Obesity Treatment Kraków

Obesity is a chronic disease with its own code in the ICD-10 classification, E66, and under the 2024 guidelines of the Polish Society for the Treatment of Obesity it does not resolve on its own. A patient who comes to Nasz Gabinet Kraków after ten years of dieting usually hears this for the first time: the weight returned not because they lacked discipline, but because a disease nobody was treating carried on progressing.

Obesity comes from a disturbance of the hormonal system that controls hunger and satiety. GLP-1 from the gut and leptin from adipose tissue carry the satiety signal to the brain; in a person with obesity that signal arrives more weakly and later, so the patient eats more before feeling full. Every diet triggers a defence of the old body weight: the metabolism slows down, appetite rises and after a few months the weight returns, often with more on top. GLP-1 analogues, or GLP-1 receptor agonists, act on the same mechanism, strengthening the satiety signal that another diet will not restore.

Untreated obesity brings with it more than 200 diseases. At our Prądnik Biały practice we most often see its effects in the test results: raised glucose, glycated haemoglobin, triglycerides and liver enzymes in fatty liver disease, and in the medical history, snoring with pauses in breathing and knee pain. Weight loss of 5 to 10 percent improves every one of those results, which is why we treat it as the goal of treatment.

The diagnosis starts with BMI. We calculate it by dividing body weight in kilograms by height in metres squared, and read it against the PTLO 2024 thresholds for adults: overweight starts at 25.0, class I obesity at 30.0, class II at 35.0 and class III at 40.0. A woman 165 cm tall weighs a little over 81 kg at a BMI of 30 and about 95 kg at a BMI of 35; the whole of class I obesity fits between those two figures.

BMI does not say how much of body weight is fat or where it collects, so we also measure waist circumference. According to the International Diabetes Federation, a circumference of 80 cm or more in women and 94 cm or more in men means abdominal obesity, that is an excess of visceral fat around the liver, the pancreas and the intestines. This fat produces inflammatory substances and raises the risk of type 2 diabetes and heart attack the most, so we also diagnose and treat abdominal obesity in people whose BMI indicates no more than overweight. Abdominal obesity together with raised blood pressure, fasting glucose and triglycerides makes up the metabolic syndrome.

When BMI, waist circumference or a history of diets is a reason to book an appointment

We invite patients to see a doctor who treats obesity when:

• BMI is 30 or higher, regardless of how the patient feels and of what the test results show,
• BMI falls between 27 and 29.9 and the overweight has been joined by prediabetes, high blood pressure, lipid disorders, fatty liver disease, sleep apnoea or pain in the knee and hip joints from overloading,
• waist circumference is over 80 cm in a woman or 94 cm in a man despite a normal BMI,
• the patient has been through at least two diets after which body weight returned to what it was before or went beyond it.

An obesity specialist is a doctor certified by the Polish Society for the Treatment of Obesity; Poland has no separate medical specialty in obesity medicine, so obesity is also treated by internal medicine doctors, endocrinologists and GPs. Nasz Gabinet Kraków sees adults only, although PTLO also allows liraglutide and semaglutide in adolescents from the age of 12 with a body weight above 60 kg.

Under the PTLO guidelines, obesity treatment rests on four pillars: nutritional treatment, physical activity, psychological support and drug treatment; in patients with class II and class III obesity, bariatric surgery is added. At Nasz Gabinet Kraków one team brings those pillars together: the doctor makes the diagnosis, rules out secondary causes of weight gain, assesses whether the patient is eligible for medication and treats the complications, the dietitian draws up the meal plan and the specialist in the psychology of eating deals with eating driven by emotions. A dietetic clinic will not prescribe a drug, and a doctor without a dietitian and a specialist in the psychology of eating leaves the patient with a medicine that reduces hunger but does not teach them to eat differently.

PTLO measures the success of treatment as the percentage of body weight lost, so we set the first goal in percentages too. Within 3 to 6 months the patient should lose 5 to 10 percent of body weight, and a patient with type 2 diabetes 7 to 15 percent; for someone weighing 120 kg that means 6 to 12 kg. Even at that level of loss blood pressure, glucose and triglycerides come down, and there are fewer pauses in breathing at night.

We plan treatment for at least 12 months, because PTLO holds that drug treatment shorter than 6 months does not make the effect last, and some patients need the drug long term. For the first months the patient comes in or joins us online every 4 weeks: we weigh them, measure waist circumference, check how they tolerate the drug and go through the test results, set the dose and issue an e-prescription (Poland's electronic prescription). Once the goal is reached we lengthen the intervals between follow-up appointments, but treatment carries on, because holding the new body weight through another year is an equally important stage of it.

What we do not do at Nasz Gabinet Kraków when treating obesity

• We do not sell medicines. We issue an e-prescription and the patient buys the drug at whichever pharmacy they choose.
• We do not treat children or adolescents. The patient must be at least 18 years old.
• We do not perform bariatric surgery. We provide non-surgical treatment; a patient who meets the criteria for an operation is prepared by us and referred to a bariatric surgery centre.

The first appointment starts with the medical history, in which the doctor establishes when the patient started putting on weight and what was happening at the time, which diets they have tried and with what result, what conditions their parents and siblings have, which medicines they take regularly, what they eat and at what times of day, whether they eat at night or have binge episodes, and how much alcohol they drink in a week. To that we add measurements of body weight, height, waist circumference and blood pressure. The first medical appointment at our practice at ul. Siewna costs PLN 250, and an online appointment costs the same.

From the laboratory we need fasting glucose, glycated haemoglobin (HbA1c), a lipid profile, TSH, the liver enzymes ALT and AST, creatinine and uric acid. The patient can have them done at any laboratory in Kraków or in their home town and bring the results with them, and if they come without any tests, we order them on the spot and start the drug once we have assessed them. The results settle two things: which complications of obesity we treat alongside, and which drug is safe for this patient.

When weight gain comes from the thyroid, from hormones or from medicines

Secondary obesity, that is weight gain caused by another disease or by a drug, is ruled out before we prescribe anything for obesity. We check the thyroid with a TSH test, in women we look for polycystic ovary syndrome (PCOS), and stretch marks, a rounded face and muscle weakness tell us to rule out Cushing's syndrome. We go through the patient's medicines separately, because glucocorticoids, insulin, some antidepressants and antipsychotics and certain anti-epileptic drugs increase body weight. The patient does not stop them on their own; a switch to a preparation that does not cause weight gain is discussed with the doctor who prescribed it, and only then do we choose the drug treatment for obesity.

We prescribe a drug for obesity when the patient meets one of the three PTLO 2024 criteria: a BMI of 30 or higher; a BMI between 27 and 29.9 together with at least one weight-related disease; or 3 to 6 months of diet and exercise without losing 5 percent of body weight. Below those thresholds we do not issue a prescription, because the side effects would outweigh the benefit.

Five active substances are authorised in Poland for the treatment of obesity: orlistat, naltrexone with bupropion, liraglutide, semaglutide and tirzepatide. The last three are GLP-1 analogues, which mimic the gut hormone released after a meal; tirzepatide also stimulates the GIP receptor. Under their influence the satiety signal reaches the brain earlier and the stomach empties more slowly, so the patient stops eating after a smaller portion and snacks less often. The patient injects the drug themselves, with a fine needle under the skin of the abdomen or the thigh: liraglutide daily, semaglutide and tirzepatide once a week. We escalate the dose gradually, weekly with liraglutide and every 4 weeks with the other two, so that the digestive tract gets used to the drug.

How much more weight participants in the STEP 1, SURMOUNT-1, SCALE and COR-I trials lost than the placebo group

Participants in every one of those trials were following a diet and an exercise programme at the same time, so the figures show the effect of a drug added to a change in habits. In STEP 1 one patient in two on semaglutide lost 15 percent of body weight or more, and weight stopped falling at around week 60, because the body had reached a new balance even though the drug carried on working.

What we do when weight loss stalls or the drug is not working

After 3 months on the therapeutic dose we check whether body weight has fallen by at least 5 percent. If it has not, PTLO advises switching to a stronger drug, and we go back with the patient to the meal plan and to the list of medicines that can hold weight loss back. A plateau after a year of treatment is an expected stage, in which the drug holds the result already achieved. We withdraw the drug gradually, because in the extension of STEP 1 participants regained two thirds of the weight they had lost within a year of stopping semaglutide; some patients stay on the drug long term, in the same way as on medicines for high blood pressure.

Marketing authorisation for the treatment of obesity is held by Wegovy, Mounjaro and Saxenda as injections and by Mysimba and Xenical as tablets; Ozempic and Rybelsus are authorised for the treatment of type 2 diabetes only. Most patients know the brand names before they know the names of the active substances, so a question about a particular product comes up at almost every first appointment at Nasz Gabinet Kraków. We then explain which substance sits behind which name, because that decides what the doctor can prescribe for obesity and how much the patient pays at the pharmacy.

How Ozempic and Rybelsus differ from Wegovy when all three contain semaglutide

Semaglutide comes in three products: Wegovy is a once-weekly injection at doses up to 2.4 mg, authorised for the treatment of obesity; Ozempic is an injection at doses up to 2 mg and Rybelsus a tablet, and both are authorised for the treatment of type 2 diabetes only, with Ozempic reimbursed in that indication alone. Liraglutide is Saxenda at a dose of 3 mg for the treatment of obesity and Victoza at a lower dose for patients with diabetes. Tirzepatide has one name, Mounjaro, and is authorised for the treatment of both diseases. So for a patient with obesity and no diabetes we prescribe Wegovy, Mounjaro or Saxenda; we do not prescribe Ozempic or Rybelsus for obesity, even when that is exactly what the patient asks about.

What a month of treatment costs the patient and why

No drug authorised for the treatment of obesity is reimbursed, so the patient pays the full pharmacy price. A month of treatment with Wegovy costs from about PLN 550 to PLN 890 at pharmacy prices from September 2026, Mounjaro from about PLN 800 at the 2.5 mg dose to about PLN 1,900 at 15 mg, and Saxenda at the full dose from about PLN 500 to PLN 1,250, depending on the pharmacy. Saxenda is also weaker than Wegovy and calls for a daily injection, which is why we offer it in exceptional cases, for example to a patient who did not tolerate a drug given once a week. Tirzepatide works the most strongly, but at the highest doses it costs more than twice as much as semaglutide and causes nausea more often, so the choice between those two drugs is settled by the coexisting diseases, the number of kilograms to be lost and the patient's budget for the whole year.

Who we offer Mysimba or Xenical to and what to expect from them

Mysimba, or naltrexone with bupropion, reduces hunger and blunts the pleasure of eating, which is why it helps people who eat under the influence of emotions; in the COR-I trial it produced a weight loss of 6.1 percent after 56 weeks against 1.3 percent on placebo. We do not use it in patients with epilepsy, in people taking opioids or where high blood pressure is uncontrolled. Xenical, or orlistat, holds about a third of the fat from a meal in the intestine, over a year brings body weight down by 2 to 3 kg more than placebo, and after a fatty meal it causes fatty diarrhoea. We choose the tablets for patients who cannot take GLP-1 analogues, for example after pancreatitis, or who will not agree to injections.

GLP-1 analogues most often cause nausea, vomiting, diarrhoea and constipation; according to the summaries of product characteristics this affects at least one patient in ten, above all in the first weeks and after every increase in the dose. In the STEP 1 trial 4.5 percent of participants stopped treatment for that reason. Less often there are gallstones, reported in 1.6 percent of people treated with semaglutide, and acute pancreatitis. Severe abdominal pain radiating to the back calls for the drug to be stopped and for contact with a doctor the same day. This is why we ask about digestive symptoms at every follow-up appointment, and raise the dose only once the previous one is well tolerated.

Who will not be given a GLP-1 analogue

We do not prescribe these drugs to women who are pregnant or breastfeeding, and semaglutide has to be stopped at least 2 months before a planned conception, because it stays in the body for weeks. Tirzepatide slows the absorption of contraceptive pills, so for 4 weeks from the start of treatment and after every increase in the dose the patient also uses a condom. We do not recommend GLP-1 analogues in severe kidney or liver failure, in class IV heart failure or after an episode of pancreatitis; in patients over the age of 75 they have been poorly studied, and the manufacturer does not recommend liraglutide at that age. In patients with type 2 diabetes we reduce the doses of insulin or sulfonylureas, because combining them with a GLP-1 analogue increases the risk of hypoglycaemia; in diabetic retinopathy the patient stays under the care of an ophthalmologist and reports any sudden worsening of vision immediately. Before general anaesthesia the patient tells the anaesthetist that they are taking the drug, because delayed gastric emptying increases the risk of aspiration.

Counterfeit pens and research-grade semaglutide bought online

Poland's Chief Pharmaceutical Inspectorate (GIF) has warned about falsified semaglutide pens from outside the pharmacy network, and in 2025, together with Poland's Chief Sanitary Inspectorate, about semaglutide sold online as a peptide for research purposes, without a prescription and with no control over the dose or the purity. A drug from a pharmacy, dispensed against a prescription, is the only version with a verified composition and dose. A patient using a product from another source is taken on for treatment only after switching to the pharmacy drug.

The meal plan from the dietitian sets a deficit of 500 to 750 kcal a day below the patient's requirement. We do not use fasting or diets below 1,200 kcal, because on those the patient loses muscle and after a few weeks responds with a binge. During treatment with a GLP-1 analogue the portions get smaller, so the dietitian insists on protein at every meal; without protein the patient loses muscle along with fat, calorie burning drops and the weight returns faster once the drug is stopped. The exercise recommended by the Polish Society for the Treatment of Obesity is 150 to 300 minutes a week, but a patient with painful knees starts with the swimming pool, a stationary bike or brisk walking and increases the load only once body weight has come down.

Why the drug does not break the habit of eating from stress and what the specialist in the psychology of eating does about it

The drug reduces physical hunger, but it does not change the habit of reaching for food after a hard day, at night or out of boredom. That pattern, with the guilt after a binge and the promise to do better from tomorrow, resembles other compulsive behaviours that we have been treating at Nasz Gabinet Kraków for years. The specialist in the psychology of eating teaches the patient to notice when they reach for food in order to calm down, and helps them find other ways of dealing with tension. The sessions are held at our Prądnik Biały practice or online, as part of addiction therapy in Kraków, alongside the drug treatment, because once the drug is stopped the old eating pattern returns if there has been no work with the specialist.

Alcohol supplies 7 kcal in every gram, not much less than fat, and the body burns it before everything else the patient has eaten; the calories from the snacks that go with a drink then land straight in the fat on the abdomen. A glass of wine is about 120 kcal and a large beer about 220 kcal, so two beers in the evening wipe out the whole deficit in that day's meal plan. This is why we count alcohol in the calorie balance in the same way as food from the first appointment onwards.

During treatment with a GLP-1 analogue alcohol makes nausea worse, causes dehydration and, in patients with diabetes, increases the risk of hypoglycaemia, so we ask patients to cut it down at least while the dose is being increased. Some patients also notice that once they start the drug they are no longer drawn to alcohol. A small randomised trial from 2025 showed a similar effect: in 48 people with alcohol use disorder, low doses of semaglutide reduced alcohol craving and the number of drinks consumed on the days when participants drank. Semaglutide, however, has no marketing authorisation for the treatment of alcohol dependence, and a result from such a small group needs confirmation. If a patient with obesity also drinks harmfully or is dependent on alcohol, we treat both diseases together, as part of alcohol addiction treatment in Kraków, because drinking undoes the effect of any diet and any drug.

The first appointment usually takes place at our practice at ul. Siewna 4/5 in Prądnik Biały, and the follow-up appointments every 4 weeks are held online. At the practice the doctor measures waist circumference, blood pressure and body weight, and compares the results of every later follow-up against those values. At an online follow-up the patient gives their body weight and waist circumference, the doctor goes through how they tolerate the drug and what the test results show, sets the dose for the next month and issues an e-prescription, which the patient fills at any pharmacy. The scope of treatment is the same at the practice and online.

There are, however, situations in which the doctor has to examine the patient in person and an appointment at the practice is compulsory: class III obesity, heart or kidney disease that calls for a physical examination, and a suspected secondary cause of obesity. A patient from outside Kraków who has blood tests done close to home and measures their own body weight and waist circumference can start treatment without travelling to the practice. The dietitian and the specialist in the psychology of eating see patients at the practice and online. A patient who is pregnant or breastfeeding and cannot take the drug for the time being receives the same meal plan and the same care from the specialist in the psychology of eating as everyone else.

Under the PTLO guidelines any doctor can diagnose and treat obesity, including a GP in primary care, while specialist metabolic clinics see patients with a referral under the National Health Fund (NFZ). In the whole of Lesser Poland such clinics operate only in Kraków: as of 3 September 2026 there were five of them, one of which was for children, and the projected waiting time for a first appointment ran from 91 to 334 days, on average 211 days. A patient from Kraków therefore waits between three months and a year for an appointment on the NFZ, and a patient from Nowy Sącz or Tarnów has to travel to Kraków for that appointment.

The patient pays for the drug themselves, because none of the five products authorised in Poland for the treatment of obesity is reimbursed. The NFZ reimburses semaglutide in its diabetes product only for patients with type 2 diabetes who meet the NFZ criteria, and a doctor who issues a subsidised prescription to a patient being treated for obesity may be ordered to pay the reimbursement back. At Nasz Gabinet Kraków the patient pays for the consultation and the follow-up appointments according to the price list (the first medical appointment PLN 250), and pays for the drug at the pharmacy: a month of treatment with a GLP-1 analogue costs from about PLN 550 to PLN 2,000 in 2026, depending on the substance and the dose. Before we start the drug we work out the cost of the whole year with the patient, because treatment broken off after three months on grounds of price ends in the weight being regained. Bariatric surgery is a service covered by public health insurance; the KOS-BAR pilot of coordinated care, run at 19 centres across the country, ended on 30 June 2026 and is waiting to be brought in as a permanent service.

In class III obesity, bariatric surgery, most often a sleeve gastrectomy or a gastric bypass, is more effective than any drug and gives a longer-lasting result. The university centre for the surgical treatment of obesity in Kraków, running since September 2020, accepts patients aged 18 to 70 with a BMI above 40, or with a BMI of 35 to 40 and diseases related to obesity; by its own figures it has operated on close to 2,000 patients so far and gives about 1,000 outpatient consultations a year. The international bariatric surgery societies went further in 2022 and allow surgery from a BMI of 35 with no coexisting diseases, and from a BMI of 30 in patients with type 2 diabetes in whom non-surgical treatment has failed.

We assess whether the patient is eligible for surgery and prepare them for it; the operation itself is carried out by a bariatric surgery centre. A patient with an operation ahead of them spends several months with us bringing body weight down by a few percent, usually on a GLP-1 analogue, getting diabetes and blood pressure under control and working with the specialist in the psychology of eating, because a smaller stomach does not remove the habit of eating under stress. Once prepared in this way, the patient is referred for the operation. After the operation the patient comes back to us for checks on body weight, on vitamin and iron supplements and for psychological support; without that care some of the people operated on put the old weight back on within a few years.

Besides people from Kraków we treat patients from across the province, most often from Wieliczka, Skawina, Niepołomice, Zabierzów, Krzeszowice, Myślenice, Bochnia, Brzesko, Wadowice, Olkusz, Miechów, Proszowice, Chrzanów, Oświęcim, Tarnów and Nowy Targ. Since the metabolic clinics under the NFZ operate only in Kraków, a patient from Lesser Poland would have to travel here anyway; to us they travel once at most.

A patient from the region has blood tests done at a laboratory in their own town, measures body weight and waist circumference at home, and has the first appointment online or comes to Prądnik Biały once. Everything then happens remotely: follow-up appointments every 4 weeks, consultations with the dietitian, sessions with the specialist in the psychology of eating and an e-prescription to be filled at a pharmacy near home. We ask patients to come back to the practice only in the situations in which the doctor has to examine them in person, described in the section on online follow-ups and appointments at the practice.

According to measurements taken by GPs between January and July 2025, 57.5 percent of adults in Kraków are overweight or have obesity. Only Poznań has a lower share among Polish cities, and even so almost six in ten adult residents carry excess weight. Until 2021 Kraków ran a city programme to prevent obesity, type 2 diabetes, high blood pressure and atherosclerosis in residents over the age of 25, and from 2021 to 2023 a programme to prevent obesity and high blood pressure in school-age children; the Zdrowy Kraków programme for 2025-2028 sets out no separate measures for adults with obesity. An adult in Kraków with obesity chooses today between primary care, the waiting list for one of the four metabolic clinics for adults, and private treatment.

Nasz Gabinet Kraków treats obesity in Prądnik Biały, in the same practice where it has been treating addiction for years. A patient whose obesity comes with a drink problem or with compulsive eating is looked after by one team, without being sent from one clinic to another.