Obesity treatment

Yes, obesity is a chronic disease listed in the WHO ICD-10 classification under code E66. In its 2024 clinical guidelines, the Polish Society for the Treatment of Obesity (PTLO) describes it as a disease that does not resolve on its own and returns after a break in treatment. As a chronic disease, it is treated like high blood pressure: instead of prescribing a one-off diet, the doctor makes a diagnosis, sets a goal, prescribes medication and plans follow-ups over several years. According to the WHO, 890 million adults worldwide were living with obesity in 2022.

The disease arises from the system that regulates appetite. After a meal, the intestines release the hormone GLP-1, while fat tissue continuously releases leptin; both hormones signal fullness to the brain. In a person with obesity, that signal is weaker, fullness comes later and wears off sooner. When such a person restricts food, the body reacts as though it were starving: it slows metabolism and increases appetite. This is why weight returns to its previous level after most diets, and often rises above it. The mechanism reflects physiology, not the patient's character, and it is this physiology that the medicines described below act on.

PTLO lists more than 200 diseases caused by excess fat tissue, particularly visceral fat surrounding the organs in the abdomen: chiefly type 2 diabetes, high blood pressure, lipid disorders, fatty liver disease, sleep apnoea, osteoarthritis of the knees and hips, and some cancers. Losing 5 to 10 percent of body weight improves the course of these conditions. That is why the doctor sets this as the initial goal, rather than a return to the patient's weight twenty years ago.

According to an NFZ analysis published in March 2025, based on measurements of 3.4 million adult patients in primary care practices, 35 percent of adults have overweight and 28 percent have obesity. Overweight or obesity affects 70 percent of men aged 18 to 64 and 51 percent of women in that age group; after age 65, the figures are 78 and 72 percent respectively. In rural areas, almost 66 percent of adults have overweight or obesity.

The differences between cities are small. NFZ data cited by Rzeczpospolita show that the highest proportions of adults with overweight or obesity are in Gorzów Wielkopolski (64 percent), Białystok (62.8) and Olsztyn (62.2), and the lowest in Poznań (55.8), Kraków (57.5) and Wrocław (58.3). Even in Poznań, where the proportion is lowest, more than one in two adults has overweight or obesity.

In its report Obesity and Its Consequences, NFZ projects that by 2035 obesity will affect more than 35 percent of adult men and more than 25 percent of women. Reimbursement for treating the complications alone - type 2 diabetes, gallbladder disease, lipid disorders, sleep apnoea, knee osteoarthritis and fatty liver disease - rose from PLN 1.2 billion in 2014 to PLN 4.2 billion in 2024. In 2024, Poland's Supreme Audit Office (NIK) concluded that the healthcare system was failing to prevent and treat obesity adequately: patient numbers are growing and waiting lists for specialist clinics are getting longer.

Obesity begins at a BMI of 30, overweight at 25. BMI is body weight in kilograms divided by height in metres squared; a woman who is 165 cm tall crosses the overweight threshold at 68 kg and the obesity threshold at 82 kg. PTLO divides obesity into three classes: class I from BMI 30, class II from 35 and class III from 40. The thresholds are the same for men and women of all ages, but BMI can be misleading in people over 65 and in athletes because it does not distinguish fat from muscle or water.

That is why waist circumference is measured too. Under the International Diabetes Federation criteria adopted by PTLO, a waist circumference of 80 cm or more in women and 94 cm or more in men indicates abdominal obesity, regardless of BMI. Visceral fat surrounds the liver and pancreas, releases inflammatory substances and reduces the action of insulin; it is more harmful than fat beneath the skin around the hips. A doctor will recognise disease in a person with a BMI of 26 and a 100 cm waist, even though BMI alone places them in the overweight category.

Is obesity treated by an obesity specialist, an internal medicine specialist, a diabetologist or a dietitian?

Obesity medicines are prescribed by a doctor, most often an internal medicine specialist, a diabetologist or an endocrinologist. Obesity medicine is not a medical specialty in Poland; an obesity specialist is a doctor of any specialty who has passed the PTLO certification examination. Dietitians and specialists in the psychology of eating do not prescribe medicines or order tests, but without their support patients rarely maintain the results after stopping medication. Under NFZ, obesity is treated at metabolic disease and diabetes clinics, with a referral from a GP; privately, patients book a doctor's appointment without a referral.

Obesity treatment rests on four pillars: changes to eating habits, physical activity, psychological support and medication, with bariatric surgery also used in class II and III obesity. PTLO recommends eating 500 to 750 kcal a day less than the body needs, doing 150 to 300 minutes of moderate exercise each week, and adding resistance training. Medication does not replace the first three pillars; it enables patients to maintain them because they no longer have to fight hunger.

In the first stage, the target is to lose 5 to 10 percent of body weight over 3 to 6 months, or 7 to 15 percent in a person with type 2 diabetes. For a patient weighing 100 kg, that means 5 to 10 kg. This is enough to lower blood pressure, improve blood glucose and lipid levels, and start reducing liver fat. The doctor sets further goals once the first has been reached.

PTLO states that treatment lasting less than 6 months does not consolidate the results, and that 12 months or longer is preferable, because the body needs that time to adjust to new habits and a lower body weight. In practice, patients see the doctor every 4 weeks while the dose is being increased, then every few months, with dietitian appointments between medical reviews. After a year, the doctor and patient decide whether to continue medication permanently or withdraw it gradually.

Three injectable medicines are licensed in Poland - semaglutide, tirzepatide and liraglutide - alongside two oral medicines: naltrexone with bupropion, and orlistat. All require a prescription, although lower-dose orlistat can also be bought over the counter. PTLO recommends medication when diet and exercise have not worked: for patients with a BMI of 30 or above, and from BMI 27 for those who already have an obesity-related disease. Treatment starts at the lowest dose, which is increased every few weeks.

The three injectable medicines are GLP-1 analogues, molecules that mimic the intestinal hormone signalling fullness. They slow stomach emptying, so meals keep patients full for longer, and strengthen the fullness signal in the brain, allowing patients to eat less without feeling hungry. Tirzepatide also stimulates the receptor for a second intestinal hormone, GIP, and produces the greatest weight loss. Semaglutide and tirzepatide are given once a week, liraglutide daily.

Effectiveness is expressed as weight loss on the medicine compared with placebo. NFZ does not reimburse any of these medicines for obesity. We checked pharmacy prices in September 2026. For Wegovy and Mounjaro, the lower figure is for the lowest dose used in the first weeks, and the upper figure for the full dose. For Saxenda, Mysimba and Xenical, we give the range between pharmacies at the full dose: the same pack of Saxenda costs PLN 320 in one pharmacy and PLN 750 in another, and five pens a month are needed at a dose of 3 mg. Cheaper alternatives to liraglutide are already available: Plyzari and Polidia.

Why a doctor does not prescribe Ozempic for weight loss in someone without diabetes

Ozempic, Wegovy and Rybelsus contain the same semaglutide. However, according to the Ozempic summary of product characteristics, the medicine's licensing document, it is licensed only for type 2 diabetes, at doses up to 2 mg, while Wegovy is licensed for obesity at 2.4 mg, the dose studied in people without diabetes in the STEP programme. A doctor prescribing Ozempic for weight loss is prescribing outside its licensed indications: there are no safety data for the medicine in people without diabetes, and when supplies are short it reduces availability for people with diabetes. For this reason, the Ministry of Health placed Ozempic on its list of medicines at risk of shortages. According to its summary of product characteristics, Mounjaro is licensed for both type 2 diabetes and obesity, so this issue does not arise.

After around 70 weeks of treatment, patients taking semaglutide lose an average of 15 percent of body weight, and those taking tirzepatide 20 percent: 15 and 20 kg respectively for someone weighing 100 kg. In STEP 1, one in two patients taking semaglutide lost at least 15 percent, and one in three at least 20 percent; in SURMOUNT-1, one in two patients on the highest tirzepatide dose lost at least 20 percent.

Weight falls fastest during the first six months, then stops falling at around week 60. The medicine has not stopped working. Reduced appetite and a slower metabolism reach a balance at the new weight, which is maintained while the patient continues medication. If a patient has lost less than 5 percent after 3 months on the full dose, PTLO considers the medicine ineffective for that patient and recommends changing it: semaglutide to tirzepatide, or to a medicine with a different mechanism.

Weight returns after the medicine is stopped. STEP 1 participants followed for a year after stopping semaglutide at week 68 regained two thirds of the weight they had lost, and blood pressure and glucose worsened again along with the weight gain. This is why the doctor does not stop the medicine overnight: they wait until weight has stabilised, withdraw it gradually and have a dietitian's plan ready for the period without medication. Some patients continue it for years, just as they would a blood pressure medicine.

The most common side effects affect the digestive system. In the Wegovy summary of product characteristics, nausea, vomiting, diarrhoea and constipation are very common, meaning they affect at least one in ten people, mainly in the week after a dose increase. In STEP 1, 4.5 percent of patients stopped treatment because of these effects. For most patients, symptoms ease when they eat smaller portions, avoid fatty foods on the day of the injection and have their dose increased more slowly by the doctor.

Less common complications include acute pancreatitis, which starts with severe upper abdominal pain radiating to the back. Gallstones, found in 1.6 percent of patients taking semaglutide, cause pain beneath the right ribs. Persistent vomiting leads to dehydration, which puts a strain on the kidneys. In June 2025, the European Medicines Agency recognised ischaemic damage to the optic nerve (NAION) as a very rare side effect of semaglutide. If vision in one eye suddenly worsens, the medicine must be stopped and urgent assessment by an ophthalmologist sought. People with diabetes taking insulin or sulfonylureas are at risk of low blood glucose, so the doctor reduces those doses when starting a GLP-1 analogue.

GLP-1 analogues are not used during pregnancy or breastfeeding; semaglutide must be stopped at least 2 months before a planned pregnancy. A history of pancreatitis is also a contraindication. Doctors do not use these medicines in patients with NYHA class IV heart failure or severe kidney or liver impairment, because the manufacturer has no safety data for these groups. Experience in people over 75 is limited, and the manufacturer does not recommend liraglutide at that age. A woman taking oral contraceptives who starts tirzepatide uses additional contraception for 4 weeks after the first dose and after each dose increase, because slower stomach emptying reduces absorption of the pill.

Why obesity medicines should only be bought from a pharmacy

Poland's Chief Pharmaceutical Inspector recalled a counterfeit batch of Ozempic on 12 October 2023. In the same month, several patients in Austria were admitted to hospital with severe hypoglycaemia because pens from illegal sources contained insulin instead of semaglutide. Nobody checks the purity or dose of vials sold online as research peptides. An obesity medicine is bought legally only from a pharmacy, on a prescription from a doctor who then supervises dose increases.

Patients eat less on medication, but the medicine alone does not determine whether they lose fat or muscle. Body composition measurements in STEP 1 showed that about 40 percent of the weight lost was lean body mass, mainly muscle. That proportion is higher in people who eat too little protein and are inactive, and after stopping the medicine only fat returns. Patients on medication cannot eat large portions, so the dietitian spreads protein across 3 to 4 meals a day and sets the order of eating: protein first, vegetables next, carbohydrates and fat last. Resistance training twice a week protects muscle more effectively than walking alone.

A GLP-1 analogue suppresses physical hunger, but habits remain: patients still eat when stressed, bored or tired, and still snack at night. When medication is stopped, appetite returns and the habit has not disappeared. A specialist in the psychology of eating teaches patients to distinguish physical hunger from emotional hunger and agrees with them what to do when they want to eat without being hungry. If an eating disorder is causing the overeating, the patient is referred for psychotherapy. Patients see this specialist during medication treatment, rather than only afterwards: while the medicine suppresses hunger, it is easier to practise new behaviours.

Type 2 diabetes is the most common complication of obesity and largely results from the same excess fat: visceral fat reduces the action of insulin, so the pancreas produces more and more until it can no longer meet the body's needs. According to the Polish Diabetes Association guidelines, prediabetes is diagnosed at a fasting glucose of 100 to 125 mg/dl or a glycated haemoglobin (HbA1c) of 5.7 to 6.4 percent, and diabetes at 126 mg/dl or above on two measurements, or an HbA1c of 6.5 percent or above. The doctor orders both tests for every patient with obesity before prescribing medication.

Weight loss alone can lead to remission of type 2 diabetes, meaning normal glycated haemoglobin without diabetes medicines. In DiRECT, GPs in Scotland and England supervised a very low calorie diet in patients whose diabetes had been diagnosed no more than 6 years earlier. After a year, 46 percent of participants were in remission, compared with 4 percent receiving usual care. The greater the weight loss, the more frequent remission became: 7 percent of those losing less than 5 kg, 57 percent of those losing 10 to 15 kg, and 86 percent of those losing 15 kg or more achieved it. When weight returns, diabetes returns too. After remission, patients remain under medical follow-up for years, just as they do with obesity alone.

In a patient with both diseases, a GLP-1 analogue treats both, because it was developed as a diabetes medicine. NFZ reimburses semaglutide for patients with type 2 diabetes who meet the reimbursement notice criteria, including those relating to BMI and HbA1c; the doctor then prescribes a product licensed for diabetes. Metformin continues, while insulin or sulfonylurea doses are reduced from the first week to avoid hypoglycaemia.

A gram of pure alcohol contains 7 kcal, so two 0.5-litre beers provide about 440 kcal, almost the entire daily deficit recommended by PTLO. The liver breaks down alcohol first, and fat burning stops for several hours. Alcohol also increases the appetite for salty and fatty food. On a GLP-1 analogue, alcohol is absorbed more slowly, making it harder for patients to judge how much they have drunk and more likely to cause nausea. Regular drinkers are more at risk of pancreatitis, a rare complication of these medicines.

Many patients notice less desire for alcohol on a GLP-1 analogue, and a clinical trial found the same. In a study published in JAMA Psychiatry in 2025, 48 people with alcohol use disorder took semaglutide or placebo for 9 weeks. Those on semaglutide experienced less alcohol craving and drank less on the days when they drank. This was a small phase II trial. No GLP-1 analogue is licensed for addiction treatment, and a doctor will not prescribe one for the purpose of reducing drinking. If drinking is getting out of control, alcohol addiction is treated separately, although treatment can run alongside obesity care.

Under NFZ, medical appointments and tests are free, but patients pay the full price for obesity medication just as in private care, because none of the five licensed medicines is reimbursed for obesity. A metabolic disease clinic requires a GP referral, and waits in large cities run to months. According to NIK, waiting lists grow longer each year, and public healthcare has no separate programme for adults with obesity. The KOS-BAR programme - comprehensive care covering preparation for bariatric surgery and a year of care afterwards - ended its pilot on 30 June 2026 and has not yet been replaced.

In private care, patients pay for appointments and avoid the waiting list. The first medical appointment at Nasz Gabinet costs PLN 250, the same in person and online. No referral is needed; patients bring test results, which they can obtain free in primary care if their GP orders the tests. Medical follow-ups every 4 weeks take place online, followed by an e-prescription.

How much patients spend on the medicine alone in the first year

At September 2026 pharmacy prices, a year of semaglutide treatment costs approximately PLN 6600 to 10,700, and tirzepatide approximately PLN 9600 to 22,800, depending on the dose. Patients pay least in the first months, when taking the lowest doses. Reduced-price semaglutide is available only to people with type 2 diabetes who meet the criteria in the Minister of Health's notice. If a doctor prescribes it with reimbursement to a patient without diabetes, NFZ may recover the undue reimbursement from the doctor.

Bariatric surgery is considered at a BMI of 40 or above, or from 35 when a patient already has type 2 diabetes, high blood pressure, sleep apnoea or another obesity-related disease. In both cases, prior non-surgical treatment - diet and medicines - must have failed to produce lasting results. The procedure reduces the stomach (sleeve gastrectomy) or bypasses part of it and a section of intestine (gastric bypass). Afterwards, the stomach holds only a few dozen millilitres, and patients usually lose 25 to 35 percent of body weight within two years. NFZ reimburses surgery under its usual rules, and the Association of Polish Surgeons lists 67 bariatric centres in the country.

The surgical centre requires records of previous non-surgical treatment. The route to surgery therefore still starts with a doctor treating obesity. For 3 to 6 months before surgery, patients take a GLP-1 analogue and follow a diet: losing 5 to 10 percent of body weight shrinks the liver and reduces the risk of complications during the operation. Afterwards, absorption of iron and vitamins B12 and D is permanently reduced, so patients take supplements and have their full blood count checked for life. A specialist in the psychology of eating works with them on emotional eating, a common reason for weight regain several years after surgery.

At Nasz Gabinet, obesity is treated by a doctor who diagnoses it using BMI and waist circumference, reviews blood tests, assesses eligibility for medication, and then sees the patient online every 4 weeks for a follow-up and issues an e-prescription after each visit. The first appointment costs PLN 250. If the patient meets PTLO criteria and has all the required results, they leave with a prescription for the lowest dose and a dietitian appointment. The dietitian plans meals for the period of medication treatment, and a specialist in the psychology of eating supports patients who eat in response to emotions. If a patient has type 2 diabetes, we treat both conditions; if their drinking is risky, we also refer them to our addiction clinic.

The first appointment takes place at a practice in one of five cities: we offer obesity treatment in Wrocław, Warsaw, Łódź, Kraków and Katowice. The doctor takes measurements, examines the abdomen and agrees on a plan for a year or more. Patients from other cities first send their test results and their own weight and blood pressure measurements, then have the first appointment online; the doctor decides whether an in-person examination is also needed before approving treatment. Patients can attend follow-ups and dietitian and psychology-of-eating consultations online from anywhere in Poland.

What we do not do in obesity treatment at Nasz Gabinet

• We do not sell medicines or arrange their purchase. Patients receive an e-prescription and have it dispensed at any pharmacy.
• We do not treat children or adolescents. We see adults only; childhood obesity is treated by paediatric and paediatric endocrinology clinics.
• We do not perform bariatric surgery. We provide and document non-surgical treatment, prepare patients for surgery and refer them to a surgical centre.