products. If an andrologist or an endocrinologist recommends testosterone treatment, that specialist runs it, together with checks of PSA and haematocrit.

The thresholds in force today were set in 2022 jointly by IFSO, the international federation of bariatric societies, and the American ASMBS; the Polish Section of Metabolic and Bariatric Surgery of the Association of Polish Surgeons belongs to the former. Surgery comes into consideration from a BMI of 35 with no further conditions, and from a BMI of 30 when the patient has a metabolic disease, most often type 2 diabetes. A recommendation from scientific societies is one thing, though, and assessment for an operation paid for by the NFZ is another; that is run by the bariatric centre under its own rules. Across the country, on the estimate of the Polish Society for the Treatment of Obesity, about half a million people meet the criteria, while a few thousand a year are operated on.

We raise the subject of a surgeon ourselves in two cases: when the patient meets the criteria and over a year of non-surgical treatment has produced no weight loss or the weight lost has returned, and when the BMI is above 40 with diabetes or severe sleep apnoea alongside it. The centre may be chosen in any province, and there are several in the Silesian conurbation. The operation itself is preceded by preparation: losing weight, bringing diabetes and blood pressure under control, correcting deficiencies of iron and vitamin D, and a psychological consultation. The anaesthetist has to be told about any GLP-1 analogue the patient is taking, because the drug slows the emptying of the stomach and before general anaesthesia the anaesthetist decides how to handle it in each individual case. After the operation what remains is lifelong supplements of vitamins and trace elements, and blood tests, frequent in the first year and roughly yearly after that.

In some of the men operated on, body weight rises again after a few years, as in any chronic disease, and we then go back to drug treatment.

Patients travel to our practice at ul. Toszecka 18 from the western and northern parts of the conurbation and from the neighbouring districts. We arrange treatment so that there are as few journeys as possible: the quarterly measurements are done on site, the remaining follow-up appointments remotely, and the patient gives blood at a laboratory where he lives.

If the patient has a metabolic clinic in his own town with a shorter wait than the one we can offer, we say so at the appointment and leave the decision to him.

There is one metabolic clinic on the NFZ in Gliwice. According to the NFZ waiting-times service, in August 2026 there were 120 people on its list and the average wait was 74 days. The Silesian province has sixteen such clinics, more than any other region apart from Mazovia, but the spread of waits is wide: in one clinic in Chorzów an average of 15 days, in Tychy 227 days with 933 people waiting, and in one of the Katowice clinics 297 days. A referral does not tie the patient to his own city, so a man from Gliwice can put his name down wherever the date is nearer, only he will then be going back there for follow-up every few weeks for a year.

The measurements, the lipid profile and the glucose can be done at his GP surgery before he decides where to carry on; he will buy the drug at the pharmacy at the same price whichever route he takes.