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. Body weight may increase again after repeated attempts to lose weight. This should not be reduced to a lack of discipline: the patient needs an assessment of the causes and a plan for further treatment.

Why do people develop obesity?

Obesity builds up gradually when the energy balance stays positive for a long time, meaning the body gets more calories from meals and drinks than it burns. The surplus energy goes into fat cells, which at first grow larger, and if weight gain continues, the body creates additional fat cells. Excess fat tissue becomes a disease when it starts to harm health. Fat tissue releases leptin and pro-inflammatory substances into the blood, and over time these substances cause insulin resistance, meaning they weaken the response of tissues to insulin.

Genes have a large influence on the risk of obesity: in twin studies they accounted for 40 to 70 percent of the differences in body weight, and children of parents with obesity develop the disease more often. A genetic tendency leads to obesity when high-calorie foods are easy to get and most of the day passes without movement. People also gain weight more easily during pregnancy, during menopause and after quitting smoking, as well as when they sleep too little, live with chronic stress or work shifts. In some patients weight gain is caused by another disease or a medicine, so before starting treatment we also check for such causes.

In a person with obesity, the regulation of appetite and satiety is also disturbed, and after weight loss appetite may increase further. Treatment therefore also includes long-term support in maintaining a lower body weight.

What are the risks of untreated obesity?

Untreated obesity brings with it more than 200 diseases. In our patients 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. 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.

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 should you see a doctor about excess body weight?

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.

The PTLO describes four foundations of obesity treatment: nutritional treatment, physical activity, psychological support and medication; bariatric surgery is also considered in class II and III obesity. At Nasz Gabinet, the doctor makes the diagnosis, assesses secondary causes of weight gain, checks eligibility for medication and treats complications. 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. Medicines help reduce hunger but do not replace work on eating habits.

The PTLO measures treatment effectiveness as a percentage of body weight lost. The initial goal is usually 5-10 percent over 3-6 months, or 7-15 percent in a patient with type 2 diabetes. For someone weighing 120 kg, a 5-10 percent reduction means 6-12 kg. This may improve blood pressure, blood glucose and triglycerides and reduce the severity of sleep apnoea. Goals are individual; they are not a promise of a particular result.

The obesity treatment programme lasts 6 months and costs PLN 1,799. The price does not include the medicine: the patient has the e-prescription dispensed at a pharmacy and pays for the medicine separately. Over these months 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. The video consultations are booked in the Nasz Gabinet app, and the dates are counted from the initial consultation.

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

Between consultations the patient enters their weight in the app once a week and their body measurements once a month. Once they have given themselves the injection, they take a photo of the pen, which the medical team looks at. At the check-up the doctor already knows these results. The PTLO advises against drug treatment lasting less than 6 months and recommends treatment for a year or longer. After the programme, the patient can therefore extend treatment with a continuation package for PLN 350. The package lasts 3 months. During that time the doctor reviews the results every month and issues an e-prescription, without video consultations.

What does obesity treatment at our clinic not include?

• 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 initial consultation 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. The patient measures body weight, height, waist circumference and blood pressure at home beforehand and gives the readings to the doctor. The initial consultation is included in the price of the programme.

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 has them done before the initial consultation at any laboratory in Kraków or in their home town. If a result is missing, the doctor orders the test and starts the drug once it has been assessed. 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 medicine with a lower risk of weight gain, if suitable, is discussed with the doctor who prescribed it, and only then do we choose the drug treatment for obesity.

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.

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.

How effective are obesity medicines in clinical trials?

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. These are separate trials, not a direct comparison of the medicines.

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.

When do we change or stop drug treatment?

After 3 months at a therapeutic dose, we assess weight change, taking the assessment rules for the particular medicine into account. If weight loss is below 5 percent, we investigate the reasons, how the medicine is being used and any difficulties following the recommendations. The doctor then assesses whether treatment should change. 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. We do not prescribe products authorised solely for type 2 diabetes to treat obesity.

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

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.

Indicative costs of obesity medicines

The indicative cost of 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.

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 contains orlistat in 120 mg hard capsules. The medicine prevents the absorption of about a third of the fat in a meal, over a year brings body weight down by 2 to 3 kg more than placebo, and may cause fatty diarrhoea after a high-fat meal. We consider oral medicines according to indications, contraindications and patient preferences, including when a patient does not want injections.

GLP-1 medicines 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.

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.

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.

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. We do not use products from unverified sources in treatment. Before further treatment, the doctor assesses the patient's health and the products used so far.

A dietitian's meal plan usually aims for a daily energy deficit of 500-750 kcal relative to the patient's needs. Our clinic does not use fasting regimens or diets below 1,200 kcal. An overly restrictive diet may cause nutritional deficiencies and muscle loss and make results harder to maintain. Patients usually eat less while taking medication, so the dietitian ensures adequate protein and other nutrients. The PTLO recommends 150-300 minutes of activity per week. We choose activities to suit fitness and joint health: swimming, a stationary bicycle or brisk walking if well tolerated. Intensity increases gradually according to fitness, pain and exercise tolerance.

When is support with emotional eating needed?

Medication helps reduce hunger but does not replace work on eating in response to stress, at night or out of boredom. We assess the need for psychological support individually, including for emotional eating, binge episodes and difficulty following recommendations. The programme includes two online consultations with a psychologist; dietitian and psychodietitian consultations are not included. A specialist helps patients recognise these situations and find other ways to manage tension. This support can be discussed with the team providing addiction therapy in Kraków. We confirm the format and availability when booking. Support does not guarantee that medication can be stopped without weight regain.

Alcohol provides 7 kcal per gram and may make an energy deficit harder to maintain. A glass of wine contains around 120 kcal and a large beer around 220 kcal; values depend on the volume and type of drink. At that value, two beers provide about 440 kcal and can substantially reduce a planned deficit of 500-750 kcal. From the initial consultation, we therefore count calories from alcohol alongside those from food.

During treatment with a GLP-1 medicine 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. Drinking alcohol may make weight loss harder and increase the risk of side effects.

No, we run the Nasz Gabinet obesity treatment programme exclusively online. The patient talks to the doctor and the psychologist by video in the app and takes measurements at home. Weight is always checked on the same scales. Before treatment starts, the doctor reviews the history and results, then decides whether the patient can be treated in the programme. At the five monthly reviews, the doctor assesses measurements, tolerability and test results using app data without a call, decides on dosing and issues an e-prescription when indicated.

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. During pregnancy and breastfeeding, nutrition is tailored to the woman's needs. Obesity medicines are not used during pregnancy. Semaglutide and liraglutide should not be used while breastfeeding; a doctor may consider tirzepatide after an individual assessment of benefits and risks.

Obesity treatment can begin with a primary care doctor. An NFZ-funded metabolic disease clinic usually requires a referral. NFZ data from 10 September 2026 listed five such clinics in Małopolska: four for adults and one for children, all in Kraków. Waiting times depend on the provider and referral urgency. Check the current appointment date in the NFZ waiting-time directory or directly with the clinic; the number of clinics in this specialty does not describe every route to obesity care in the region.

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. With us, patients pay PLN 1,799 for the six-month programme and buy the medicine separately at a pharmacy. The price of the medicine depends on the product, dose and pack size, so we discuss it at the initial consultation. This lets the patient budget for long-term treatment.

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.

Bariatric surgery is one of the most effective treatments for advanced obesity. Common procedures are sleeve gastrectomy and gastric bypass. One of Kraków's bariatric surgery centres has operated since September 2020 and describes eligibility for patients aged 18-70 with a BMI above 40, or 35-40 with obesity-related conditions. International guidelines from 2022 also cover a BMI of at least 35 without comorbidities and at least 30 in patients with type 2 diabetes after unsuccessful non-surgical treatment. Medical indications should be distinguished from NFZ funding rules; the surgical centre makes the final eligibility decision.

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.

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.

Patients from the region have blood tests at a local laboratory and measure their weight and waist circumference themselves. They book the two doctor consultations and two psychologist consultations in the Nasz Gabinet app and attend them by video. The five monthly medical reviews use app data without a call, and the e-prescription can be dispensed at a local pharmacy. Dietitian and psychodietitian consultations are not included in the programme.

Among adult Kraków residents whose height and weight were recorded in primary care from January to July 2025, around 57.9 percent had overweight or obesity. This was calculated from Centre for e-Health data: 146,198 people with a BMI of at least 25 out of 252,700 with measurements. These figures describe that patient group, not a representative survey of all adult Kraków residents.

The Zdrowy Kraków 2025-2028 programme includes prevention and education, including nutrition and non-communicable diseases. This is not equivalent to providing individual obesity treatment. Options for starting treatment can be discussed with a primary care doctor or a clinic treating obesity.

The Nasz Gabinet clinic in Prądnik Biały has been treating addiction for years, and the same team runs the online obesity treatment programme. 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.