Obesity Treatment Kielce

Obesity is a chronic disease in which excess body fat harms health. Its ICD-10 code is E66. It develops from an inherited tendency, the environment and lifestyle, and disturbed appetite regulation, and in some people also from other diseases or medicines. The disease does not go away on its own, which is why the Polish Society for the Treatment of Obesity (PTLO) 2024 guidelines describe the need for long-term care. When weight loss stops, the doctor assesses the cause, treatment tolerance and the next goal; this does not always require a different medicine.

Hormones involved in appetite include leptin from fat tissue, GLP-1 from the gut and ghrelin, which stimulates hunger. In obesity, responses to fullness signals may be impaired. After weight loss, appetite may increase and energy expenditure may fall, so maintaining a lower weight requires ongoing support. Weight regain is neither proof of weak willpower nor the inevitable outcome of every diet.

How does obesity develop with age?

Obesity builds up gradually over the years of a person's life in which food provides more calories than the body burns. When body weight rises moderately, fat cells grow larger, and when the gain is large and lasts a long time, the number of these cells also increases. Enlarged fat tissue releases substances that sustain chronic inflammation and reduce the sensitivity of tissues to insulin. With age, muscle mass declines and the body uses less energy over the day, so portions that once did not raise body weight provide an energy surplus years later.

The tendency to obesity is largely inherited: according to twin studies, 40 to 70 percent of the differences in body weight between people have a genetic basis. In later stages of life other factors add to this tendency: sedentary work, high-calorie food within easy reach, shift work, too little sleep and chronic stress. In many people marked weight gain begins after pregnancy, during menopause or after quitting smoking. Some people gain weight because of another disease or a medicine; we check for these causes before treatment and list them in the section on tests.

What conditions accompany obesity in older people?

In older people, obesity may coexist with muscle loss, heart and joint disease and diabetes. We accept adults of different ages into the programme, and we plan treatment taking these conditions and the ability to manage everyday activities independently into account.

BMI may be insufficient, especially with muscle loss or a high muscle mass. It is calculated by dividing weight in kilograms by height in metres squared. At 164 cm and 86 kg, it is about 32, indicating class I obesity. WHO thresholds are 25 for overweight and 30, 35 and 40 for the three obesity classes. BMI does not distinguish muscle, bone, water and fat. With muscle loss, a BMI of 27 can coexist with abdominal obesity. PTLO cites a US study of older adults in which BMI sensitivity against an assessment of body fat was about 32.9% in men and 38.5% in women. These figures do not describe its accuracy in every older person.

Waist measurement adds information. International Diabetes Federation criteria for European populations identify abdominal obesity from 80 cm in women and 94 cm in men. Visceral fat accumulates around abdominal organs and is associated with higher metabolic risk. Suspected sarcopenic obesity, excess fat combined with muscle loss, requires assessment of muscle function. Timing five chair stands without using the hands is one possible test. Diagnosis under the ESPEN/EASO 2022 criteria also requires body composition assessment and confirmation of reduced muscle mass.

When should you seek an obesity consultation?

Consider a consultation with a BMI from 30 or overweight accompanied by hypertension, prediabetes, type 2 diabetes, lipid disorders, fatty liver, sleep apnoea or pain in weight-bearing joints. A large waist can justify a health assessment even below BMI 27. A consultation does not automatically lead to a prescription. Many medicines require BMI ≥30, or ≥27 with a relevant weight-related condition; Xenical requires BMI ≥30 or >28 with risk factors. Insulin resistance is not another name for prediabetes. In Poland, an obesity specialist is a doctor who works in obesity treatment; this is not a separate medical specialty or a title reserved exclusively for PTLO certificate holders.

We run our obesity treatment programme online for 6 months, and its price is PLN 1,799. The patient buys the medicine at a pharmacy with an e-prescription, and its cost is not included in the price of the programme. At the initial consultation the doctor asks when weight gain began, about previous weight and attempts to lose it, regular medicines and family history. Sleep, tiredness on waking and everyday activity are discussed. The patient measures weight, height, waist and blood pressure at home beforehand, and the doctor also asks older people about muscle strength and everyday fitness. The doctor discusses the test results and orders further tests if needed. On that basis the doctor decides whether the patient can be treated in the programme and whether medication can start.

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, and the later dates are set from the day of the initial consultation.

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

Between consultations, the patient enters weight in the app every week and body measurements every month. After the injection, the patient photographs the pen, and the medical team then looks at the photo. The doctor sees these results before starting the check-up. PTLO recommends treatment for a year or longer, so after the programme a continuation package for 3 months can be bought for PLN 350. The package does not include video consultations, but the doctor reviews the patient's results every month and issues an e-prescription.

Dose increases depend on the product, tolerance and effects. At check-ups the doctor asks about nausea, constipation, fluid intake and meals, assesses weight change and considers further tests. Not every appointment leads to a higher dose. Effectiveness is assessed differently for different medicines; there is no common rule to switch at six months or stop at one year. Once the goal is reached, weight maintenance still needs a plan.

What are the limits of treatment in our programme?

• A prescription requires a medical indication. Wanting to reduce a normal body weight does not by itself justify an obesity medicine.
• Changes to other medicines are coordinated with the doctor managing that treatment. If a psychiatric, cardiac or neurological medicine promotes weight gain, alternatives and risks to the underlying condition need assessment. Do not stop it yourself.
• We see adults aged 18 and over. Children and adolescents need paediatric care, age-appropriate criteria and the relevant product indications.

The doctor chooses the tests. These may include fasting glucose, glycated haemoglobin (HbA1c), lipids, ALT and AST, creatinine with eGFR, TSH, uric acid and a full blood count. HbA1c helps assess glucose over roughly the previous 3 months, but blood and kidney disorders can affect its interpretation. eGFR assesses kidney filtration and matters when choosing a medicine. TSH helps assess thyroid function, while ALT and AST form part of liver assessment; alone, they do not establish the cause or severity of liver damage. A lipid profile measures cholesterol and triglycerides.

Hydration, nutrition and fall risk need particular attention in older patients. Vomiting, diarrhoea and insufficient fluid intake can cause dehydration and electrolyte problems. Sodium and potassium testing depends on illnesses and treatment. Bone density assessment may help with osteoporosis or steroid use. Have earlier results ready for the initial consultation; the doctor will decide which need repeating. A six-month-old result may be insufficient if health has worsened. Tests can be done in Kielce or close to home.

Which illnesses and medicines can contribute to weight gain?

Examples include an underactive thyroid, the rare Cushing's syndrome and medicines. Raised TSH may require an FT4 test. A rounded face, wide purple stretch marks and hypertension can justify testing for excess cortisol, but do not establish the diagnosis. A hormonal cause does not rule out coexisting obesity; care for both needs coordination. Some antidepressants, antipsychotics, antiepileptics, steroids, insulin and sulfonylureas can promote weight gain. Prepare a list of all your medicines, as combining them may increase the risk of interactions, dosing errors and falls.

After 65, the aim is better mobility, quality of life and health. Weight-loss pace, protein and exercise should suit nutritional status and ability; medication is considered when expected benefits outweigh risks. PTLO cites estimates of 0.5 to 1% annual lean-mass loss from the third decade and 10 to 20% muscle loss by the seventh decade. These do not predict changes in every person. A 15 kg loss through diet alone may include muscle. Muscle loss is associated with weakness, poorer prognosis, falls and loss of independence. Lower weight is therefore only one measure of success.

Suspected sarcopenic obesity calls for muscle function assessment followed by body composition, the proportions of fat and muscle. Bioimpedance analysis (BIA) is one method; its results depend on hydration and equipment, among other factors. An ordinary scale with BIA cannot by itself provide a reliable diagnosis. Someone who struggles to rise from a chair needs a different plan from a person of the same weight who manages stairs easily.

The individual product information guides medicine choice. Saxenda is not recommended from 75, while Mysimba is not recommended above 75 and needs caution above 65. Experience with Wegovy and Mounjaro from age 85 is limited. Xenical's safety and effectiveness have not been studied in older people. Age alone does not automatically change every dose. Increases depend on product guidance, tolerance and health; fluid intake is also worth discussing at follow-up.

How can obesity treatment help knee pain and preparation for joint replacement?

IDEA assigned 454 people aged at least 55 with overweight or obesity and knee osteoarthritis to diet with exercise, diet alone or exercise alone. After 18 months, the combined group had lost 10.6 kg on average, or 11.4%, and reported less pain and better function than the others. Walking knee load in the diet-only group was about 200 newtons lower than with exercise alone. STEP 9 in 2024 enrolled 407 people with obesity and knee pain, with a mean BMI around 40 and age 56. After 68 weeks on semaglutide 2.4 mg, weight fell 13.7% versus 3.2% on placebo; pain on a 0 to 100 scale fell 41.7 versus 27.5 points. These are group averages, not a guaranteed outcome for an older individual.

Agree preparation and surgery timing with the orthopaedic surgeon. Weight loss may help, but not everyone should wait to reach a fixed BMI. ACR/AAHKS 2023 conditionally recommends not delaying surgery for that reason alone in eligible patients with advanced symptomatic joint disease after ineffective non-surgical treatment; evidence quality is low or very low. Preserving muscle before surgery helps prepare for rehabilitation.

What is known about semaglutide after a heart attack or stroke?

SELECT enrolled 17,604 people aged 45 or over, with BMI ≥27, previous heart attack, stroke or peripheral arterial disease, and no diabetes. They received semaglutide 2.4 mg or placebo, with mean follow-up of 39.8 months. Cardiovascular death, heart attack or stroke occurred in 6.5% versus 8.0%. The one-fifth reduction refers to the relative hazard of this combined outcome; the difference in observed percentages was 1.5 percentage points. Adverse events led 16.6% versus 8.2% to stop treatment. Care after a heart attack should be coordinated with the cardiologist. Wegovy and Saxenda are not recommended in NYHA IV heart failure, with symptoms at rest; this is not a shared prohibition for every medicine discussed.

Medication is considered according to the individual product's indications after weighing benefits and risks. Failure to lose 5% despite 3 to 6 months of nutrition and activity changes may prompt reassessment, but does not create an indication independent of BMI. Treatments include semaglutide, tirzepatide, liraglutide, the two-drug combination naltrexone with bupropion, and orlistat. This is not an exhaustive list of all authorised products.

GLP-1 and GIP are gut hormones involved in the body's response to food. Semaglutide and liraglutide act on GLP-1 receptors; tirzepatide acts on GIP and GLP-1 receptors. Medicines can reduce hunger, help limit portions and slow stomach emptying. Injectable semaglutide and tirzepatide are given weekly, liraglutide daily. Gradual dose increases aim to reduce digestive symptoms. Mounjaro starts at 2.5 mg weekly, increasing to 5 mg after 4 weeks; further 2.5 mg increases are possible if needed, at intervals of at least 4 weeks. Adult maintenance doses are 5, 10 or 15 mg. Saxenda increases are at least one week apart, not monthly.

What weight losses did the trials show?

In STEP 1, semaglutide 2.4 mg produced average weight loss of 14.9% after 68 weeks versus 2.4% on placebo. In SURMOUNT-1, tirzepatide 15 mg produced 20.9% after 72 weeks versus 3.1%. In SCALE, liraglutide 3 mg produced 8.4 kg after 56 weeks versus 2.8 kg. These studies involved adults with overweight or obesity without diabetes, alongside lifestyle intervention. Populations, doses and durations differed; the results are neither a direct drug comparison nor a kilogram forecast for an individual. A plateau can mark weight maintenance but requires assessment. Adult Saxenda treatment must stop if at least 5% of initial weight has not been lost after 12 weeks on 3 mg. Other products have their own assessment rules.

What should you agree with the doctor before stopping?

In the STEP 1 extension, a subgroup regained on average about two thirds of lost weight within a year after semaglutide treatment and lifestyle intervention ended. Some metabolic improvements also reversed. The study did not test whether tapering prevents regain. Continued treatment, possible withdrawal and reviews are individual decisions. Discuss meals, activity and what to do if weight rises again; some people need medication for years.

The specific product information determines the indication, not the active ingredient alone. Wegovy, Mounjaro, Saxenda, Mysimba and Xenical have obesity indications. Ozempic, Rybelsus and Victoza are authorised for type 2 diabetes, although they share ingredients with some obesity products. Check the prescription's name, formulation, dose and indication.

What does an Ozempic prescription mean without diabetes?

Ozempic contains injectable semaglutide at doses up to 2 mg; Rybelsus contains semaglutide tablets for type 2 diabetes. Wegovy has an obesity indication; 2.4 mg is no longer its only injectable maintenance dose. The documentation also includes 7.2 mg for selected adults with initial BMI ≥30 after at least 4 weeks on 2.4 mg if a higher dose is needed, and an oral formulation for adults. Authorisation does not confirm every pack's availability in Polish pharmacies. Liraglutide 3 mg is Saxenda, while up to 1.8 mg is Victoza for diabetes. Mounjaro has indications in both conditions. Ozempic used solely for obesity is outside its authorised indication (off-label); lack of an indication does not mean no research exists. Reimbursement depends on the product, indication and current list.

What determines the monthly medicine cost?

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are paid for in full for obesity according to the July 2026 reimbursement-list review. Cost depends on product, dose, pack and pharmacy. Not every treatment reaches the highest dose, and starting-dose prices do not describe the whole course. Check current medicine prices at the pharmacy, because you buy the medicine separately, outside the programme.

Which oral medicines are used for obesity?

Mysimba, naltrexone with bupropion, acts on brain areas involved in appetite and reward. It is not an automatic choice for emotional eating. COR-I found average loss of 6.1% after 56 weeks versus 1.3% on placebo. Contraindications include seizure disorders, uncontrolled hypertension and certain opioid-related situations; naltrexone blocks opioid effects and can precipitate withdrawal in someone dependent on them. Stop treatment if 5% of initial weight has not been lost after 16 weeks; if treatment continues, reassess benefits, cardiovascular safety and maintained response at least annually. Xenical is orlistat in 120 mg capsules. It inhibits fat-digesting enzymes and reduces absorption of about one third of meal fat; studies found roughly 2 to 3 kg greater annual loss than placebo. Oily stools can occur, especially after fatty meals. Stop if at least 5% of initial weight has not been lost after 12 weeks. Preferences, tolerance and costs also influence product choice.

Common symptoms include nausea, vomiting, diarrhoea and constipation, particularly during dose increases. In STEP 1, digestive symptoms led 4.5% of participants to stop. Smaller portions and less fatty meals may help, beyond injection days. The doctor decides what to do if a new dose is poorly tolerated. Hydration needs attention in older people. Fluid amounts must account for heart and kidney health and other doctors' advice; do not increase fluids yourself if you have a restriction.

When is a particular medicine unsuitable?

Semaglutide, liraglutide and tirzepatide are not used in pregnancy. Stop semaglutide at least 2 months and tirzepatide at least one month before a planned pregnancy. Wegovy and Saxenda should not be used during breastfeeding; current Mounjaro information allows individual consideration. Previous pancreatitis requires caution, rather than being a shared absolute prohibition. Wegovy and Saxenda are not recommended in severe kidney or liver impairment or NYHA IV. For Wegovy, severe renal impairment includes eGFR <30 ml/min/1.73 m². Mounjaro does not require dose adjustment solely for kidney or liver impairment, but severe disease has limited data and requires caution. Age restrictions are described in the older-patient section. Discuss contraception with tirzepatide; an additional barrier method for 4 weeks after starting or increasing the dose may be a precautionary recommendation, not a general EU product-information requirement. With insulin or sulfonylureas, the doctor assesses dose changes using risk and glucose readings. Before anaesthesia or deep sedation, tell the team about the medicine so they can plan preparation.

Which symptoms need urgent medical help?

Severe persistent upper abdominal pain, including pain spreading to the back, can mean acute pancreatitis: stop the medicine and seek urgent help, even without vomiting. Pain under the right ribs with fever or jaundice also needs urgent assessment. Gallstones were reported in 1.6% of semaglutide-treated patients in trials. Sudden visual deterioration requires urgent eye assessment; in 2025 EMA recognised NAION, ischaemic optic nerve damage, as a very rare semaglutide adverse effect. Do not wait until the next day if you cannot keep fluids down, pass very little urine, faint or become confused. Shaking, cold sweats and weakness while on insulin can mean hypoglycaemia: measure glucose if possible and follow your agreed plan. Severe cases require immediate medical help; never give food or drink by mouth to an unconscious person.

Why buy prescription medicines only from a pharmacy?

The origin and storage of an injection pen sold through an advert may be unknown. In 2023 European authorities, including Poland's GIF, warned about counterfeit Ozempic; Austria reported hospital admissions after suspicious products, and insulin was detected in counterfeits. Online products sold as research reagents offer no assurance of ingredients or sterility. Buy prescription medicines at a pharmacy and agree dose changes with a doctor.

When medication reduces appetite, a dietitian can help plan protein and regular meals. Small portions made mainly of bread and fruit may provide too little protein, increasing muscle-loss risk during weight reduction. Amounts depend on nutrition and kidney health; the body weight used for calculations must also be specified, as in the table above. Protein can be spread across three or four meals with poultry, curd cheese, yoghurt or other suitable foods. Content varies by product and preparation, so check labels. The commonly used 500 to 750 kcal daily deficit needs individual adjustment. The dietitian asks who shops and cooks: someone in their seventies eating meals prepared by a daughter needs different advice from someone cooking independently. The order of vegetables, protein and starchy foods can be adapted to the person.

Activity helps preserve muscle, improve function and control weight. The goal of 150 to 300 aerobic minutes weekly plus two or three strength sessions must fit exercise capacity. The cited PTLO plan for older adults leaves at least 48 hours between strength sessions. With painful knees, swimming, a stationary bike or Nordic walking may be options. Light bands and chair stands in sets of 8 to 12 are examples; choice and load depend on function and pain.

When does a psychodietitian join the treatment?

Psychodietetic support may help with evening snacking in front of the television, sweets after an argument or eating from boredom in retirement. Medication does not replace work on eating behaviour. A psychodietitian (a dietitian trained in the psychology of eating) helps identify situations in which emotions prompt eating and find other responses. Binge eating with loss of control needs assessment for an eating disorder and care chosen by an appropriate specialist.

Alcohol provides 7 kcal per gram. Two half-litre beers may contain around 450 kcal, depending on the drink, making the planned deficit harder to maintain. Alcohol can also make portions and food choices harder to control. One evening cannot, however, determine the whole treatment result.

Alcohol may worsen nausea and increase hypoglycaemia risk with insulin and some other medicines. Symptoms can be mistaken for intoxication. No single serving can be considered safe for everyone during this treatment. Discuss alcohol with the doctor, particularly during dose increases or digestive symptoms.

A phase two study published in JAMA Psychiatry in 2025 randomly assigned 48 people with alcohol use disorder to semaglutide or placebo for 9 weeks. Treated participants reported less craving and drank less on drinking days. This was a small, short trial; a larger study appeared in 2026, but such findings do not themselves establish an authorised addiction-treatment indication. Someone drinking daily or unable to stop can seek alcoholism treatment in Kielce, or addiction therapy for other substances. This care should be coordinated with 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, weigh yourself, measure your waist and blood pressure and prepare your test results. If you see dark, velvety patches on your skin, tell the doctor about them. They can suggest insulin resistance but do not confirm it. On the basis of your history and results, the doctor decides whether you can be treated in the programme.

Between consultations, records of weight, blood pressure, symptoms and fluid intake are useful; the doctor reviews them before deciding on the dose and the e-prescription. If you find video calls difficult, a relative can help you with the consultation. Check available nutrition appointments and formats when booking too. Severe pain, persistent vomiting or signs of dehydration need urgent medical assessment according to severity, without waiting for a scheduled consultation.

NFZ-funded care can start in primary care (POZ). Tests and specialist referrals depend on indications and funding scope. On 11 September 2026 the NFZ directory listed seven metabolic-clinic entries in Świętokrzyskie, three in Kielce. This does not mean seven adult obesity clinics: confirm services and accepted ages with the chosen provider.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are paid for in full for obesity according to the July 2026 list review. Reimbursement of some semaglutide products for type 2 diabetes has separate conditions. Dietetic advice in coordinated care depends on the diagnosis and the primary-care practice's participation. The Moje Zdrowie programme also includes dietary education by a dietitian or another authorised team member. This does not guarantee full individual diet therapy at every practice; ask what is available.

Privately, we run a six-month online programme for PLN 1,799, with two 30-minute doctor consultations, two 40-50-minute online consultations with a psychologist and five medical reviews of app data without a call. You buy the medicine separately at a pharmacy with an e-prescription and book consultation dates in the Nasz Gabinet app.

The Polish 2025 bariatric consensus includes BMI ≥35 regardless of complications and consideration of surgery at BMI 30 to 34.9 with type 2 diabetes inadequately controlled despite treatment. Age above 65 alone is not a contraindication. The team assesses function, frailty, cognition, nutrition and illnesses. Previous treatment is part of assessment, but a surgical consultation need not wait until every method has been exhausted. Check clinical criteria and NFZ funding conditions separately with the centre.

The Association of Polish Surgeons' bariatric directory has one Świętokrzyskie entry: a centre in Kielce. The directory is not a complete register of every service. The KOS-BAR pilot ended on 30 June 2026; NFZ-funded surgery remains possible. Long-term postoperative care should follow the bariatric team's plan, with primary care and other doctors involved.

Preparation includes reviewing previous treatment, tests and nutrition according to the centre's advice. Reducing liver volume may make surgery easier. Sleeve gastrectomy reduces the stomach, while bypass procedures also alter absorption. Iron, vitamin B12, vitamin D and calcium deficiencies need attention after different procedures, including sleeve gastrectomy. Lifelong supplementation is needed after surgery; the bariatric team plans the products and tests. Care continues for years, with early checks more often than annually. Seek advice when you notice weight regain. Medication can also be considered after surgery in some people.

We also treat adults from Skarżysko-Kamienna, Starachowice, Ostrowiec Świętokrzyski, Końskie, Jędrzejów, Busko-Zdrój, Pińczów, Staszów, Sandomierz and Włoszczowa, and from Morawica, Chęciny, Masłów and Daleszyce. Blood tests can be done at a laboratory close to home, and all consultations take place online. A patient from Staszów or Włoszczowa is therefore treated in the same way as someone living in Kielce.

The NFZ directory also has metabolic-clinic entries in Jędrzejów, Ostrowiec, Starachowice and Staszów. Some concern paediatric services, so check whether the provider treats adults with obesity and what referral is needed before booking.

In 2024, people aged at least 60 made up 29.8% of Świętokrzyskie residents, Poland's highest share by this measure. Demographic data describe the region, not a particular practice's patients.

PTLO cites European figures of 42.4% overweight and 20.9% obesity among older people. These are not Kielce rates. With age, muscle loss can mean that a large waist accompanies a less elevated BMI. Care must therefore account for strength, nutrition, heart and joint conditions, diabetes and everyday independence.

In the Nasz Gabinet programme, an adult patient's obesity plan takes other conditions into account. Coordination with a cardiologist, diabetes specialist, orthopaedic surgeon or geriatrician depends on the person's health and goals.