Obesity Treatment Łódź

Obesity is a chronic disease classified as E66 in ICD-10. The Polish Society for the Treatment of Obesity recommends long-term care involving nutrition, physical activity and, where indicated, medication or surgery. A diet lasting a few weeks does not replace a plan for maintaining a lower body weight.

What causes obesity and why does it build up over years?

We speak of obesity when excess fat tissue harms health. This excess builds up over years when food provides more energy than the body uses for organ function and movement. The surplus is taken up by fat cells: at first they grow larger, and with a longer-lasting surplus the body forms additional fat cells. Enlarged fat tissue releases hormones and pro-inflammatory compounds that over time promote insulin resistance, meaning a weaker response of tissues to insulin.

Obesity has many causes. Genes play a large part: according to twin studies, they account for 40 to 70 percent of the differences in body weight between people, and the disease often affects several people in one family. A genetic tendency leads to obesity especially where high-calorie food is easy to get and work and commuting are done sitting down. Short sleep, chronic stress, shift work and quitting smoking also increase the risk, as do pregnancy and menopause in women. Weight gain can also result from another disease or a medicine the patient takes, so we check for these causes at the initial consultation.

The gut hormone GLP-1 and leptin released by fat tissue are among the signals involved in appetite regulation. After weight loss, changes in appetite and energy expenditure can make it harder to maintain the result. This does not mean that weight must return after every diet. Medicines acting on GLP-1 receptors help increase fullness and reduce food intake.

What conditions accompany obesity?

Obesity increases the risk of conditions including type 2 diabetes, hypertension, fatty liver, obstructive sleep apnoea and osteoarthritis of the knees and hips. It can also coexist with prediabetes or polycystic ovary syndrome. Losing 5 to 10 percent of body weight may improve health, but the effect depends on the condition and the patient. During treatment, we assess weight change, blood pressure, blood glucose and relevant test results.

We start by measuring weight and height and calculating BMI: weight in kilograms divided by the square of height in metres. 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 who is 180 cm tall and weighs 98 kg has a BMI of 30.2, or class I obesity. At 130 kg his BMI is 40.1, which corresponds to class III obesity and also warrants discussing bariatric treatment.

BMI does not distinguish fat from muscle or show where fat is stored. We therefore also assess waist circumference. The International Diabetes Federation thresholds for abdominal obesity in people of European ancestry are 80 cm for women and 94 cm for men. Waist circumference is an indirect indicator, not a direct measurement of fat around the organs. Abdominal obesity can also occur with a BMI in the overweight range. Together with blood pressure, glucose and lipid results, it helps assess metabolic risk.

When should you consult a doctor who treats obesity?

Reasons for an appointment include excess weight, weight gain after medication, weight regain after previous attempts or a weight-related condition. You do not need to reach a BMI of 27 to seek advice; criteria for prescribing medication are a separate matter. An obesitologist is a doctor who treats obesity, and PTLO certification is one way of demonstrating competence. Obesitology is not a separate medical specialty in Poland. At Nasz Gabinet in Łódź, this service treats adults.

Treatment combines suitable nutrition, physical activity, psychological support and medication when indicated. Bariatric surgery is also considered for some patients. Weight may rise again after weight loss, so the plan also addresses maintaining results. The professionals involved have different roles:

• The doctor diagnoses obesity and its complications, selects tests and assesses whether medication is needed; following assessment, they set the dose and issue an e-prescription.
• The psychologist provides two online consultations, after months 1 and 3, lasting 40-50 minutes each.

An initial target may be a 5 to 10 percent weight reduction over 3 to 6 months; targets of 7 to 15 percent may also be considered in type 2 diabetes. The doctor sets these individually. For someone weighing 110 kg, losing 5 to 10 percent means reaching 99 to 104.5 kg, rather than a guaranteed result after six months. Blood pressure, glucose, lipids or sleep apnoea symptoms may improve before the target weight is reached.

At Nasz Gabinet we treat obesity in an online programme. It lasts six months and costs PLN 1,799, and the patient buys the medicine separately at a pharmacy with an e-prescription. The programme 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 patient books the video consultations in the Nasz Gabinet app. The dates are set from the initial consultation.

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

Once a week the patient logs weight in the app, and once a month body measurements. After each injection, the patient adds a photo of the pen, which the medical team looks at. The doctor reviews these data before the check-up. Some people need the medicine long term, and the Polish Society for the Treatment of Obesity (PTLO) recommends treatment lasting a year or longer. After the programme it can be extended with a continuation package for 3 months for PLN 350. The package does not include video consultations, and the doctor issues an e-prescription every month after reviewing the results.

Scope of obesity treatment at Nasz Gabinet

• We do not sell medicines. If the doctor issues a prescription, the patient has it dispensed at a pharmacy.
• We treat adults. This service is for people aged 18 and over.
• We do not perform bariatric surgery. We provide non-surgical treatment and refer patients to a surgical centre for assessment.

The doctor asks when weight started increasing, what changed at that time, which diets the patient has tried and which conditions run in the family. They discuss medication, usual eating habits, binge eating, night eating and alcohol intake. The patient measures weight, height, waist circumference and blood pressure at home, and the doctor discusses these measurements at the initial consultation. The patient does not pay separately for this consultation, because it is part of the programme.

Tests depend on the medical history, existing results and planned treatment. They may include fasting glucose, HbA1c, a lipid profile, TSH, ALT and AST, creatinine and uric acid. Tests can be done at a laboratory in Łódź or near home. They help assess health and guide treatment; on their own, they do not establish whether obesity caused an abnormal result. Have any existing results ready before the initial consultation rather than ordering a standard package yourself.

How do we assess the effects of other conditions and medicines on weight?

Other conditions and medicines can contribute to weight gain. Depending on symptoms, we consider investigations for hypothyroidism, polycystic ovary syndrome or Cushing's syndrome. We also review glucocorticoids, insulin and certain antidepressants, antipsychotics and antiepileptic medicines. Do not stop them yourself. A medicine with less effect on weight can be discussed with the prescribing doctor if a change is appropriate. Switching is not always necessary or possible and need not precede all obesity treatment.

Many obesity medicines are indicated for adults with a BMI of at least 30, or from 27 to below 30 with at least one weight-related condition. The criteria depend on the product: Xenical requires a BMI of at least 30, or above 28 with associated risk factors. An unsuccessful diet is not a separate indication that bypasses these thresholds. Before prescribing, the doctor also assesses contraindications, other medicines and potential benefits.

GLP-1 and GIP are gut hormones involved in the response to a meal, including regulation of insulin release. GLP-1 also helps regulate appetite. Semaglutide and liraglutide stimulate the GLP-1 receptor, while tirzepatide stimulates both GIP and GLP-1 receptors. These medicines increase fullness and help reduce food intake; they can also slow stomach emptying. Other options discussed here are orlistat and the combination of naltrexone with bupropion.

Liraglutide is injected under the skin daily; injectable semaglutide and tirzepatide are given weekly. Patients learn injection technique, for example in the abdomen or thigh. Doses are increased gradually according to the product and tolerability, with intervals of at least one week for liraglutide. Tirzepatide starts at 2.5 mg weekly, increasing to 5 mg after four weeks. Further increases of 2.5 mg are made only if needed and after at least four weeks on the current dose. Not everyone needs the maximum dose.

What did STEP 1 and SURMOUNT-1 show?

In STEP 1, semaglutide 2.4 mg produced an average weight reduction of 14.9 percent after 68 weeks, compared with 2.4 percent with placebo. Half of those receiving the medicine lost at least 15 percent. In SURMOUNT-1, tirzepatide 15 mg produced a 20.9 percent reduction after 72 weeks, compared with 3.1 percent with placebo. These were separate trials in people without diabetes, with support for changes to diet and activity. At a starting weight of 100 kg, those averages would correspond to around 15 and 21 kg; they do not predict an individual's result. Average weight in STEP 1 levelled off at about week 60; maintaining the result is also a treatment goal.

How do we assess effectiveness and plan the end of treatment?

Assessment timing and stopping criteria depend on the medicine. In adults, Saxenda should be stopped if at least 5 percent of initial weight has not been lost after 12 weeks on 3 mg. The 5 percent threshold is assessed after 16 weeks for Mysimba and after 12 weeks of treatment for Xenical. Mysimba subsequently requires at least annual review of benefits, cardiovascular risk and maintenance of the effect. An inadequate response calls for discussing the next steps with the doctor, rather than switching to a stronger medicine yourself.

In the STEP 1 extension, participants regained about two thirds of the weight they had lost within a year of stopping semaglutide. Organised lifestyle support also ended in that part of the trial. This does not prove that gradually reducing the dose prevents weight regain. Decisions to continue or stop treatment are individual, with a plan for follow-up and maintaining the result.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical have weight-management indications for appropriately assessed patients. Ozempic and Rybelsus contain the same semaglutide as Wegovy, but are authorised for type 2 diabetes. Mounjaro contains a different substance, tirzepatide. The name, indication, formulation and dose matter when choosing treatment; a name heard from friends is not enough to decide.

Which medicines are authorised for obesity, and which only for type 2 diabetes?

For obesity without diabetes, we choose a product with the appropriate indication, such as Wegovy or Mounjaro, if the patient meets the criteria. This does not mean that everyone will receive a prescription. The doctor considers the specific product and the patient's health, not just the substance name.

Wegovy 7.2 mg may be considered in adults with an initial BMI of at least 30 if a higher dose is needed and they have taken 2.4 mg for at least four weeks. European product information also includes Wegovy tablets for adults. Authorisation does not mean that every form and dose is available in Polish pharmacies; availability must be checked for the specific pack.

Effectiveness, administration and costs

The difference versus placebo was 17.8 percentage points for tirzepatide 15 mg in SURMOUNT-1 and 12.5 points for semaglutide 2.4 mg in STEP 1. Comparing two separate studies does not replace a direct comparison of medicines. Liraglutide in SCALE produced an 8.4 kg reduction after 56 weeks versus 2.8 kg with placebo and requires daily injections. Trial results inform discussions but do not promise a particular number of kilograms.

Cost depends on the product, dose, pack size and pharmacy. Check the current price before starting treatment, and consider the budget when choosing subsequent doses. One pack does not always cover a full month. Prices for older Wegovy doses do not establish the cost of 7.2 mg or the oral formulation.

When do we consider oral treatment?

Naltrexone with bupropion affects appetite and food-related reward mechanisms. In COR-I, weight loss after 56 weeks was 6.1 percent versus 1.3 percent with placebo. Mysimba must not be used in conditions including epilepsy, opioid use and uncontrolled hypertension. Orlistat reduces absorption of about one third of meal fat; after a year it produces, on average, 2 to 3 kg more weight loss than placebo and may cause oily stools, particularly after fatty meals. The choice of tablets or capsules depends on indications, contraindications, tolerability, preferences and cost. A history of pancreatitis requires individual assessment rather than automatically replacing every medicine with an oral product.

Nausea, vomiting, diarrhoea and constipation are among the most common side effects of medicines acting on GLP-1. They may worsen at the start or after a dose increase. In STEP 1, gastrointestinal symptoms led 4.5 percent of participants to stop semaglutide; this is not the proportion of all participants who had these symptoms. The doctor sets the pace of dose increases according to tolerability and product instructions. Gallstones were reported in 1.6 percent of those taking semaglutide. Severe, persistent abdominal pain, including pain spreading to the back, may indicate pancreatitis: do not take the next dose and seek urgent medical help.

When are obesity medicines unsuitable, and when is caution needed?

Semaglutide, liraglutide and tirzepatide must not be used during pregnancy. Before a planned pregnancy, semaglutide must be stopped at least two months beforehand and tirzepatide at least one month beforehand. Wegovy and Saxenda should not be used while breastfeeding; for Mounjaro, a doctor may consider treatment individually. European Mounjaro information does not require dose adjustment of oral contraceptives. An additional barrier method for four weeks after starting and after each dose increase can be discussed as a precaution.

Wegovy and Saxenda are not recommended in severe kidney or liver impairment or NYHA class IV heart failure. Mounjaro has different restrictions: kidney or liver impairment alone does not require a dose adjustment, but data in severe disease are limited and caution is needed. A history of pancreatitis requires individual assessment. Saxenda is not recommended from age 75, and Mysimba above age 75, with caution above 65. Experience with Wegovy and Mounjaro from age 85 is limited. The doctor assesses health and the full medication list.

Insulin or sulfonylureas may increase the risk of low blood glucose in combination with treatment; the doctor adjusts doses if results require it. Diabetic retinopathy needs eye follow-up. Sudden visual deterioration requires urgent ophthalmic care. Persistent vomiting, inability to drink or a marked reduction in urine require urgent assessment without waiting for a routine appointment. Tell the team about the medicine before general anaesthesia or deep sedation; the anaesthetist plans preparation, considering retained stomach contents and aspiration risk.

What if a patient is already using semaglutide bought outside a pharmacy?

The Polish Chief Pharmaceutical Inspectorate has warned about falsified pens and, jointly with the Chief Sanitary Inspectorate in 2025, semaglutide sold as a research peptide. Such products do not provide assurance of their contents, purity or dose. Prescription medicines should be bought from a pharmacy. We see people using products from other sources to assess safety and plan the next steps. They should not calculate an equivalent dose or switch products themselves.

Meals are adapted to health, energy needs and daily life. A deficit of 500 to 750 kcal a day may be a starting point, but does not suit everyone. We do not recommend self-directed fasting or restrictive diets. With a smaller appetite, adequate protein and other nutrients help limit muscle loss alongside fat loss. Protein intake needs individual adjustment in kidney disease. Activity, including strengthening exercises, also matters. A target of 150 to 300 minutes a week is adapted to ability; painful knees may call for starting with water-based exercise, a stationary bike or short walks.

How do we identify binge eating and night eating, and who treats them?

Reduced appetite does not resolve every eating difficulty. A psychodietitian helps identify the effects of stress, loneliness and daily habits and find other ways to manage tension. Binge eating with loss of control or night eating may require assessment for eating disorders and help from a psychotherapist or psychiatrist. They are not automatically addictions. If an addiction also exists, we discuss addiction therapy in Łódź. The programme includes two online consultations with a psychologist. Dietitian and psychodietitian consultations are not included; any further support depends on the assessment.

A gram of pure alcohol provides 7 kcal. A 150 ml glass of wine contains approximately 120 kcal and a large beer around 220 kcal, depending on the product. Two such beers provide 440 kcal and can substantially reduce a planned deficit of 500 to 750 kcal. We therefore include energy from alcohol in the calculation. Alcohol metabolism affects how other energy sources are used, but does not mean that every meal eaten with alcohol is automatically stored as abdominal fat.

Alcohol may worsen gastrointestinal symptoms and dehydration and increase hypoglycaemia risk with insulin or sulfonylureas. A small 2025 randomised trial involving 48 people with alcohol use disorder found that low-dose semaglutide reduced alcohol craving and the amount consumed on drinking days. Short follow-up in a small group cannot promise the same effect for everyone. Semaglutide is not authorised to treat alcoholism. When obesity coexists with harmful drinking or dependence, both problems need a treatment plan; we also discuss alcohol addiction treatment in Łódź. Continued drinking may make weight control harder and increase harm.

We provide all obesity treatment online, including for people living in Łódź. Consultations with the doctor and the psychologist take place by video in the Nasz Gabinet app. The patient measures weight, waist circumference and blood pressure at home. The doctor discusses these measurements and compares them with baseline, taking measurement conditions into account. The doctor decides on admission to the programme on the basis of the history and test results.

At the five monthly reviews, the doctor assesses results and tolerability using app data, without a call. If continued medication is indicated, the doctor sets the dose and issues an e-prescription. Dietitian and psychodietitian consultations are not included in the programme. During pregnancy and breastfeeding, nutrition is adapted to that stage rather than automatically continuing the previous weight-loss plan.

A primary care doctor can also diagnose and treat obesity. Where indicated, they can order tests or refer to specialist care. Public care for adults with obesity in Łódź includes a specialist centre. Check current admission rules and dates with the provider and in the NFZ Treatment Waiting Times Guide. The KOS-BAR pilot ended on 30 June 2026, but this did not end NFZ funding for bariatric surgery. Surgical eligibility and funding rules are separate from the history of the pilot.

Under the reimbursement list effective from 1 July 2026, the Wegovy, Mounjaro, Saxenda, Mysimba and Xenical products discussed here are not reimbursed for obesity treatment. Reimbursement for certain diabetes products depends on the product and eligibility criteria, not simply on how the appointment is paid for. Primary care tests require indications, and nutrition education may be part of Moje Zdrowie or appropriate coordinated care. This does not mean that every practice provides the same dietary treatment.

The private obesity treatment programme at Nasz Gabinet costs PLN 1,799 for 6 months, while the pharmacy sets medicine prices. Discuss the budget before treatment, because the cost of the medicine depends on doses and packs. Stopping medication may be followed by weight regain, so financial difficulties should prompt a joint plan rather than a self-directed dose change.

Bariatric surgery is an effective treatment for obesity. Procedures include sleeve gastrectomy and gastric bypass. The 2025 Polish consensus recommends considering surgery from BMI 35 regardless of evident complications, and at BMI 30 to 34.9 in people with type 2 diabetes inadequately controlled despite treatment. Clinical criteria must be distinguished from funding rules and assessment at a particular centre. Older age alone does not determine refusal; function, comorbidities and operative risk are also assessed.

We do not perform surgery at Nasz Gabinet in Łódź. We refer patients to a bariatric centre for assessment and can work with the team on preparation, including diabetes, blood pressure and nutritional status. Not everyone needs several months of medication first. Long-term follow-up after surgery follows the surgical team's recommendations: weight checks, tests, nutrition and supplements appropriate to the operation. Psychological support tailored to need may help change habits and maintain results.

We also treat residents of Pabianice, Zgierz, Aleksandrów Łódzki, Konstantynów Łódzki, Ozorków, Głowno, Stryków, Brzeziny, Koluszki, Rzgów, Tuszyn, Łask, Zduńska Wola, Bełchatów, Piotrków Trybunalski, Tomaszów Mazowiecki, Łowicz and Kutno. The whole programme takes place online.

Tests can be done at a laboratory near home; prepare your own weight and waist measurements for the initial consultation. You book later consultations in the app and have the e-prescription dispensed at a pharmacy in your town.

A summary of primary care measurements from January to July 2025 covered 832,000 adults in the Łódź region. Of those measured, 543,000, or around 65 percent, had overweight or obesity; 229,000, around 28 percent, had obesity. In this group, overweight and obesity combined affected 61 percent in Łódź and 71 percent in Rawa county. These are data on people measured in primary care, not a representative survey of all residents or a count of everyone with obesity in Łódź.

The regional government funds a programme for overweight and obesity in ten-year-olds. This children's programme does not describe all public help available to adults. A February 2026 regional announcement also identifies a centre in Łódź that treats adults with obesity. Obesity care also considers psychiatric medicines, eating difficulties and alcohol problems where present. The necessary cooperation with other specialists is agreed individually.