Obesity Treatment Łódź

Obesity is a chronic disease. It has its own code in the ICD-10 classification, E66, and in its 2024 guidelines the Polish Society for the Treatment of Obesity (PTLO) places it among the diseases that progress without treatment and do not resolve on their own. For a patient in Łódź that means we treat obesity as we treat other chronic diseases, that is over years, with a drug chosen by the doctor and with regular follow-up appointments. A diet lasting a few weeks does not treat this disease.

The disease comes from a disturbed hunger and satiety mechanism. After a meal the gut releases the hormone GLP-1 and adipose tissue releases leptin, and the brain reads both signals as information that the person has eaten enough. In someone with obesity that information reaches the brain more weakly and with a delay, so hunger returns sooner, and the portion after which a healthy person stops eating leaves the patient without a feeling of fullness. After every diet the brain also works to restore the old body weight, slowing the metabolism and increasing appetite until the kilograms return. This mechanism is what produces the yo-yo effect, and it is what GLP-1 analogues, or GLP-1 receptor agonists, act on.

Untreated obesity leads to more than 200 diseases and complications. In patients at Nasz Gabinet Łódź the conditions we most often diagnose alongside obesity are prediabetes or type 2 diabetes, high blood pressure, fatty liver disease, obstructive sleep apnoea, osteoarthritis of the knees and hips and, in women, polycystic ovary syndrome (PCOS). Weight loss of 5 to 10 percent improves the course of every one of those diseases, which is why we measure the success of treatment by weight, blood pressure, glucose and liver enzyme results.

For the diagnosis we use the body mass index (BMI), that is body weight in kilograms divided by height in metres squared. Under PTLO 2024, in adults overweight starts at a BMI of 25.0, class I obesity at 30.0, class II at 35.0 and class III at 40.0. A man 180 cm tall weighing 98 kg has a BMI of 30.2, which is class I obesity; at 130 kg his BMI is 40.1, class III obesity, at which we already consider bariatric surgery.

BMI on its own is not enough, because it does not separate fat from muscle and it does not show where the fat collects. That is why we also measure waist circumference at the first appointment. 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 organs of the abdomen, which places the greatest strain on the liver, the pancreas and the heart. We also diagnose abdominal obesity in people whose BMI still falls within the overweight range. When abdominal obesity is joined by raised blood pressure, fasting glucose and triglycerides, we speak of the metabolic syndrome.

When failed diets and a BMI of 27 or more are a reason to see an obesity specialist

We ask anyone with a BMI of 30 or higher to see a doctor who treats obesity, and the same goes for anyone with a BMI of 27 or more whose overweight comes with prediabetes, high blood pressure, lipid disorders, fatty liver disease, sleep apnoea or pain in the knees and hips from joints overloaded by excess body weight. People who have been through several diets and returned to their starting weight after each one should also come in. That pattern is typical of untreated obesity. 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. At Nasz Gabinet Łódź we treat adults only, although PTLO also allows drug treatment with liraglutide and semaglutide in adolescents from the age of 12 with a body weight above 60 kg.

PTLO divides obesity treatment into four pillars: nutritional treatment, physical activity, psychological support and drug treatment, with bariatric surgery added in some patients with class II and class III obesity. Diet alone brings body weight down, but after a few months the kilograms return, while the drug alone reduces hunger without changing what the patient eats or why. This is why three people look after the patient at Nasz Gabinet Łódź, each with a different job:

• the doctor diagnoses obesity and its complications, orders blood tests, assesses whether the patient is eligible for drug treatment, sets the dose and issues an e-prescription (Poland's electronic prescription),
• the dietitian draws up a meal plan with a deficit of 500 to 750 kcal and makes sure that the smaller portions still contain enough protein,
• the specialist in the psychology of eating works with the patient on eating under stress, binge episodes and eating at night.

We set the goal for the first stage as a percentage, because that is how PTLO defines success: a loss of 5 to 10 percent of body weight within 3 to 6 months, and 7 to 15 percent in patients with type 2 diabetes. A patient weighing 110 kg should therefore weigh between 99 and 104 kg after six months. A loss on that scale brings blood pressure down, improves blood glucose and the lipid profile and reduces the number of pauses in breathing at night, well before the patient reaches the weight they are aiming for.

We plan treatment for at least 12 months, because 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 has a follow-up appointment every 4 weeks, at our Górna practice or online, and each time we weigh them, measure waist circumference, ask about side effects and set the dose for the next month. Once body weight is stable we space the follow-up appointments out, but we do not end treatment, because holding the new weight through another year is a separate stage of it.

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

• We do not sell medicines. The patient leaves with an e-prescription and buys the drug at any pharmacy.
• We do not treat children or adolescents. We take on adult patients only.
• We do not perform bariatric surgery. We provide non-surgical treatment and refer a patient who meets the criteria for an operation to a surgical centre.

At the first appointment the medical history takes longer than the examination. The doctor asks at what age the patient started putting on weight and what changed at the time, how many diets there have been and how they ended, whether anyone in the family has obesity, diabetes or thyroid disease, which medicines the patient takes regularly, what they eat on an ordinary day, whether they eat at night or have binge episodes, and how much alcohol they drink in a week. We also measure body weight, height, waist circumference and blood pressure. The first medical appointment at our practice at ul. Rogozińskiego costs PLN 250, and an online appointment costs the same.

From the blood tests we need fasting glucose and 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 Łódź or in their home town and bring the results to the appointment; if they come without any tests, we order them at the first appointment and start the drug once we have assessed them. The results show whether obesity has already damaged the liver and the kidneys and disturbed glucose metabolism, and that decides both the choice of drug and which complications we treat alongside.

How we rule out secondary obesity, from the thyroid to antidepressants

In some patients the weight gain comes from another disease or from the medicines they take, and we rule that cause out before prescribing anything for obesity. We test for an underactive thyroid, in women for polycystic ovary syndrome, and where the typical signs appear, such as stretch marks, a rounded face and muscle weakness, for Cushing's syndrome. We also go through the patient's list of medicines, because glucocorticoids, insulin, some antidepressants and antipsychotics and certain anti-epileptic drugs cause weight gain. The patient does not stop them on their own; we contact the doctor who prescribed them about a switch to a preparation that does not cause weight gain, and only then do we choose the drug treatment for obesity.

The PTLO 2024 criteria set out three groups of patients to whom we can prescribe a drug for obesity: adults with a BMI of at least 30; people with a BMI between 27 and 29.9 whose overweight comes with at least one weight-related disease; and patients in whom six months of diet and exercise have not brought body weight down by 5 percent. Below those thresholds the drug causes more side effects than it brings benefit, and the patient will not get it from us, even when they ask for it.

Five active substances are authorised in Poland for the treatment of obesity: orlistat, naltrexone with bupropion and three drugs from the GLP-1 group, namely liraglutide, semaglutide and tirzepatide, which stimulates the GIP receptor as well as the GLP-1 receptor. GLP-1 analogues mimic the gut hormone released after a meal: the brain receives the satiety signal earlier, the stomach empties more slowly, and the patient stops eating after a smaller portion and thinks about food less often between meals. 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 has time to get used to it.

What the STEP 1 and SURMOUNT-1 trials showed

In the STEP 1 trial, patients taking semaglutide 2.4 mg lost on average 14.9 percent of their body weight over 68 weeks, against 2.4 percent in the placebo group; one participant in two on the drug lost at least 15 percent. In the SURMOUNT-1 trial, tirzepatide at a dose of 15 mg produced a weight loss of 20.9 percent after 72 weeks, against 3.1 percent in the placebo group. A patient weighing 100 kg can therefore lose about 15 kg on semaglutide and about 20 kg on tirzepatide, provided that, like the participants in both trials, they follow a diet and exercise regularly. In STEP 1 body weight stopped falling at around week 60; this is an expected stage, in which the drug carries on working but holds the new weight instead of bringing it down.

How much body weight has to come off after 3 months and why we do not stop the drug overnight

We assess how well the drug is working after 3 months on the therapeutic dose. If body weight has not fallen by at least 5 percent, PTLO advises switching to a stronger drug, and we go back with the patient to the dietitian. We plan the withdrawal of the drug as carefully as we plan starting it: in the extension of STEP 1, participants regained two thirds of the weight they had lost within a year of stopping semaglutide. So we reduce the dose gradually, and only once the patient's eating habits are settled; some patients stay on the drug long term, in the same way as on a medicine for high blood pressure.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical hold marketing authorisation for the treatment of obesity, while Ozempic and Rybelsus are authorised for the treatment of type 2 diabetes only, even though they contain the same semaglutide as Wegovy. Patients come to Nasz Gabinet Łódź with a brand name they heard from friends or read about online and ask about that particular product. We answer the question at the first appointment, because the differences between these products decide what the doctor can prescribe for obesity, how often the patient injects and how much they pay at the pharmacy.

Which drugs are authorised for the treatment of obesity and which only for type 2 diabetes

So for a patient with obesity and no diabetes we prescribe Wegovy or Mounjaro, even when Ozempic is exactly what they are asking about; the substance is the same, but the diabetes product has a different indication and a different maximum dose.

Which drug works most strongly, how often it is injected and what a month costs

Tirzepatide brings body weight down most strongly: in SURMOUNT-1 by 17.8 percentage points more than placebo, against 12.5 points for semaglutide in STEP 1. In the SCALE trial liraglutide produced a loss of 8.4 kg after 56 weeks against 2.8 kg on placebo, and it calls for a daily injection, which is why we prescribe it rarely, usually when a patient has not tolerated a drug given once a week. Wegovy costs from about PLN 550 to PLN 890 a month at pharmacy prices from September 2026, Mounjaro from about PLN 800 at 2.5 mg 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.

When we choose tablets instead of injections

Naltrexone with bupropion reduces hunger and blunts the pleasure of eating, which is why it helps patients 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. Orlistat blocks the absorption of about a third of the fat from a meal, over a year it brings body weight down by 2 to 3 kg more than placebo, and after a fatty meal it causes fatty diarrhoea. We offer both tablets to patients who cannot take GLP-1 analogues, for example after pancreatitis, or who will not accept injections. The final choice depends on how many kilograms the patient has to lose, on their coexisting diseases, on how well they tolerate nausea and on their budget. We go through it at the first appointment, together with the full cost of a year of treatment.

The most common side effects of GLP-1 analogues involve the digestive tract. Nausea, vomiting, diarrhoea and constipation affect at least one patient in ten, mainly in the first weeks of treatment and after every increase in the dose; in the STEP 1 trial they were the reason 4.5 percent of participants stopped treatment. This is exactly why we raise the dose slowly, and only once the previous one is well tolerated. 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.

When a GLP-1 analogue is contraindicated and when it only calls for caution

We do not prescribe GLP-1 analogues to women who are pregnant or breastfeeding, and semaglutide has to be stopped at least 2 months before a planned conception, because the drug stays in the body for a long time. 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 these drugs in severe kidney or liver failure, in class IV heart failure or after an episode of pancreatitis, and experience with them in elderly people is limited. 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 planned general anaesthesia the patient tells the anaesthetist that they are taking a GLP-1 analogue, because delayed gastric emptying increases the risk of aspiration during the procedure.

What we do when the patient is already using semaglutide bought outside a pharmacy

Poland's Chief Pharmaceutical Inspectorate has warned about falsified semaglutide pens sold outside pharmacies, and in 2025, together with Poland's Chief Sanitary Inspectorate, about semaglutide offered online as a peptide for research purposes, with no prescription and with no control over the dose or the purity. A legal GLP-1 analogue is bought only at a pharmacy, against a prescription. A patient who is using a product from another source is taken on for treatment only after switching to the pharmacy drug, because we do not know what they have been taking so far or at what dose.

The dietitian draws up a meal plan with a deficit of 500 to 750 kcal a day against the patient's requirement, without fasting and without diets below 1,200 kcal, on which the body loses muscle and the patient responds after a few weeks with a binge. During treatment with a GLP-1 analogue the patient eats markedly less, so enough protein has to fit into a smaller portion of food; without it muscle is lost along with the fat, and a patient with less muscle burns fewer calories and puts weight back on faster once the drug is stopped. PTLO recommends 150 to 300 minutes of exercise a week, but in a patient with osteoarthritis of the knees we start with the swimming pool, a stationary bike and walking, and increase the intensity as body weight comes down.

How we recognise binge eating and night eating and who treats them

The drug reduces physical hunger, but it does not change the habit of reaching for food in the evening after a hard day, at night or when alone. 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 Łódź for years. The specialist in the psychology of eating teaches the patient to recognise the situations in which they reach for food in order to calm down, and helps them find other ways of dealing with tension. These sessions are held at our Górna practice or online, as part of addiction therapy in Łódź, and run alongside the drug treatment, because without them the old eating pattern returns once the drug is stopped.

A gram of pure alcohol supplies 7 kcal, not much less than a gram of fat, and the body burns alcohol before anything else, so the calories from a meal eaten with a drink are laid down as body fat, above all in the abdomen. A 150 ml glass of wine is about 120 kcal and a large beer about 220 kcal; two beers in the evening cancel out the whole deficit the dietitian planned for that day. This is why we count alcohol in the same way as food from the first appointment onwards and enter it into the balance.

Alcohol does harm during treatment with a GLP-1 analogue: it makes the nausea caused by the drug worse, it dehydrates, and in a patient with diabetes it brings a risk of hypoglycaemia. At the same time many patients report of their own accord, once the drug has been started, that they are no longer drawn to alcohol. A randomised trial from 2025 in 48 people with alcohol use disorder supports this, as low doses of semaglutide reduced alcohol craving and the number of drinks consumed on the days when participants drank; that result comes from a small group, however, and semaglutide has no marketing authorisation for the treatment of alcohol dependence. When a patient's obesity comes with harmful drinking or alcohol dependence, we offer treatment for both diseases in one place, as part of alcohol addiction treatment in Łódź, because carrying on drinking undoes the effect of any diet and any drug.

The patient has the first appointment at the Nasz Gabinet Łódź practice at ul. Rogozińskiego 23 in Górna, and the follow-up appointments every 4 weeks online. On site the doctor measures waist circumference, blood pressure and body weight, and every later measurement is compared against that first one. 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 and issues an e-prescription to be filled at any pharmacy. Online treatment covers the same ground as treatment at the practice, and the patient does not have to take time off work to travel across Łódź.

Whatever the patient prefers, we arrange an appointment at the practice in class III obesity, in heart and kidney disease that calls for a physical examination, and where we suspect a secondary cause of obesity. A patient from outside Łódź can start treatment online, provided they have blood tests done at a laboratory close to home and measure their own body weight and waist circumference. The dietitian and the specialist in the psychology of eating see patients both at the practice and online. Anyone who cannot take medication for the time being, for example during pregnancy or breastfeeding, follows the same nutritional plan and the same work on eating behaviour, without drug treatment.

Under the PTLO guidelines any doctor can diagnose and treat obesity, a GP in primary care included, while metabolic and endocrinology clinics under the National Health Fund (NFZ) see patients with a referral. Patients eligible for surgery were covered by the KOS-BAR pilot programme, which in the Łódź province was run by a single centre in Łódź; the programme ended on 30 June 2026 and the Ministry of Health says it will become a permanent service. Until then bariatric surgery remains reimbursed under the general rules, and for a patient with class I or class II obesity who does not qualify for surgery the NFZ runs no separate treatment programme.

None of the five drugs authorised in Poland for the treatment of obesity is reimbursed. Semaglutide in the product authorised for the treatment of diabetes is reimbursed only in patients with type 2 diabetes who meet the reimbursement criteria, and where a subsidised prescription is issued for obesity the NFZ may require the doctor to pay the reimbursement back. Privately the patient pays for the consultation and the follow-up appointments according to the Nasz Gabinet Łódź price list (the first medical appointment PLN 250) and for the drug at the pharmacy, where 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. We go through the cost of the whole year before starting the drug, because treatment broken off after three months on grounds of price ends in the weight going back on, and for a patient on a limited budget we can choose a cheaper substance from the start.

In class III obesity, bariatric surgery, most often a sleeve gastrectomy or a gastric bypass, gives a greater and longer-lasting weight loss than any drug. The KOS-BAR programme accepted patients with a BMI above 40, or above 35 with diseases related to obesity, and since 2022 the international bariatric surgery societies have allowed the operation from a BMI of 35 even without coexisting diseases, and from a BMI of 30 in patients with type 2 diabetes in whom non-surgical treatment is not working. The youngest patient at the KOS-BAR centre in Łódź was 20 and the oldest 64, which shows that age on its own does not rule out surgery.

At Nasz Gabinet Łódź we do not operate, but we assess whether the patient is eligible for surgery and prepare them for it over several months: we bring body weight down by a few percent, often on a GLP-1 analogue, get diabetes and blood pressure under control and work on emotional eating, because after the operation the stomach holds less but the habit of eating under the influence of emotions stays. Once prepared in this way, the patient is referred to a bariatric surgery centre, and after the operation we monitor body weight, keep an eye on vitamin and iron supplements and provide psychological support, because without care after surgery some patients return to their old body weight within a few years.

Patients travel to Nasz Gabinet Łódź from across the region, most often from Pabianice, Zgierz, Aleksandrów Łódzki, Konstantynów Łódzki, Ozorków, Głowno, Stryków, Brzeziny, Koluszki, Rzgów, Tuszyn, Łask, Zduńska Wola, Bełchatów, Piotrków Trybunalski, Tomaszów Mazowiecki, Łowicz and Kutno. Just like a resident of Łódź who does not cross the city for every follow-up, a patient from the region goes through most of the treatment without travelling to Łódź.

The patient 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 the Górna practice for it once. Follow-up appointments every 4 weeks, consultations with the dietitian and sessions with the specialist in the psychology of eating are all held remotely, and the patient fills the e-prescription at a pharmacy near home. We ask patients to come to the practice only when the doctor has to examine them in person, that is in class III obesity, in heart or kidney disease and where a secondary cause of obesity is suspected.

Between January and July 2025, GPs measured and weighed 832,000 adult residents of the Łódź province. Of those, 543,000, or 65 percent, were overweight or had obesity, and 229,000, or 28 percent of everyone measured, had obesity itself. In Łódź the share of adults who are overweight or have obesity is the lowest in the province, at 61 percent, and in Rawa county the highest, at 71 percent.

The Łódź province was the first in Poland to fund a treatment programme for overweight and obesity from its own budget, but only for ten-year-olds: each child attends 26 sessions with a doctor, a dietitian, a psychologist and a physiotherapist. Neither the province nor the city offers any programme to an adult in Łódź with obesity, so they are treated either in primary care or privately. We treat obesity in Górna, in the same practice in which we treat addiction, so a patient who has obesity alongside a drink problem or compulsive eating is looked after by one team.