Obesity Treatment Gliwice

Obesity is a chronic disease. In the International Classification of Diseases ICD-10 it has the code E66, and in its 2024 recommendations the Polish Society for the Treatment of Obesity describes it as a disease that requires long-term care. After weight loss the body may respond with stronger hunger, so keeping the results off requires continued support. We decide on the approach and the length of treatment individually.

Take an example: a man who lost more than ten kilograms three times over a decade now weighs more than he did before his first attempt. Once body fat has been lost, the body may use less energy than its new weight would suggest and release more ghrelin, a hormone that stimulates appetite. As fat stores shrink, levels of leptin, a hormone involved in regulating satiety, may also fall. Hunger then comes back sooner after the same meal. Not every diet, however, ends with the weight returning.

Where does excess body fat come from?

Obesity is a disease in which there is so much body fat that it begins to harm health. The excess usually builds up over many years in which the body takes in more energy from meals and drinks than it uses and stores the surplus in fat cells. With moderate weight gain, fat cells increase in volume, and when weight gain lasts longer, new cells form. In men, body fat often accumulates in the abdomen, around the internal organs. This visceral fat is the most harmful, because it releases substances that sustain chronic inflammation and makes the tissues less sensitive to insulin. For this reason abdominal obesity is associated with a higher risk of type 2 diabetes, high blood pressure, fatty liver disease and coronary artery disease. Obesity can also lower testosterone, and testosterone deficiency encourages muscle loss.

Obesity usually has several causes. Twin studies show that genes explain 40 to 70 percent of the differences in body weight between people, and children of parents with obesity develop the disease more often. A genetic tendency leads to weight gain when high-calorie food is easy to get and the day is filled with sitting at work, in the car and in front of the television. Short sleep, chronic stress, shift work, quitting smoking and alcohol, whose calories are easy to overlook, also promote weight gain. Body weight can also be increased by anti-inflammatory steroid tablets, for example Encorton, some psychiatric drugs and insulin, as well as by an untreated underactive thyroid, although this condition usually does not explain all of the obesity. We check for medicines and diseases that promote weight gain before treatment begins.

How does obesity treatment begin?

Treatment begins with diagnosing obesity and assessing its complications. The doctor establishes whether there are indications for drug treatment, checks how well the patient tolerates the drug and judges its effectiveness according to the rules for that particular product. The programme includes two online consultations with a psychologist, after months 1 and 3, lasting 40-50 minutes each. As early as the initial consultation we explain that treatment may include months with no fall in body weight.

We start by measuring body weight and waist circumference. 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 about 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. BMI does not, however, distinguish muscle from fat. In a man who does physical work or trains with weights the index can be high with little body fat, which is why the index alone settles nothing.

The patient measures waist circumference at home, 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, regardless of BMI, and above 102 cm the risk of metabolic complications rises more markedly. In women the thresholds are 80 and 88 cm, because body size and the distribution of body fat differ. In men fat is more often laid down inside the abdomen, and visceral fat is associated with a higher risk of metabolic complications. We also take a weight history: what the patient weighed at around the age of twenty, when his weight started to rise, what treatments he has tried and whether he managed to maintain a lower weight. We ask about how he feels, his sex drive and morning erections, because the scope of further investigations depends on those answers.

At what BMI can drug treatment be considered?

BMI is one of the eligibility criteria. For many of the drugs discussed here the threshold is 30, or 27 if the patient has a weight-related condition 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. Xenical has a different criterion: a BMI of at least 30, or above 28 with risk factors. Before prescribing, the doctor also assesses the patient's health, previous treatment and the safety of therapy, so meeting the threshold does not guarantee a prescription. Below a BMI of 27 the standard weight-management indications of the drugs discussed here are not met. Low testosterone on its own is not grounds for prescribing an obesity drug, although many patients come to us for exactly that reason.

Age alone does not rule out treatment, but it affects the choice of product. Saxenda is not recommended from the age of 75, Mysimba is not recommended over 75 and requires caution over 65, and for Wegovy and Mounjaro there is limited data in people aged 85 and over.

We look after patients with obesity in a six-month online programme for PLN 1,799. The price does not include the drugs, which the patient buys at a pharmacy with an e-prescription. Treatment starts with a 30-minute initial consultation with the doctor by video. The doctor reviews the medicines and supplements the patient takes; in men over forty these often include a blood pressure drug, a statin and sometimes an erection product bought without a prescription. The doctor then goes through the patient's weight history and test results and orders any missing tests. The doctor assesses the weight, waist circumference and blood pressure measured by the patient at home, sets the treatment goal and decides whether the patient can be treated in the programme. An e-prescription is issued when the results and the patient's health allow drug treatment to start, and with the first prescription for a drug given by pen injector the doctor explains how to use the pen.

The programme includes two 30-minute doctor consultations, two 40-50-minute online consultations with a psychologist and five medical reviews of app data without a call. The patient books the video consultations in the Nasz Gabinet app. The schedule is counted from the initial consultation.

The price also includes an AI assistant and monitoring of body weight and treatment progress.

After each medical review the doctor issues an e-prescription. Every week the patient enters his body weight in the app, and every month his body measurements. The patient documents each injection with a photo of the pen, and the medical team reviews these photos. The doctor looks at these results before the check-up. The guidelines of the Polish Society for the Treatment of Obesity (PTLO) recommend treatment for a year or longer, so after the programme we offer a continuation package for 3 months for PLN 350. In the package the doctor reviews progress every month and issues an e-prescription, without video consultations.

The dose is increased gradually, according to the summary of product characteristics of the specific product. Wegovy starts at the lowest of five doses and is increased every 4 weeks up to 2.4 mg; in adults with a starting BMI of at least 30, after at least 4 weeks on 2.4 mg, the summary of product characteristics allows an increase to 7.2 mg if needed. Mounjaro starts at 2.5 mg a week and moves to 5 mg after 4 weeks, with further increases of 2.5 mg made only if needed, at intervals of at least 4 weeks. The Saxenda dose is increased at intervals of at least a week. Before a dose change the patient reports the weight and blood pressure he has measured at home and describes how he is tolerating the drug. Not every check-up ends with a dose increase. Strength training goes into the plan from the start, because weight falls fastest in the first months and that is when muscle is most easily lost along with the fat. The doctor decides when the blood tests should be repeated.

Treatment is usually considered effective when body weight has fallen by at least 5 percent. When this is assessed depends on the product: for Saxenda it is 12 weeks on the 3 mg dose, for Xenical 12 weeks and for Mysimba 16 weeks. If the drug is poorly tolerated or other problems arise, the doctor reviews treatment earlier. We decide whether to continue, change the dose or end drug treatment after assessing its effect and safety, without a stopping date fixed in advance.

What does our programme not cover?

• We do not prescribe testosterone and we do not provide hormone treatment for men. Eligibility for such treatment is decided by an andrologist or an endocrinologist. In the Nasz Gabinet programme we treat obesity, and weight loss may improve testosterone levels.
• We do not treat erectile dysfunction and we do not prescribe erection drugs. When a patient has these problems we check blood pressure, cholesterol and glucose, because erectile dysfunction is a reason to assess cardiovascular risk.
• We do not change cardiac treatment or the doses of blood pressure drugs without agreeing it with the doctor in charge. If home readings show blood pressure getting steadily lower as the patient loses weight, we contact the doctor in charge, and the patient records the readings and does not change the doses himself. Dizziness, fainting or marked weakness with low blood pressure need urgent medical assessment, without waiting for a scheduled consultation.

The doctor decides which tests are needed. Most often they include a full blood count, fasting glucose or glycated haemoglobin, a lipid profile, liver enzymes, creatinine and TSH, the hormone that steers the thyroid. The doctor judges whether older results need repeating. A GP orders tests funded by the National Health Fund (NFZ) according to clinical indications and the rules of the service; the results can be sent before the initial consultation. With a BMI of 27 to 29.9, eligibility for a drug often depends on the glucose or the lipid profile, because these tests can reveal a weight-related condition. Creatinine with a calculated eGFR shows how the kidneys are working, and TSH helps assess thyroid function. The liver enzymes ALT and AST cannot diagnose fatty liver on their own, and normal results do not rule it out. In the lipid profile of a man with abdominal obesity, triglycerides often rise and HDL cholesterol falls, so we look at these two values particularly carefully.

When do we order a testosterone test and how should it be done?

We measure testosterone in men with symptoms: a drop in sex drive, no morning erections, marked fatigue or a loss of muscle despite training. Blood is taken in the morning, between seven and eleven, fasting. A low result has to be repeated on a different day, because a single reading after a sleepless night or during an infection may come out too low. With a borderline result and an altered level of SHBG, the protein that binds sex hormones, the doctor also assesses free testosterone. If the result is low, luteinising hormone and prolactin are measured. They help establish the cause of the deficiency but do not settle it on their own, so the doctor interprets them together with the symptoms and the other results. Disease of the pituitary or the testes requires specialist treatment. A result from a test package bought online may be reliable; what matters is the time and conditions of the blood draw and the laboratory method used.

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 STEP 1, women made up three quarters of the participants. Men often come forward for a reason other than the weight itself: with a blood glucose result from an occupational health check, with high blood pressure picked up by chance, after a heart attack or because of erectile dysfunction.

What lowers testosterone when there is excess body fat?

Obesity can lower testosterone levels. Contributing factors include changes in SHBG levels and in hormonal regulation. Adipose tissue contains aromatase, an enzyme that converts testosterone into oestradiol, a hormone that is also present in men. Excess insulin and chronic inflammation can weaken 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 reports that it affects 35 to 50 percent of men with obesity and type 2 diabetes; that figure does not describe all men with excess weight. Patients often put the symptoms, such as lower sex drive, poorer sleep, loss of strength and loss of muscle, down to age. In its 2020 guidelines the European Academy of Andrology recommends diagnosing hypogonadism only when the symptoms are accompanied by repeated morning fasting measurements below the cut-off, which is taken at around 12 nmol/l, and when other causes have been assessed.

Obesity treatment when testosterone is low

Under the same guidelines, the first step in men with overweight and obesity is a change of lifestyle and weight loss, and testosterone treatment is considered only later. As body fat decreases and insulin sensitivity improves, testosterone levels may rise. Weight loss can improve the results, but it does not replace investigation of other causes of the deficiency. A 2026 systematic review covering studies of GLP-1 analogues in men with obesity, diabetes or functional hypogonadism describes a moderate rise in testosterone and improved erections. The only randomised trial, carried out in men with normal hormone levels, showed no difference from placebo. These data do not allow us to promise an improvement to every man.

Testosterone treatment has contraindications of its own. Before it starts, PSA is measured, the prostate is examined and the haematocrit is checked, because thickening of the blood is a common complication of this therapy. Testosterone also suppresses sperm production, which matters for a man planning a child. Eligibility for testosterone treatment is decided by an andrologist or an endocrinologist.

What did the T4DM trial show, and what conclusions do we not draw from it?

The Australian T4DM trial enrolled men with impaired glucose tolerance or newly diagnosed type 2 diabetes who were taking part in a lifestyle programme and did not have pathological hypogonadism. The trial looked at preventing type 2 diabetes and at improving glucose control in newly diagnosed disease. Type 2 diabetes was diagnosed in 12 percent of the men receiving testosterone and in 21 percent of those receiving placebo. A haematocrit above 54 percent, meaning excessive thickening of the blood, was found in 22 percent of the men treated with testosterone against 1 percent in the placebo group. The results apply to this particular group of men and are not evidence for giving testosterone routinely in obesity. Testosterone has no indication for treating obesity, which is why we do not prescribe it at our clinic.

How do we interpret test results in men?

The table brings together the measurements and tests we assess most often. The doctor interprets them together with the symptoms and the other results.

Erectile dysfunction and the risk of heart disease

An erection depends on blood flow through the arteries of the penis, which are narrower than the coronary arteries, so changes in the blood vessels may cause symptoms there earlier. Erectile dysfunction is a reason to assess cardiovascular risk, but on its own it does not mean a diagnosis of atherosclerosis. In observational studies, men with erectile dysfunction had a 44 percent higher relative risk of cardiovascular events and a 62 percent higher relative risk of heart attack than other men. These are associations observed in studies and they do not prove cause. We ask a patient who reports this problem to measure his blood pressure, and we check the lipid profile together with glucose.

In some men, weight loss can improve erections. In an Italian randomised trial, 110 men with obesity and erectile dysfunction, without diabetes, high blood pressure or hyperlipidaemia, were divided into two groups of 55. For two years the intervention group took part in a diet and exercise programme. Normal erectile function returned in 17 men in that group against 3 in the control group. The data on GLP-1 analogues here come from small studies and we regard them as preliminary.

With men who have had a heart attack we discuss the effect of treatment on the heart separately. The SELECT trial enrolled 17,604 people aged 45 and over with established cardiovascular disease, a BMI of 27 or more and no diabetes; men made up 72 percent of the participants, and more than three quarters of the participants had previously had a heart attack. They received semaglutide 2.4 mg or placebo, and follow-up lasted an average of 39.8 months. Cardiovascular death, heart attack or stroke occurred in 6.5 percent of those taking semaglutide and in 8.0 percent of those taking placebo. That is a relative risk reduction of 20 percent and a difference of 1.5 percentage points. The result applies to semaglutide 2.4 mg in this group of patients and cannot be extended to the whole class of drugs or to all men. Because of side effects, 16.6 percent of the semaglutide group stopped treatment against 8.2 percent of the placebo group. We show a patient who has had a heart attack both of these figures, and we agree the treatment plan with his cardiologist.

GLP-1 and GIP are gut hormones released after a meal. They are involved in regulating appetite and insulin release, and enzymes in the blood break down natural GLP-1 within a few minutes. Drugs that stimulate the receptors for these hormones have been modified to act for a full day or for a week. They can reduce hunger, slow the emptying of the stomach and make it easier to stop at a smaller portion. Patients often say that a smaller meal fills them up and that they think about food less often between meals. Liraglutide and semaglutide act on the GLP-1 receptor, and tirzepatide on the GIP and GLP-1 receptors. Semaglutide and tirzepatide are injected under the skin once a week, into the abdomen, the thigh or the upper arm, and liraglutide once a day.

What change in body weight can be expected? A worked example

Trials report their results as a percentage of body weight, while patients are interested in kilograms, so at the appointment we convert the figures together with the patient. In the STEP 1 trial, semaglutide 2.4 mg taken for 68 weeks reduced body weight by an average of 14.9 percent, against 2.4 percent on placebo. In the SURMOUNT-1 trial, tirzepatide 15 mg taken for 72 weeks reduced it by an average of 20.9 percent, against 3.1 percent on placebo. In both trials the participants also made lifestyle changes. In the SCALE trial, liraglutide 3 mg reduced body weight after 56 weeks by an average of 8.4 kg, against 2.8 kg on placebo. The trials differed in population, dose and duration, so their results are not a direct comparison of the drugs. For a starting weight of 106 kg, the STEP 1 average corresponds to about 16 kg and the SURMOUNT-1 average to about 22 kg. This conversion illustrates a trial average and is not a forecast for any individual man, because results varied widely between participants.

Weight coming back once treatment ends

In an extension of the STEP 1 trial, some participants were followed up after they stopped semaglutide and the lifestyle programme ended. A year later they had regained on average about two thirds of the weight they had lost, and much of the improvement in blood glucose and blood pressure had been reversed. The trial did not test whether reducing the dose gradually over several months prevents the weight from returning. We decide whether to continue or end treatment after assessing its effect, tolerance and the patient's health. Before the drug is stopped, we agree a plan for meals, activity and follow-up with the patient. A gain of more than 5 percent of the weight reached during treatment is a reason for reassessment by the doctor. The patient should not go back to the previous dose on his own.

The first question usually concerns a drug name heard at work or at the gym. We compare selected drugs used to treat obesity: Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. This is not a complete list of all authorised products. Wegovy contains semaglutide, Mounjaro tirzepatide, Saxenda liraglutide, Mysimba a combination of two substances, naltrexone and bupropion, and Xenical orlistat. Ozempic and Rybelsus contain semaglutide and Victoza contains liraglutide, the same substances as in Wegovy and Saxenda, but these three products are authorised for treating type 2 diabetes. Whether a product is indicated for treating obesity is determined by its summary of product characteristics.

How does a product licensed for diabetes differ from an obesity product?

The products differ in dose, form and the group of patients in whom they were studied. Ozempic contains injectable semaglutide at doses up to 2 mg and Rybelsus contains semaglutide in tablets; both are indicated for type 2 diabetes. Injectable Wegovy is indicated for weight management and went through the STEP trial programme in people with obesity. The 2.4 mg dose is no longer its only maintenance dose: the current summary of product characteristics also describes 7.2 mg in adults with a starting BMI of at least 30, after at least 4 weeks on 2.4 mg, if needed. The European documentation also covers Wegovy tablets for adults. Authorisation does not confirm that a particular dose or form is available in Polish pharmacies. Liraglutide at 3 mg is Saxenda, also given by injection, and at doses up to 1.8 mg it is Victoza, used in diabetes. Mounjaro with tirzepatide is indicated in both diseases. Treatment starts at 2.5 mg a week, after 4 weeks the dose is 5 mg, further increases are made only if needed, and the maintenance doses are 5, 10 or 15 mg.

Prescribing a drug outside its authorised indication is a doctor's decision that requires medical justification. Reimbursement has to be distinguished from the authorised indication: reimbursement of Ozempic applies to specific groups of patients with type 2 diabetes, and a doctor who issues a reimbursed prescription to someone outside those groups may be asked to pay the reimbursement back. We choose the product after assessing the indications, contraindications and the patient's preferences, and where type 2 diabetes is also present we take the diabetes specialist's treatment plan into account.

The monthly cost of treatment with each of the products

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are not included for the treatment of obesity in the list of reimbursed medicines in force from 1 July 2026, so patients pay the full price for them. The monthly cost depends on the product, the dose, the pack size and the pharmacy. Not every patient reaches the highest dose, so neither the price of the starting dose nor the price of the highest dose describes the cost of treatment for everyone. Prices of Wegovy at doses up to 2.4 mg do not reflect the cost of the 7.2 mg dose or of the tablets. The same dose can cost different amounts in two pharmacies in Gliwice, so it is worth comparing prices before the first purchase.

Oral obesity drugs

Some patients prefer tablets or tolerate them better. Mysimba contains naltrexone and bupropion, which act on the centres in the brain that regulate appetite and on the reward system. Emotional eating may be one element of the assessment, but on its own it does not decide the choice of this drug. In the COR-I trial body weight fell after 56 weeks by an average of 6.1 percent, against 1.3 percent on placebo. Treatment is stopped if at least 5 percent of the starting body weight has not been lost after 16 weeks, and if treatment continues the doctor reviews the benefits, cardiovascular safety and whether the effect is being maintained at least once a year. The product is not used in, among other situations, uncontrolled high blood pressure, epilepsy, bipolar disorder or a history of bulimia or anorexia, in people taking opioids or monoamine oxidase inhibitors, or during abrupt withdrawal from alcohol. 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 comes as hard capsules containing 120 mg of orlistat. Orlistat reduces the absorption of roughly a third of the fat in a meal, and in trials it gave about 3 kg more weight loss than placebo after a year. It requires the fat in the diet to be limited, because a fatty meal leads to fatty stools. Treatment is stopped if at least 5 percent of the body weight measured before the start has not been lost after 12 weeks. Wegovy also comes in an oral form, so the tablet form alone does not determine how strongly a drug works.

According to the summary of product characteristics, the contraindication to semaglutide is hypersensitivity to the active substance or to any of the excipients. A separate group consists of situations in which the drug is not recommended or caution is needed, and the rules differ between products. Obesity drugs are not used in pregnancy. Semaglutide is stopped at least 2 months, and tirzepatide at least a month, before a planned pregnancy. Wegovy and Saxenda should not be used while breastfeeding, while the current summary of product characteristics for Mounjaro allows treatment to be considered on an individual basis. Wegovy and Saxenda are not recommended in severe kidney or liver impairment; Mounjaro does not need a dose change for that reason alone, but data in severe disease are limited and caution is needed. A history of pancreatitis calls for caution and individual assessment. Wegovy and Saxenda are not recommended in severe gastroparesis, which means markedly slowed emptying of the stomach. Mounjaro has not been studied in this patient group; its use requires caution and an individual medical assessment.

The American label also lists medullary thyroid cancer in the patient's own or family history and multiple endocrine neoplasia type 2. The European summary of product characteristics contains no such entry. Even so, at Nasz Gabinet we have adopted the rule of not offering the drug to these patients. We ask about insulin and sulfonylureas, because with these drugs the risk of hypoglycaemia rises; the doctor assesses whether their doses need to change on the basis of blood glucose readings, together with the diabetes specialist. We also ask about steroid tablets taken long term, because they increase body weight themselves and make it harder to judge whether treatment is working. Before anaesthesia or deep sedation the patient tells the procedure team about the drug he is taking.

How common are side effects?

Most of the phone calls in the first weeks are about the stomach and the bowels. The data on how often these complaints occur come from a pooled analysis of the STEP 1 to 3 trials and relate to Wegovy, not to all obesity drugs. 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; these complaints were also reported by participants on placebo, only less often. The median duration of an episode of nausea was 8 days. That figure refers to individual episodes and does not mark the point by which nausea settles in half of patients. In the STEP 1 trial, 4.5 percent of those taking the drug and 0.8 percent of those taking placebo stopped treatment because of gastrointestinal complaints. If a new dose is poorly tolerated, the doctor may keep the patient on the current dose for longer; smaller portions, eating more slowly and a break from fatty food also help. Rapid weight loss encourages stones to form in the gall bladder: 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 should you phone us and when should you go to the emergency department?

Yellowing of the whites of the eyes or of the skin, and a weight loss of more than 2 kg in a week despite eating normally, call for a phone call to us the same day. Dizziness on standing up in a person treated for high blood pressure should also be reported to the doctor. It can have various causes, including a blood pressure drug dose that has become too high after weight loss. Vomiting that leaves the patient unable to keep fluids down, passing very little urine, fainting or confusion need urgent medical help without waiting until the next day. Severe abdominal pain radiating to the back needs urgent assessment in hospital: the patient stops taking the drug and goes to the emergency department without waiting for our reply. Sudden worsening or loss of vision needs urgent eye care; in people with diabetes, rapid improvement in blood glucose control can also temporarily worsen the changes at the back of the eye. We answer the phone every day from 8am to 8pm. The out-of-hours health service helps with sudden illness or a worsening of health that is not directly life-threatening. For the warning signs described above, the right place remains the emergency department, at any time of day.

How can you avoid counterfeit semaglutide pens?

In 2023 counterfeit semaglutide pens were detected in several European countries. When dispensing the drug, the pharmacist scans the two-dimensional code on the pack and checks it in the European medicines verification system. 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 sold outside pharmacies. 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 decide what the patient eats or at what time. The dietitian therefore starts with a dietary history and with the shape of the patient's day, including whether he has his main meal during a break at work or only in the evening once he is home. The dietitian sets the calorie deficit and the amounts of protein and fluid according to the patient's health, activity and tolerance of treatment, taking kidney and heart disease into account. A commonly used deficit is 500 to 750 kcal a day, with protein at 1 to 1.5 g per kilogram of ideal body weight, that is the weight that suits the patient's height, spread across all meals. 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. Protein helps protect muscle, which can be lost along with fat when body weight falls quickly. We also make sure the patient gets fibre from vegetables, grains and wholegrain products, which reduces the risk of constipation while the bowels are working more slowly. The amount of fluid is set individually, and on days with nausea we discuss it with the patient separately.

We plan exercise separately, and its main job is to maintain muscle and fitness. The energy the training itself uses up is smaller than most patients assume. The more muscle that stays, the easier it is to maintain energy expenditure, including after the drug is stopped. We usually 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 walking between sessions. For a patient who has not exercised 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 over fifty want to go back to the sport of their youth and start with running. We increase the intensity of exercise according to fitness, symptoms and the condition of the joints, and agree with each patient individually when to return to running. Walking, cycling or swimming, which put less strain on the knees, work well to begin with.

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

Patients describe eating without hunger in different ways: in the evening they keep going to the fridge, after a day at work they feel they deserve something, or they eat out of boredom in front of the television. The drug reduces hunger but does not remove a habit reinforced over years. The psychodietitian teaches the patient to catch the moment just before reaching for food and to rearrange the day so that he does not come home after eight hours without a meal. We work separately with patients whose evening eating goes together with alcohol, because eating and drinking then need a joint plan. A large evening meal on its own does not mean binge eating disorder. If a patient describes repeated episodes of eating very large amounts with a sense of losing control, we suggest an assessment for this disorder, including a psychiatric consultation.

Alcohol provides energy and can make it harder to control eating. 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 provide 800 to 1,000 kcal. That is roughly one to two days of the planned deficit. Cutting down on drinking makes it easier to reduce the calories in the diet. Regular drinking can also raise blood pressure and lower testosterone, and alcohol drunk as a way of getting to sleep disrupts sleep in the second half of the night.

During treatment with a GLP-1 analogue, alcohol can make nausea worse, and nausea is more common at the start of treatment and when the dose is increased. In people taking insulin or sulfonylureas, alcohol increases the risk of hypoglycaemia, including in the early morning. We do not require every patient to abstain; the doctor gives individual advice on drinking. We do, however, ask for the true number of glasses and beers, because without it it is hard to explain why body weight is not falling. One symptom we warn about separately: severe pain that bands around the abdomen after alcohol during this treatment needs urgent assessment in hospital, because it may be a sign of acute pancreatitis.

It happens that a conversation about weight turns into a conversation about alcohol, and the drinking turns out to be the more urgent matter. Daily drinking makes it harder to lose weight. If the patient does not manage to cut down, the doctor may recommend a break from drinking and suggest treating the addiction first. A person who is dependent on alcohol should agree with a doctor how to stop, because stopping drinking suddenly may require medical supervision. We also run alcoholism treatment in Gliwice. We do not treat alcohol addiction in passing with an obesity drug, because it requires a separate assessment and a separate plan, which we draw up as part of addiction therapy.

The initial and final doctor consultations and the two psychologist consultations take place by video. The five monthly medical reviews use the data in the app and do not involve a call. During a video call the doctor goes through the results, the patient's weight history and chronic illnesses, and reads the blood pressure from home measurements and the waist circumference the patient has measured following instructions. The patient checks the skin in his armpits and groin himself, because dark, velvety patches may appear there with insulin resistance. If he has noticed them, we ask him to mention it during the consultation. Blood pressure at home is best measured with a cuff matched to the circumference of the arm, because a cuff that is too narrow gives a falsely high reading in a person with obesity. Finally, the doctor decides on the basis of the history and results whether the patient can be treated in the programme.

At a check-up the doctor assesses the change in body weight, tolerance of the drug, blood pressure, test results and the safety of treatment. The patient has blood taken at the laboratory nearest his home and sends us the result before the consultation, and he gets the prescription code by text message.

Treatment on the NFZ can begin with a GP. A primary care doctor can diagnose obesity, order tests according to clinical indications and the rules of the service, and refer the patient to a specialist clinic where this is indicated. The cardiovascular prevention programme (ChUK) is available without a referral to people aged 35 to 65. Eligibility requires no diagnosis of diabetes, chronic kidney disease, familial hypercholesterolaemia or certain cardiovascular conditions; a doctor assesses whether a particular diagnosis excludes participation. The patient must not have had tests under ChUK in the preceding 5 years or under the Moje Zdrowie programme in the preceding 12 months. The programme covers, among other things, measurement of blood pressure, weight and waist circumference, a lipid profile, glucose and an assessment of risk, with the scope of tests set by the terms of the programme. In this way a man who has not seen a doctor for years can have his blood pressure measured and his lipid profile and glucose results ready before his initial consultation. The Moje Zdrowie programme, available in primary care from the age of 20, includes a health review and may include educational advice, including dietary advice. Access to a dietitian under coordinated care, on the other hand, depends on the diagnosis and on the surgery's rules.

On the NFZ, where indicated and with a referral, patients can also have an abdominal ultrasound scan, which helps assess fatty liver disease, and, after assessment at a specialist centre, bariatric surgery. Privately, the patient pays for our online treatment programme, which costs PLN 1,799 for 6 months. The programme includes two consultations with a psychologist; dietitian and psychodietitian consultations are not included. The patient buys the drug at a pharmacy. The products discussed on this page are not reimbursed for the treatment of obesity. Whether a drug with the same substance is reimbursed for another indication, for example Ozempic in type 2 diabetes, depends on the diagnosis and on the criteria in the list of reimbursed medicines. We talk about the possible monthly spending on the drug at the initial consultation, because it may affect the choice of product. If an andrologist or an endocrinologist recommends testosterone treatment, that specialist runs it, together with checks of PSA and haematocrit.

A 2025 Polish consensus recommends surgical treatment at a BMI of at least 35, regardless of coexisting conditions, and at a BMI of 30 to 34.9 particularly in patients with type 2 diabetes that cannot be brought under control with non-surgical treatment. Similarly broad indications were adopted in 2022 by IFSO, the international federation of bariatric societies, and the American ASMBS. BMI alone does not complete the assessment: the bariatric centre also assesses the patient's illnesses, nutritional status, physical fitness and mental health. The rules for NFZ funding of the operation, which the centre applies, have to be distinguished from clinical recommendations. 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 suggest a surgical consultation when the patient has indications for it, without waiting for a set period of unsuccessful treatment. The centre may be chosen in any province, and there are several in the Silesian conurbation. Preparation for the operation is decided by the centre; it often includes losing weight, bringing diabetes and blood pressure under control, correcting deficiencies, for example 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 the anaesthetist decides individually how to proceed before general anaesthesia. After the operation what usually remains is lifelong supplements of vitamins and trace elements, and blood tests, more frequent in the first year.

The KOS-BAR coordinated care pilot ended on 30 June 2026. Bariatric operations on the NFZ are still performed under the general rules, as part of guaranteed healthcare services. In some patients body weight rises again a few years after the operation, and drug treatment can then be considered.

We run the programme online, so a patient from Zabrze, Knurów, Pyskowice or the neighbouring districts is treated without travelling to Gliwice. The doctor and psychologist consultations take place by video, and the patient has blood taken at a laboratory where he lives. The five monthly medical reviews use app data without a call.

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 NFZ statistics for August 2026, 120 people were waiting for it and the average wait was 74 days. The current waiting time and the scope of admissions should be checked with the clinic, because the previous month's average is not the date of a future appointment. The NFZ directory lists sixteen metabolic clinic entries for the Silesian province, but some of them relate to services for children, so not all of them see adults. Average waits in the region vary widely: according to statistics read in September 2026, they were 15 days at one clinic in Chorzów, 228 days in Tychy and 297 days at one of the Katowice clinics. 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. He does, however, need to allow for travelling to follow-up appointments at the clinic he chooses.

The patient can have his blood pressure, lipid profile and glucose checked by his GP before deciding where to continue treatment. The cost of the drug depends on the product, the dose, the pharmacy and any entitlement to reimbursement for a given indication.