Obesity Treatment Katowice

Obesity is a chronic disease, coded E66 in ICD-10. At Nasz Gabinet, we assess its causes and complications, agree a treatment plan and monitor results. Care also includes maintaining the lower body weight.

What causes obesity and how does it develop?

The Polish Society for the Treatment of Obesity (PTLO) describes obesity as an excess of fat tissue that harms health. This excess develops slowly when the body uses less energy for the work of its organs and for movement than it gets from food and drinks. The unused energy goes into fat cells, which first grow, and with further weight gain the body produces more fat cells. The enlarged fat tissue releases leptin and pro-inflammatory substances, which cause insulin resistance and in this way increase the risk of type 2 diabetes.

Obesity has many causes. The disease often affects several generations of one family, and twin studies show that genes explain 40 to 70 percent of the differences in body weight. A tendency to gain weight shows itself especially in surroundings where high-calorie food is close at hand and work requires no physical effort. It is easier to gain weight with shift work, including night shifts, too little sleep and chronic stress, as well as during pregnancy, during menopause and after quitting smoking. Some patients gain weight because of another disease or a medicine they take. However, an underactive thyroid alone usually does not explain obesity in full.

Once the disease has developed, it is sustained by disturbed appetite regulation: after weight loss appetite may increase and make the lower weight harder to maintain. Treatment therefore also includes long-term support.

What are the complications of obesity?

Obesity increases the risk of more than 200 diseases. Common complications include type 2 diabetes, high blood pressure, fatty liver disease, sleep apnoea and knee osteoarthritis. Losing 5 to 10 percent of body weight may improve blood glucose control, blood pressure and other complications, so this is often our first treatment goal.

We start by calculating body mass index (BMI). It is calculated by dividing weight in kilograms by the square of height in metres. A man 180 cm tall weighing 98 kg has a BMI of 30.2, which on the PTLO thresholds for adults means class I obesity; overweight starts at 25, class I obesity at 30, class II at 35 and class III at 40. At that same height the line for class I obesity falls at about 97 kg and for class II at about 113 kg.

BMI does not tell fat from muscle and says nothing about where the fat sits, so the second measurement is waist circumference. On the criteria of the International Diabetes Federation, a waist of 80 cm or more in women and 94 cm or more in men means abdominal obesity. These thresholds apply to people of European ancestry. Visceral fat, which surrounds the liver and the pancreas, releases inflammatory substances and raises the risk of type 2 diabetes and heart attack more than fat under the skin does. A BMI of 27 and a waist circumference of 105 cm indicate increased metabolic risk and warrant medical assessment.

When should you see a doctor about excess body weight?

We book an appointment with a doctor who treats obesity at a BMI of 30 or above, and also at a BMI of 27 to 29.9 if the patient already has prediabetes, type 2 diabetes, high blood pressure, lipid disorders, fatty liver disease, sleep apnoea or joint pain from overloading. We also book people whose BMI is normal but whose waist is above the limit and whose blood tests show insulin resistance, that is a poor response of the body to its own insulin. In Poland, an obesitologist is a doctor who treats obesity; this is not a separate medical specialty. The PTLO runs a certification programme for doctors. Here obesity is treated by doctors with a background in internal medicine. We see adult patients only.

We treat obesity in an online programme that lasts 6 months and costs PLN 1,799. The medicine is not included in this amount, because the patient buys it at a pharmacy with an e-prescription. At the initial consultation, the doctor asks about weight changes, previous diets, regular medicines and family medical history. They calculate BMI from the measurements the patient has taken at home, review test results and request any missing tests. After reviewing the history and results, the doctor decides whether the patient can be treated in the programme. The programme includes two video consultations with a psychologist. Dietitian and psychodietitian consultations are not included in the programme.

The initial goal is usually a 5-10 percent weight reduction over 3-6 months, or 7-15 percent with type 2 diabetes. Goals reflect the patient's health and do not guarantee a particular result. The PTLO advises against drug treatment lasting less than 6 months. In the programme the patient has two 30-minute doctor consultations, two 40-50-minute online consultations with a psychologist and five medical reviews of app data without a call and books the video consultations in the Nasz Gabinet app. The dates are counted from the initial consultation.

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

In the app the patient logs weight once a week and body measurements once a month. After each injection, the patient takes a photo of the pen, which the medical team looks at. The results reach the doctor before each check-up. The PTLO recommends treatment for a year or longer, so after the programme we offer a continuation package: 3 months for PLN 350. The package covers a monthly review of the results by the doctor and an e-prescription. It does not include video consultations.

We decide whether to continue medication based on benefits, tolerability and individual needs, rather than simply reaching one year of treatment. The programme includes two video consultations with a psychologist. Dietitian and psychodietitian consultations are not included in the programme.

What does obesity treatment at our clinic not include?

• We do not sell medicines. The patient receives an e-prescription and has it dispensed at any pharmacy.
• We do not treat children or teenagers. We see adult patients only.
• We do not perform bariatric surgery. We run and document non-surgical treatment, and we refer a patient who is eligible for an operation to a surgical centre.

Before starting medication, we assess glucose and lipid metabolism, among other factors, and check for contraindications. We order fasting glucose and glycated haemoglobin, which show diabetes and prediabetes, a lipid profile (cholesterol and triglycerides), the liver enzymes ALT and AST, creatinine with eGFR (kidney function), TSH (thyroid), uric acid and a full blood count. In women with irregular periods we add hormone tests for polycystic ovary syndrome. The tests and timing of repeat testing are individual and depend on results, other conditions and the medicine.

Have recent results from primary care or occupational health ready. The doctor will decide whether they are sufficient and which tests are missing. Tests can be done in Katowice or near home; the patient sends the results before the initial consultation.

Thyroid disease, medicines and weight gain

An elevated TSH must be interpreted alongside symptoms and, among other tests, fT4; it does not establish hypothyroidism on its own. Thyroid disease and obesity can be treated in parallel. Where symptoms suggest it, the doctor also considers rarer causes such as Cushing's syndrome. Some antidepressants, antipsychotics, antiepileptics, insulin, sulfonylureas and glucocorticoids can contribute to weight gain. Do not stop them yourself; any alternative with a smaller effect on weight is discussed with the prescribing doctor.

We also assess diabetes risk in patients with obesity. On the guidance of the Polish Diabetes Association we diagnose prediabetes at a fasting glucose of 100 to 125 mg/dl or a glycated haemoglobin of 5.7 to 6.4 percent, and diabetes at a fasting glucose of 126 mg/dl or more in two measurements or a glycated haemoglobin of 6.5 percent or more. Excess visceral fat can contribute to insulin resistance, and weight loss may improve blood glucose control.

DiRECT studied an intensive weight-management programme in people with type 2 diabetes of no more than 6 years' duration who were not using insulin. In the British DiRECT trial, run in ordinary GP surgeries, 46 percent of patients achieved remission of type 2 diabetes after a year on a weight-loss programme, against 4 percent in the control group. Among those who lost 15 kg or more, 86 percent went into remission, and among those who lost 5 to 10 kg, 34 percent did. In this study, remission meant HbA1c below 6.5 percent after at least 2 months without diabetes medication. Weight regain increases the risk of diabetes returning.

Metformin can usually be continued if it remains indicated and well tolerated. Treatment choices for type 2 diabetes follow diabetes indications, not only the BMI criteria for obesity treatment. Ozempic may be reimbursed when its specific criteria are met. For patients taking insulin or a sulfonylurea, the doctor assesses whether the doses need to be reduced, because combining them with a GLP-1 medicine increases the risk of hypoglycaemia. All current medicines are reviewed to avoid duplicating treatment; semaglutide should not be combined with other GLP-1 receptor agonists. Patients with diabetic retinopathy need eye checks. Sudden deterioration in vision during treatment requires urgent assessment by an ophthalmologist.

Medicines used to treat obesity in Poland include orlistat, naltrexone with bupropion, liraglutide, semaglutide and tirzepatide. GLP-1 and GIP are gut hormones released after a meal that help regulate blood sugar. GLP-1 also affects appetite and slows stomach emptying. Liraglutide and semaglutide activate the GLP-1 receptor, while tirzepatide activates two receptors: GIP and GLP-1. These medicines help reduce hunger and food intake. Liraglutide is injected under the skin daily, while injectable semaglutide and tirzepatide are given once a week. The doctor increases the dose gradually, depending on the medicine, treatment response and tolerability.

We consider obesity medication for adults with a BMI of 30 or above, or a BMI of 27 to 29.9 with at least one weight-related condition. The doctor considers the results of diet and physical activity so far and the indications for the particular medicine. For Xenical, the threshold for overweight patients with risk factors is a BMI of 28. An unsuccessful diet alone does not replace the eligibility criteria for medication. Saxenda is injected daily, with the dose gradually increased to 3 mg as directed by the doctor. Injectable Wegovy and Mounjaro are given once a week. Tirzepatide starts at 2.5 mg weekly and increases to 5 mg after 4 weeks. Further increases of 2.5 mg are possible if needed after at least 4 weeks on the current dose. Maintenance doses are 5, 10 or 15 mg. The doctor selects the dose based on treatment response and tolerability.

How far body weight falls in the semaglutide, tirzepatide and liraglutide trials

In the STEP 1 trial, patients on semaglutide 2.4 mg lost on average 14.9 percent of their body weight after 68 weeks, against 2.4 percent in the placebo group; one in two patients on the drug lost at least 15 percent. In the SURMOUNT-1 trial, tirzepatide at a dose of 15 mg produced a fall of 20.9 percent after 72 weeks, against 3.1 percent on placebo. Liraglutide at a dose of 3 mg in the SCALE trial produced a fall of 8.4 kg after 56 weeks, against 2.8 kg on placebo. Participants in these trials did not have type 2 diabetes and also received support with diet and physical activity. These are separate trials, not a direct comparison of the medicines.

At a starting weight of 110 kg, 14.9 percent corresponds to about 16 kg and 20.9 percent to about 23 kg. This illustrates trial averages; it does not predict an individual patient's result.

In the head-to-head SURMOUNT-5 trial in adults with obesity without type 2 diabetes, average weight loss after 72 weeks was 20.2 percent with tirzepatide 10 or 15 mg and 13.7 percent with semaglutide 1.7 or 2.4 mg. The maximum tolerated doses were used. The trial did not include semaglutide 7.2 mg. Health conditions, tolerability and treatment cost also guide the choice of medicine.

Weight stabilisation and stopping medication

Weight stabilises at different times for different people. A plateau does not necessarily mean the medicine has stopped working. If the response is insufficient, we review how the medicine is used, tolerability and adherence to the plan before considering a change. Assessment criteria and timing depend on the medicine. For Mysimba, the assessment 16 weeks after starting treatment determines whether it can continue: the medicine must be stopped if weight loss is below 5 percent. For adults taking Saxenda, treatment must be stopped if body weight has not fallen by at least 5 percent after 12 weeks at 3 mg daily.

In the STEP 1 extension, participants regained an average of about two-thirds of their previous weight loss one year after stopping semaglutide and the lifestyle intervention provided in the trial. We decide individually when to end treatment and agree on a follow-up plan. STEP 1 did not establish that gradual dose reduction prevents weight regain.

Medicines authorised for obesity include Wegovy, Mounjaro, Saxenda, Mysimba and Xenical; Ozempic and Rybelsus are authorised only for type 2 diabetes.

Which of the three semaglutide products is authorised to treat obesity

Semaglutide is available as Wegovy (obesity treatment), Ozempic (injections up to 2 mg for type 2 diabetes) and Rybelsus (tablets for type 2 diabetes). The maintenance dose of injectable Wegovy is 2.4 mg weekly. In adults with an initial BMI of 30 or above, a doctor may increase it to 7.2 mg if needed after at least 4 weeks at 2.4 mg. Ozempic reimbursement applies to diabetes when the reimbursement criteria are met. Liraglutide is available as Saxenda at 3 mg for obesity and Victoza at a lower dose for diabetes. Mounjaro contains tirzepatide and is authorised for both conditions. At our clinic, we do not prescribe Ozempic or Rybelsus for obesity.

Wegovy tablets have also been authorised in the European Union. Authorisation does not mean every formulation and dose is available in Polish pharmacies; availability should be checked before having a prescription dispensed.

Indicative costs of obesity medicines

The indicative cost of injectable Wegovy is around PLN 550-890 for 4 weeks at doses up to 2.4 mg; this range does not cover treatment with 7.2 mg. For Mounjaro, 4 weeks cost from around PLN 800 at 2.5 mg to around PLN 1,900 at 15 mg. Saxenda at the full dose costs around PLN 500-1,250 for 30 days. Prices depend on the pharmacy, dose and pack size, so current prices and availability should be checked before having the prescription dispensed. Indications, tolerability and the patient's budget guide the choice of medicine.

Other obesity medicines: Mysimba and Xenical

Mysimba combines naltrexone and bupropion and acts on appetite regulation and the brain's reward system. In the COR-I trial it produced a fall of 6.1 percent after 56 weeks, against 1.3 percent on placebo. We do not prescribe it in epilepsy, in patients taking opioids or in uncontrolled high blood pressure. Xenical contains orlistat in 120 mg hard capsules. It blocks the absorption of about a third of the fat in a meal and over a year produces a fall 2 to 3 kg greater than placebo; the typical side effect is fatty stools after a fatty meal. We consider oral medicines according to indications, contraindications and patient preferences, including when a patient does not want injections.

The most common side effects are nausea, vomiting, diarrhoea and constipation, affecting more than one in ten people, especially early in treatment and during dose increases. In STEP 1, 4.5 percent stopped treatment because of these symptoms. Smaller portions, avoiding fatty foods and regular fluids can help with mild symptoms. If they persist, the doctor reviews dosing.

Symptoms requiring urgent medical attention

The following symptoms require urgent medical attention. Do not wait for a scheduled check-up. Loss of consciousness requires immediate medical help.

• severe, persistent abdominal pain, especially radiating to the back, with or without vomiting: possible pancreatitis; do not take another dose before urgent medical assessment
• pain below the right ribs, fever or yellowing of the skin: possible gallbladder disease
• sudden deterioration or loss of vision: urgent eye assessment is needed
• vomiting or diarrhoea that prevents you from keeping fluids down, especially with little urine, dizziness or weakness: do not wait for a full day to pass
• shaking, cold sweats, confusion or faintness while taking insulin or a sulfonylurea: possible low blood glucose

Pregnancy, chronic conditions and other medicines during obesity treatment

Liraglutide, semaglutide and tirzepatide should not be used during pregnancy. Before a planned pregnancy, semaglutide should be stopped at least 2 months beforehand and tirzepatide at least one month beforehand. Semaglutide and liraglutide should not be used while breastfeeding. A doctor may consider tirzepatide after an individual assessment of benefits and risks; breastfeeding data are limited.

Semaglutide and liraglutide are not recommended in severe kidney or liver impairment or NYHA class IV heart failure. Tirzepatide does not require a dose adjustment for kidney or liver impairment, but caution is needed in severe impairment because experience is limited. A history of pancreatitis requires caution when considering semaglutide or tirzepatide and does not in itself rule out treatment. If a doctor confirms acute pancreatitis during treatment, the medicine being taken when it occurred should not be restarted.

Liraglutide is not recommended for people aged 75 or older. There are limited data on the use of semaglutide and tirzepatide in people aged 85 or older.

The EU product information for Mounjaro does not require an oral contraceptive dose adjustment and does not consider the reported effect clinically relevant. Patients taking tirzepatide and the contraceptive pill are advised to add a barrier method as a precaution. It should be used for 4 weeks after starting treatment and after each dose increase. An alternative is to switch to non-oral contraception after consulting a doctor.

For patients taking insulin or a sulfonylurea, the doctor assesses whether the doses need to be reduced, because combining them with a GLP-1 medicine increases the risk of hypoglycaemia. All current medicines are reviewed to avoid duplicating treatment; semaglutide should not be combined with other GLP-1 receptor agonists. Patients with diabetic retinopathy need eye checks. Sudden deterioration in vision during treatment requires urgent assessment by an ophthalmologist.

Planned general anaesthesia. The patient tells the anaesthetist that they take the medicine, because delayed gastric emptying increases the risk of aspiration.

Why not to buy semaglutide from classified ads

In October 2023, the Polish pharmaceutical inspectorate warned about counterfeit Ozempic pens found abroad. Austria reported serious adverse effects after counterfeits in which insulin was confirmed. Buy prescription medicines from a pharmacy, not advertisements or products labelled "research peptides".

Weight loss reduces both fat and lean body mass. Lean mass includes muscle, water and internal organs, so a reduction in lean mass does not mean only muscle loss. Adequate protein and resistance exercise help limit muscle loss. A dietitian adapts the meal plan to individual needs, usually with a deficit of 500-750 kcal a day. Protein from meat, fish, dairy or pulses can be spread over 3-4 meals, adjusting their number and size to work hours and treatment tolerability. Vegetables, carbohydrates and fats complete the meals.

Activity helps maintain fitness and muscle, increases energy expenditure and improves insulin sensitivity. The PTLO recommends 150-300 minutes of moderate activity a week and two strength-training sessions. With knee pain, swimming, a stationary bike or walking with poles may be options, depending on tolerability. Someone previously inactive can start with 10 minutes a day and build up gradually; the plan depends on fitness and health, not weight alone.

How the psychodietitian works on eating from stress and from night shift tiredness

Medication does not replace work on eating habits, including eating in response to stress, fatigue or a night shift. The psychodietitian (a dietitian trained in the psychology of eating) teaches the patient to tell physical hunger from emotional hunger, and works out with them what to do at such a moment instead of eating. When a patient has episodes of binge eating, the psychodietitian checks whether an eating disorder needing psychotherapy lies behind them. The programme includes two online consultations with a psychologist, after months 1 and 3, lasting 40-50 minutes each. Dietitian and psychodietitian consultations are not included.

A gram of pure alcohol carries 7 kcal, so a 0.5 litre can of beer comes to about 220 kcal, a 50 ml shot of vodka to about 110 kcal and a 150 ml glass of wine to about 120 kcal. Three such beers provide about 660 kcal and reduce the planned calorie deficit. Calories from alcohol count towards energy intake just like those from food.

Alcohol can worsen nausea and other gastrointestinal symptoms. With insulin or a sulfonylurea, it increases the risk of low blood glucose. Heavy drinking is also a risk factor for pancreatitis. We recommend abstinence during dose escalation. Further advice depends on other conditions, medicines and tolerability; one drink is not universally safe for everyone.

Some patients notice that on the drug they are drawn to alcohol less. In a 2025 trial in JAMA Psychiatry, 48 people with alcohol use disorder took semaglutide or placebo for 9 weeks; in those given semaglutide, alcohol craving fell, as did the number of drinks on the days they drank. This was a small phase two trial, so we do not use semaglutide as a treatment for addiction. A patient whose drinking is getting out of hand we refer to alcoholism treatment in Katowice. With other substances we refer them to addiction therapy in Katowice. We run both at Nasz Gabinet Katowice alongside obesity treatment.

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. Before the initial consultation, prepare test results and a medicine list, and measure your weight, waist and blood pressure at home.

Before each check-up, patients weigh themselves at home, preferably on the same scales. The doctor reviews results, side effects and dosing, and issues an e-prescription when indicated. Test timing is assessed individually throughout treatment. Warning signs require urgent care at the nearest appropriate facility. The programme includes two video consultations with a psychologist. Dietitian and psychodietitian consultations are not included in the programme.

Obesity treatment can start in primary care. A specialist metabolic clinic under the NFZ usually requires a referral. The NFZ directory checked on 10 September 2026 listed three such clinics in Katowice, including one for children, and 13 elsewhere in Silesian Voivodeship. This does not cover all obesity treatment providers. Waiting times depend on the clinic and referral urgency; check the NFZ treatment-date directory or contact the clinic directly.

Patients pay the full price for Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. Semaglutide in Ozempic may be reimbursed for type 2 diabetes when the reimbursement criteria are met. At Nasz Gabinet, the programme fee is PLN 1,799 and covers six months of care. The patient buys the medicine at a pharmacy, and its cost depends on the product, dose and pack size. We discuss it at the initial consultation so the patient can budget for long-term treatment.

Some bariatric surgery pathways use BMI thresholds of 40, or 35 with obesity-related conditions. These are not the full range of indications: international 2022 guidance also includes BMI from 35 without complications and selected cases at lower BMI, such as type 2 diabetes after unsuccessful non-surgical treatment. Medical indications must be distinguished from NFZ funding rules. At BMI 41, a bariatric consultation is already worth considering; the centre assesses previous treatment and health. Bariatric surgery centres operate in Katowice, Bytom, Zabrze and Jaworzno, among other locations. Before registering, check whether the centre treats adults, its eligibility rules and whether the procedure is funded by the NFZ. Bariatric surgery can be funded by the NFZ under its general rules. The KOS-BAR pilot ended on 30 June 2026. The surgical centre can explain eligibility and the current organisation of care.

We help assess the need for a bariatric consultation and prepare patients for surgery. Preparation is individual and includes diabetes and blood pressure control, nutritional assessment and, when needed, medication and psychological support. Several months of drug treatment or a fixed amount of weight loss are not universal requirements for every operation. Afterwards, follow-ups help monitor body weight, nutritional status and the need for vitamin and iron supplements. Support is tailored to the patient's needs.

Changes to the digestive tract and deficiency risks depend on the operation. Ongoing reviews, appropriate nutrition and tailored supplementation are needed; the doctor monitors blood count, iron and vitamins B12 and D, among other measures. Weight regain can have various causes. Psychological and psychodietetic support is tailored to individual needs.

We also see patients from Siemianowice Śląskie and Chorzów. We also see patients from Sosnowiec, Bytom, Ruda Śląska, Gliwice, Tychy, Mysłowice and smaller towns across the Silesian province. The doctor and psychologist consultations in the programme take place by video. The five monthly medical reviews use app data without a call.

Patients can also check NFZ treatment options near home. When changing clinics, bring test results and records of previous treatment. The doctor taking over care decides on the ongoing plan and dosing.

In Centre for e-Health data published in July 2026, about 63.3 percent of adult Silesian Voivodeship residents with recorded height and weight measurements had overweight or obesity. Measurements covered January 2025 to April 2026. The corresponding figure for Katowice was about 60.1 percent. These are data on people with measurements, not a representative survey of all residents. In the 65-69 and 70-74 age groups, the regional proportion was about 75 percent.

In 2013-2015 data, Silesian Voivodeship had Poland's highest crude diabetes mortality rate, 46.4 percent above the national rate. This is historical: after age adjustment, the indicator ranked second, and these figures do not describe the current situation.

In 2017-2020, the regional government ran a programme addressing overweight, obesity and diabetes in working-age adults. "Śląskie w formie" for 2026-2027 targets school-age children. The August 2026 call for an implementing organisation does not itself confirm that participant recruitment has started. Adults can discuss treatment with primary care, a specialist clinic or a private practice.