Obesity Treatment Lublin

After a period of weight loss the body sets off mechanisms that favour regaining the lost weight. Obesity is a chronic disease: in the ICD-10 classification it has the code E66, and in 2024 the Polish Society for the Treatment of Obesity (PTLO) issued clinical guidelines on diagnosing and treating it. At Nasz Gabinet we therefore plan treatment for the long term: once the weight-loss stage is over, we agree with the patient how to keep the weight that has been reached.

Hormones take part in regulating appetite. Ghrelin, released mainly by the stomach, drives hunger. GLP-1 from the gut produces satiety after a meal, and leptin from body fat tells the brain how much energy is stored. After a few weeks of eating less, ghrelin levels usually rise and leptin levels fall, so hunger can be stronger than at the start of the diet. The body may also use less energy than the lower weight alone would explain. The size and duration of this adaptation vary from person to person. When the old way of eating returns, body weight often rises again.

What is obesity and where does it come from?

Obesity is a disease in which excess body fat puts health at risk. The excess usually builds up over many years in which food provides more energy than a person uses. Fat cells first increase in volume, and if weight gain continues, the body produces more fat cells. Body fat is also a secretory organ: besides leptin, it releases substances that sustain chronic inflammation. Under their influence the muscles and liver respond less well to insulin. This condition is called insulin resistance.

The tendency to gain weight is largely inherited: according to twin studies, genes explain 40 to 70 percent of the differences in body weight between people. Genes have the strongest effect on body weight in surroundings where high-calorie food is easy to get and people spend most of their working day and commute sitting down. Too little sleep, chronic stress and shift work also speed up weight gain. Body weight often rises after pregnancy, during menopause and after quitting smoking. Before treatment we check whether another disease or a medicine is responsible for the weight gain; we describe these causes in the section on tests.

What are the risks of untreated obesity?

Excess body fat raises the risk of complications that can develop for a long time without symptoms. The PTLO guidelines list more than 200 complications of obesity. In our patients from Lublin the most common are high blood pressure, prediabetes and type 2 diabetes, fatty liver disease, osteoarthritis of the knees and hips, and sleep apnoea. A weight loss of 5 to 10 percent often lowers blood pressure, improves blood glucose and the lipid profile and eases the course of these conditions. We treat this range as an approximate target for the first stage of treatment, and the doctor adjusts it to the patient's health.

We measure waist circumference and blood pressure and review the blood test results. We start, though, with the simplest measure, the body mass index: body weight in kilograms divided by height in metres squared. A man of 178 cm weighing 105 kg has a BMI of 33.1, which is class I obesity. The thresholds the PTLO has adopted from the World Health Organization are these: overweight from 25, class I obesity from 30, class II from 35 and class III from 40.

BMI does not distinguish muscle from fat and says nothing about where the fat has settled. In someone in their seventies muscle is lost with age, so a normal BMI does not rule out a large amount of body fat. That is why we measure waist circumference: under the International Diabetes Federation criteria for the European population, abdominal obesity is diagnosed from 80 cm in women and from 94 cm in men. Fat stored around the liver, the pancreas and the intestines releases inflammatory substances and raises the risk of diabetes and of heart attack more than fat on the thighs and buttocks.

When is it worth booking a consultation about obesity?

We see adults with a BMI of 30 or above for a consultation, as well as people with a BMI of 27 or above who have a weight-related condition: prediabetes, type 2 diabetes, high blood pressure, lipid disorders, fatty liver disease, sleep apnoea or overloaded joints. We also see patients with a normal BMI whose waist circumference is above the threshold and whose blood results point to insulin resistance, a weakened response of the tissues to their own insulin. Being seen for a consultation does not mean being eligible for a medicine. The authorised indications of the medicines discussed here are based on BMI: for most of them a BMI of 30, or of 27 with a weight-related condition, and for Xenical a BMI of 30, or above 28 with risk factors. Abdominal obesity with a normal BMI does not meet these indications, so in such a patient the doctor assesses metabolic risk and plans treatment without an obesity medicine. An obesity specialist is a customary name for a doctor who treats obesity; it is neither a separate medical specialty nor a title reserved for holders of a PTLO certificate. Obesity treatment here is run by doctors with a background in internal medicine.

We treat people living in Lublin in an online programme. The programme lasts 6 months and costs PLN 1,799, and the patient buys the medicine separately at a pharmacy. Before the first consultation the patient has blood tests done and measures their own weight, height, waist circumference and blood pressure at home. From the history and the results the doctor decides whether the patient can be treated in the programme. A full set of tests and a BMI above the threshold do not guarantee a prescription. The programme consists of 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, on dates counted from the initial consultation.

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

The dose of semaglutide and tirzepatide is raised no more often than every 4 weeks, and tirzepatide is increased beyond 5 mg only when there is a need. Between consultations the patient records their weight in the app once a week and their body measurements once a month, and after each injection sends a photo of the pen to the medical team. The doctor looks through these results before the check-up. The doctor orders follow-up tests as needed and compares them with the results from before treatment.

Keeping the result requires a plan beyond the first six months as well, and in many patients obesity treatment lasts for years. PTLO recommends treatment for a year or longer. After the programme the patient can extend care with a continuation package for 3 months for PLN 350. In the package the doctor reviews the results every month and issues an e-prescription, but does not hold video consultations.

The scope of obesity treatment in the Nasz Gabinet programme

• We prescribe a medicine only when there is a medical indication. The indications of authorised medicines cover obesity and overweight with a weight-related condition. A large waist alone with a normal BMI does not meet them, and a person of normal weight who wants to lose a few kilograms before a holiday will not get a prescription.
• We treat adults. Patients under 18 are seen by paediatric clinics.
• Cirrhosis of the liver requires specialist treatment. Decisions about treating advanced liver disease, including whether an obesity medicine may be used, are made by a hepatologist, and we coordinate the care of such a patient with the hepatologist.

The doctor decides on the set of tests. It usually covers fasting glucose and glycated haemoglobin (HbA1c), a lipid profile, the liver enzymes ALT and AST, GGT, creatinine with a calculated eGFR, TSH, uric acid and a full blood count with a platelet count. HbA1c reflects average blood glucose over about 3 months and helps diagnose prediabetes or diabetes; anaemia and kidney disease, among other things, can distort the result. From the eGFR the doctor reads how the kidneys are working and takes that result into account when choosing a medicine. TSH helps assess thyroid function. ALT, AST and GGT show strain on the liver but do not establish the cause of liver damage, and with simple fatty liver they often stay normal. The lipid profile shows cholesterol and triglyceride levels.

From age, AST and ALT activity and the platelet count we calculate the FIB-4 index. It helps assess the risk of advanced liver fibrosis and needs no extra blood sample. In people aged 35 to 65, a result below 1.3 means a low risk of advanced fibrosis but does not rule it out definitively. After a low result the assessment is usually repeated in 1 to 3 years, or sooner if other worrying results or symptoms appear. Above that we send the patient for elastography, a scan that measures the stiffness of the liver, and above 2.67 straight to a hepatologist. In people over 65 the lower threshold is 2.0, because age alone raises the index. In people younger than 35 FIB-4 is less reliable, so the doctor also assesses risk from other information.

The doctor decides whether earlier results are still current. The patient sends in results from a GP surgery or from a workplace health check, and the doctor judges whether they are enough or need repeating, for example after a change of medicines or a worsening of health.

The patient has any missing tests done at any laboratory in Lublin and sends us a photograph of the result before the consultation.

When is another illness or a medicine behind the weight gain?

Before we accept obesity as a disease in its own right, we look for secondary causes. A raised TSH suggests an underactive thyroid; we confirm it by measuring FT4 and first bring the thyroid hormones back to normal, because untreated hypothyroidism adds a few kilograms, mostly retained water, and distorts any judgement of how treatment is working. Less often we come across an excess of cortisol in Cushing's syndrome; testing for it is warranted by a rounded face, wide purple stretch marks and high blood pressure in a young person, although these signs alone do not confirm the diagnosis. The commonest secondary cause remains medication: some antidepressants and antipsychotics, anti-epileptic drugs, steroids, insulin and sulfonylureas. We do not stop such a medicine without the agreement of the doctor who started it; our doctor writes to the psychiatrist or the neurologist to ask whether there is a similar drug that is less likely to cause weight gain.

The report means that fat has built up in the liver cells. In people with obesity the cause is most often metabolic disturbance. In 2023 the hepatology societies changed the naming: what used to be called non-alcoholic fatty liver disease became metabolic dysfunction-associated steatotic liver disease, or MASLD for short. It is diagnosed when imaging shows fatty change and the patient has at least one of five cardiometabolic risk factors: an excessive waist circumference, raised glucose, high blood pressure, high triglycerides or low HDL cholesterol. The doctor also has to assess alcohol intake and rule out other causes of fatty liver, such as viral hepatitis or the effects of medicines. In abdominal obesity the metabolic criterion is met, so the diagnosis depends on the assessment of alcohol and of the other causes.

The new naming also separates the metabolic form from the alcohol-related one by the amount of alcohol consumed. MASLD is diagnosed in women who drink less than 140 g of pure alcohol a week and in men who drink less than 210 g. A half-litre beer at 5 percent contains about 20 g of alcohol, so these thresholds correspond roughly to seven and ten such beers a week. The thresholds serve to classify the disease and do not mark a safe amount of alcohol. Above them, but not exceeding 350 g in women and 420 g in men, the diagnosis is the mixed metabolic and alcohol-related form, abbreviated to MetALD. Above those figures we speak of alcohol-related liver disease. In a patient who drinks regularly, alcohol damages the liver further, so weight loss alone may not halt the disease.

Liver disease often causes no symptoms, and symptoms alone cannot reliably show how advanced it is.

How do we check what stage the liver disease has reached?

After an ultrasound we do not order another scan straight away. First we calculate the FIB-4 index, and if the result is raised we send the patient for elastography. Both assess the risk of liver fibrosis; liver enzymes alone cannot diagnose steatohepatitis. We refer to a hepatologist when FIB-4 is high, when elastography shows increased liver stiffness or when the picture of the liver is unclear. A liver biopsy is ordered by the hepatologist in the few situations where the result will change the way the patient is treated.

How much weight loss improves the liver and what did the ESSENCE trial show?

The European guidelines from 2024, issued jointly by the hepatology, diabetes and obesity societies, recommend a deficit of 500 to 1000 kcal a day for patients with fatty liver disease and excess weight. The guidelines give approximate targets: a weight loss of at least 5 percent reduces the fat in the liver, a loss of 7 to 10 percent helps the inflammation settle, and a loss of at least 10 percent helps fibrosis improve. These figures come from studies of groups of patients and do not guarantee the same effect in every patient, especially where there is fibrosis.

In the ESSENCE trial semaglutide at a dose of 2.4 mg was given to patients with steatohepatitis and stage two or three fibrosis. The published analysis covered the first 800 participants after 72 weeks of treatment; the trial is continuing and provides for 240 weeks of follow-up. The inflammation resolved without any worsening of fibrosis in 62.9 percent of those treated, against 34.3 percent on placebo, and fibrosis improved without any worsening of inflammation in 36.8 percent against 22.4 percent. Body weight fell by an average of 10.5 percent against 2.0 percent. In March 2026 the European Commission, following the opinion of the European Medicines Agency, granted conditional marketing authorisation for semaglutide in the treatment of steatohepatitis with stage two or three fibrosis, in patients without cirrhosis. This product has a different trade name from the medicine used in obesity. At Nasz Gabinet we treat obesity, and the improvement in liver results can follow from the weight loss; a patient with suspected advanced liver disease we look after together with a hepatologist.

We consider a medicine for a patient who meets the indications of the particular product: for most medicines that is a BMI of 30, or of 27 with a condition related to excess weight. If 3 to 6 months of a changed diet and regular exercise have not brought body weight down by 5 percent, the doctor reviews the treatment plan, but such a result does not replace the BMI criteria. The medicine will not replace a change of diet or exercise; it makes it easier for the patient to keep those changes up.

GLP-1 and GIP are hormones released by the gut after a meal that take part in regulating appetite and blood glucose. Liraglutide and semaglutide act on the GLP-1 receptor, and tirzepatide on the GIP and GLP-1 receptors. These medicines slow the emptying of the stomach, so the patient feels full for longer, and act on the satiety centres in the brain, so in most patients appetite between meals goes down. Semaglutide injections and tirzepatide are given once a week, liraglutide every day. In trials tirzepatide produced on average a greater weight loss than semaglutide. The dose is raised gradually, because this limits nausea and other digestive symptoms; raising the dose too quickly increases the risk of side effects. Effectiveness is judged by the rules that apply to the particular product. If weight loss is insufficient, the doctor considers changing the dose, the product or the approach, and switching from semaglutide to tirzepatide is one of the options. Among the medicines used to treat obesity, the PTLO lists semaglutide, tirzepatide, liraglutide, a combination of two substances, naltrexone with bupropion, and orlistat.

What results were achieved in the STEP 1 and SURMOUNT-1 trials?

In the STEP 1 trial semaglutide at a dose of 2.4 mg lowered body weight after 68 weeks by an average of 14.9 percent, against 2.4 percent on placebo. In SURMOUNT-1 tirzepatide at a dose of 15 mg lowered it after 72 weeks by 20.9 percent, against 3.1 percent. For a person weighing 95 kg these averages would correspond to about 14 kg less on semaglutide and about 20 kg less on tirzepatide. This conversion illustrates the average trial results and is not a forecast for an individual patient. Liraglutide at a dose of 3 mg produced in the SCALE trial, after 56 weeks, a loss of 8.4 kg against 2.8 kg on placebo, which at the average weight of the participants corresponded to roughly 8 percent. The trials differed in length, doses and participants, so they do not compare the medicines directly. Some participants lost a great deal more, others very little.

What happens to body weight after the medicine is stopped?

In the STEP 1 trial the average weight loss in the treated group levelled off at around week 60. That point describes the average in the trial group, and in an individual patient it may come earlier or later. A halt in weight loss does not have to mean that the medicine has stopped working and may be a stage of keeping the weight that has been reached. In the STEP 1 extension a subgroup of participants stopped receiving both the medicine and dietary support once the trial ended. Within a year they regained on average two thirds of the lost weight, and part of the improvement in blood pressure and blood glucose was reversed. The study did not test whether tapering the dose prevents weight regain. We make the decision to stop the medicine together with the patient, with a plan for eating, exercise and further follow-up. In some patients the medicine stays for longer.

The medicines with an indication for obesity include Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. Ozempic, Rybelsus and Victoza are authorised for type 2 diabetes, although they contain the same active substances as Wegovy and Saxenda. Who may use a medicine and at what dose is set by the summary of product characteristics of the product, not by the active substance alone.

Why does the same substance have two names and two indications?

A manufacturer authorises a medicine for the group of patients, the form and the doses it has studied. Semaglutide as Wegovy is authorised for obesity; this product at a dose of 2.4 mg was tested in STEP 1. The Wegovy summary of product characteristics now also covers a 7.2 mg injection dose for adults with a starting BMI of 30 or above, after at least 4 weeks on 2.4 mg, as well as a tablet form. Authorisation does not mean that every dose and form is available in Polish pharmacies. The same semaglutide as an injection in doses up to 2 mg is Ozempic, and in tablet form Rybelsus, both intended for the treatment of type 2 diabetes. It is similar with liraglutide: 3 mg in Saxenda for obesity, up to 1.8 mg in Victoza for diabetes. Mounjaro, that is tirzepatide, is authorised for both conditions. Since March 2026 semaglutide has had one further indication in the European Union, in steatohepatitis, under a separate trade name; we write about that in the section on the liver. To a patient without diabetes we prescribe a product with an indication for obesity, because the authorised indication sets who may use the medicine and at what dose in line with its summary of product characteristics.

What does a month of treatment cost in a Lublin pharmacy?

According to a review of the reimbursement list from July 2026, none of the five products discussed is reimbursed for obesity, so the patient pays the full pharmacy price. The monthly cost depends on the product, the dose, the pack size and the pharmacy, which is why we do not give a single figure. Injectable treatment starts with lower doses in the first weeks, but not every patient reaches the highest dose, and prices for lower doses cannot be carried over to the 7.2 mg dose or to tablets. With orlistat the dose does not change, so the cost depends mainly on the pack and the pharmacy. The price of the same pack varies between pharmacies, so before having a prescription dispensed the patient can ask about the price in a few of them.

When do we consider oral treatment?

The doctor considers oral treatment, among other situations, when a GLP-1 analogue injection is contraindicated or poorly tolerated; the choice also depends on other conditions, the patient's preferences and cost. One option is Mysimba, a combination of two substances, naltrexone and bupropion, in tablets. Both components act on brain areas involved in regulating appetite and on the reward system, the centres responsible for the pleasure of eating. Eating in response to emotions does not in itself decide the choice of this medicine; the doctor weighs benefits and risks as with any other product. We do not give it in epilepsy or in uncontrolled high blood pressure, because bupropion raises the risk of seizures and can raise blood pressure, nor in people treated with opioids, because naltrexone blocks the action of those drugs and can bring on withdrawal symptoms. Participants in the COR-I trial lost on average 6.1 percent of their body weight after 56 weeks, against 1.3 percent on placebo. Mysimba is stopped if at least 5 percent of the starting body weight has not been lost after 16 weeks. The second option is orlistat, that is Xenical in 120 mg hard capsules. It reduces the absorption of roughly a third of the fat in a meal and over a year produces a weight loss 2 to 3 kg greater than placebo, with oily, loose stools as a side effect, especially after a fat-rich meal. Orlistat is stopped if at least 5 percent of body weight has not been lost after 12 weeks.

Semaglutide, liraglutide and tirzepatide are not used in pregnancy. A woman planning a pregnancy stops semaglutide at least 2 months beforehand and tirzepatide at least a month beforehand. Wegovy and Saxenda should not be used while breastfeeding, while the current Mounjaro summary of product characteristics allows treatment during that time to be considered individually. After previous pancreatitis the manufacturers advise caution; in that situation our clinic does not start a GLP-1 analogue. Wegovy and Saxenda are not recommended in severe kidney impairment, that is an eGFR below 30 ml/min/1.73 m², in severe liver impairment or in heart failure of NYHA class IV, the most severe, with breathlessness already at rest. Mounjaro needs no dose change because of kidney or liver impairment alone, but data on patients with severe failure of these organs are limited, so the doctor uses it with caution. Saxenda is not recommended from the age of 75, and there are few data on Wegovy and Mounjaro in people aged 85 and over. To a woman on the contraceptive pill who starts tirzepatide we recommend an additional barrier method, such as a condom, for 4 weeks after starting and after every dose increase, because slower stomach emptying can weaken the absorption of the pill. This is a precautionary recommendation of our clinic.

The commonest side effects involve the digestive tract. Nausea, vomiting, diarrhoea and constipation occur in more than one patient in ten, usually in the week after a dose increase, and ease off as the body gets used to the medicine. They led 4.5 percent of the participants in STEP 1 to stop treatment. Smaller portions, avoiding fatty food on the day of the injection and drinking water between meals all help, and when the symptoms persist the doctor may leave the patient on the lower dose for longer.

Which symptoms mean we do not wait for the next appointment?

Severe, persistent pain in the upper abdomen, often radiating to the back, with or without vomiting, can mean acute pancreatitis. The patient then stops the medicine and needs urgent medical help. Pain under the right ribs with fever or yellowing of the skin or eyes can mean a complication of gallstones, such as inflammation of the gallbladder or bile ducts, and also needs urgent medical help. Gallstones were found in 1.6 percent of patients taking semaglutide and appear more often with rapid weight loss. A sudden deterioration of vision in one eye needs urgent assessment by an ophthalmologist; in 2025 the European Medicines Agency recognised ischaemic damage to the optic nerve as a very rare side effect of semaglutide. Persistent vomiting or diarrhoea, being unable to keep fluids down, passing very little urine, dizziness on standing or confusion point to a risk of severe dehydration and kidney injury; with these symptoms the patient seeks help straight away, without waiting until the next day. Shaking hands, cold sweat and weakness in a patient taking insulin or a sulfonylurea can mean low blood sugar. If the patient is conscious and can swallow safely, they eat or drink something sweet and then contact the doctor, who will review the doses. Impaired consciousness, seizures or loss of consciousness need urgent medical help, and such a person must not be given anything by mouth.

Why is the medicine bought only in a pharmacy?

In October 2023 several patients in Austria were taken to hospital with severe hypoglycaemia after injecting from a pen bought outside a pharmacy. Testing of the contents of the pens found insulin instead of semaglutide. Around the same time European authorities, including Poland's Chief Pharmaceutical Inspectorate, warned about falsified semaglutide pens. A pen from a small ad and a vial labelled as a peptide for research purposes go through no quality control at all, and the patient has no way of checking their contents or sterility. That is why our patients buy the medicine only in a pharmacy, on an e-prescription, and it is the doctor who decides on any dose change.

The basis is a balanced diet with enough protein over the day. The medicine reduces appetite, but it does not decide whether what is lost is fat or muscle: with too little protein and no exercise, muscle mass goes along with the fat. Less muscle means a lower energy expenditure at rest and poorer physical function, which makes it harder to keep a lower weight once treatment ends. The dietitian agrees an energy deficit with the patient, often 500 to 750 kcal a day, and spreads the protein over three or four meals, because on the medicine the patient eats smaller portions. For obesity treatment the PTLO gives an approximate range of 1 to 1.5 g of protein per kilogram of ideal body weight. The dietitian sets the amount of protein and the size of the deficit individually, particularly in patients with kidney or liver disease. The patient can eat vegetables and protein foods at the start of the meal and starchy foods at the end.

Training is there to help preserve muscle and improve the sensitivity of the tissues to insulin; the calories burned in the gym are a bonus. We recommend 150 to 300 minutes of moderate exercise a week, in line with World Health Organization recommendations, and two strength sessions a week, matched to the patient's abilities. Strength training is particularly needed by patients past sixty, in whom muscle is being lost with age as well. Someone with knee pain does not start with running but with the swimming pool, a stationary bike or Nordic walking. Activity is increased step by step, for example starting with 10 minutes of walking a day and adding a few minutes each week. Breathlessness after a few minutes of walking, especially if it is severe or new, first needs to be assessed by a doctor, because heart or lung disease can be the cause.

How does a psychodietitian help with emotional eating?

The medicine reduces appetite, but reaching for food under tension, out of anger or out of boredom weakens far less, and in some patients does not change at all. The psychodietitian (a dietitian trained in the psychology of eating) teaches the patient to tell physical hunger from eating out of tension, and works out with him what he will do at such a moment before he opens the fridge. When a patient describes binge eating with a sense of losing control, we check whether this is an eating disorder, because a change of diet alone will not be enough then.

A gram of pure alcohol supplies 7 kcal. An evening with three glasses of wine is about 360 kcal, a large part of the daily deficit the dietitian sets. The body breaks down alcohol first, which temporarily limits the use of fat as a source of energy, and after drinking it is harder to control portions and food choices.

In a patient with a fatty liver, regular drinking damages it further, on top of the metabolic disturbances; the thresholds at which the diagnosis changes to the mixed form are given in the section on the liver. With drinking at that level, losing weight alone may not be enough to bring the liver enzymes back to normal.

Alcohol can make the nausea that comes with treatment worse, and in someone taking insulin or a sulfonylurea it raises the risk of low blood sugar, whose symptoms are easy to mistake for drunkenness. That is why in the weeks when the dose is going up we ask for abstinence. At later stages the doctor discusses alcohol intake with the patient individually. With fatty liver it is better to cut down on alcohol, and with advanced fibrosis or cirrhosis of the liver complete abstinence is recommended. No amount of alcohol can be considered safe for every patient during treatment.

A separate matter is something some of our patients report: on the medicine they are drawn less to alcohol. The effect was tested in an early clinical trial from 2025, published in JAMA Psychiatry. Forty-eight people with alcohol use disorder were randomly assigned to semaglutide or to placebo for 9 weeks; those treated felt alcohol craving less often and drank fewer measures on the days when they did drink. The group was small and the treatment short, so we do not prescribe semaglutide for addiction. To a patient whose drinking is slipping out of control we offer alcoholism treatment in Lublin, and where other substances are involved addiction therapy. We run both paths ourselves, alongside the obesity treatment.

We run the programme entirely online, so a patient from Lublin does not travel to the clinic. Before the initial consultation the patient sends test results and their own measurements of weight, waist circumference and blood pressure. Intertrigo and acanthosis nigricans, the dark, velvety patches that can accompany insulin resistance, sometimes appear in the skin folds. It helps to tell the doctor about them.

The five medical reviews after months 1, 2, 3, 4 and 5 use app data, without a call. The doctor assesses home measurements, tolerability and treatment progress and adjusts the dose or medicine if needed. If the doctor issues an e-prescription, the code arrives by text message. Persistent vomiting, severe abdominal pain or signs of dehydration need urgent medical help, without waiting for a scheduled consultation. The programme also includes two online consultations with a psychologist, after months 1 and 3, lasting 40-50 minutes each.

The National Health Fund (NFZ) pays for an appointment with a primary care doctor, tests ordered in line with the indications and the range of services of the given facility, appointments at a metabolic clinic with a referral and bariatric surgery for people who meet the criteria. Reimbursement of medicines depends on the product and the indication. According to a review of the reimbursement list from July 2026, Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are not reimbursed for obesity. Some semaglutide products are reimbursed in type 2 diabetes, and only when the criteria set out in the reimbursement announcement are met. A person without diabetes is not entitled to that reimbursement, and the NFZ can demand that the doctor repay the amount. That is why a patient treated for obesity pays the full pharmacy price for the medicine, whoever issued the prescription.

Free dietary advice in primary care is available through coordinated care or the Moje Zdrowie (My Health) programme, and the scope of advice varies between surgeries. Coordinated care covers high blood pressure, heart failure, chronic coronary artery disease, atrial fibrillation, diabetes, asthma and chronic obstructive pulmonary disease, as well as an underactive thyroid and thyroid nodules; a diagnosis of obesity on its own is not on that list. The Moje Zdrowie programme provides educational advice, including on diet, which may be given by a dietitian or another authorised member of the primary care team. Such advice is not the same as individual dietary therapy, so its scope has to be checked at your own surgery. A metabolic clinic is a separate route, with a referral and a waiting list.

At Nasz Gabinet the patient pays PLN 1,799 for the six-month online programme, and separately for the medicine at the pharmacy. The programme includes two online consultations with a psychologist; dietitian and psychodietitian consultations are not included. The patient books the consultations in the programme in the Nasz Gabinet app.

Clinical criteria and the conditions for NFZ funding of surgery have to be considered separately. The Polish bariatric consensus from 2025, like the recommendations of the international metabolic surgery societies from 2022, provides for surgery at a BMI of 35 or above regardless of other conditions, and at a BMI of 30 to 34.9 allows it to be considered in patients with type 2 diabetes that remains uncontrolled despite treatment. The decision to operate is made by the bariatric centre after assessing body weight, other conditions, nutritional status and physical function, and the funding conditions have to be confirmed with the chosen centre. Surgery is a separate method, with a different effectiveness and a different risk from drug treatment; a surgical consultation does not have to wait until all other treatment methods have been exhausted.

Surgery does not end the treatment of obesity.

A patient who could benefit from surgery we refer for a consultation at a surgical centre, and we work with the centre on the preparation for the procedure: we document the treatment so far, complete the tests and help put the centre's dietary recommendations into practice. Weight loss before the procedure can reduce the size of the liver and make the operation easier. The centre decides whether weight loss is needed before the procedure; a referral for a consultation does not require it in every patient. The KOS-BAR pilot of comprehensive bariatric care, which a centre in the Lublin province also took part in, ended on 30 June 2026. The end of the pilot does not mean the end of bariatric operations funded by the NFZ.

In the first weeks after a sleeve gastrectomy the stomach takes a few dozen millilitres of food, in time a little over a hundred, and after an operation that bypasses part of the small intestine vitamins and trace elements are absorbed less well. After surgery the patient takes supplements for life, to an extent that depends on the type of procedure, and has iron, vitamin B12, vitamin D and calcium, among others, checked regularly. Follow-up after bariatric surgery lasts for life. We look after these patients together with the operating centre, particularly when body weight starts to return after two or three years.

The online programme is also open to patients from Świdnik, Puławy, Lubartów, Łęczna, Kraśnik, Bychawa and Opole Lubelskie, as well as from Zamość, Chełm and Biała Podlaska. The patient can have blood tests done locally and has the doctor and psychologist consultations by video. The five monthly medical reviews use app data without a call.

Video consultations make treatment easier for people who work shifts or run a farm. According to data from 2021 cited in the provincial programme, two metabolic clinics worked under the NFZ in the province, both requiring a referral. The current admissions of such clinics, including whether they accept adults with obesity, have to be checked with the chosen facility.

According to the survey of the health of the Polish population carried out by Statistics Poland in 2019, obesity affected 20.3 percent of the residents of the Lublin province aged 15 and over, and overweight a further 37.3 percent. Together that gives 57.6 percent of people carrying excess weight, and the obesity figure was one of the highest in the country. Among those over 50, 68.6 percent of the region's residents were overweight or obese. The authors of the provincial programme set these figures against the demographic situation of the region: one of the lowest life expectancies in the country and a high average age of residents. The complications of obesity here are therefore added on top of an ageing population.

In December 2024 the provincial authority adopted a programme for the prevention of obesity among adult residents for the years 2024 to 2028: tests, medical, dietary and psychological consultations and reimbursement for exercise classes, with a target weight loss of 5 percent. The programme's authors planned to cover about 100 people a year against more than 1.5 million adult residents of the province, so the number of places in the programme is limited.

The authors of the programme also wrote that the public system lacks accessible, comprehensive treatment for obesity and that patients pay for it out of their own pocket; according to data from 2021, two metabolic clinics worked under the NFZ in the whole province.

Nasz Gabinet will not replace the provincial programme or an NFZ clinic. In the online programme we look after an adult patient with obesity from diagnosis, through drug treatment where it is indicated and work on eating, to maintaining the result. The patient pays for the treatment themselves and knows the price of the programme before starting.