Obesity Treatment Lublin

Because the body defends the weight it has grown used to. Obesity is a chronic disease in which the control of appetite and of energy expenditure fails; in the ICD-10 classification it has its own code, E66, and in 2024 the Polish Society for the Treatment of Obesity (PTLO) issued separate clinical guidelines on diagnosing and treating it. At Nasz Gabinet Lublin we treat obesity as a relapsing illness, on the assumption that once one stage of treatment ends the next has to be planned, in the same way as in asthma or reflux disease.

Appetite is governed by hormones. Ghrelin, released by an empty 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 rises and leptin falls, so hunger is stronger than it was at the start of the diet. At the same time the metabolism slows down: the body burns 200 to 300 kcal a day less than it should at the new, lower weight. That gap persists for years and means that the old way of eating is enough to bring the weight back.

Excess body fat damages organs before the patient notices a single symptom. 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 lowers blood pressure, improves blood glucose and the lipid profile and eases the course of these conditions, which is why we set that as the target for the first six months.

Waist circumference, blood pressure and 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 criteria of the International Diabetes Federation, 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.

Who we assess as eligible for treatment at Nasz Gabinet Lublin

Every adult with a BMI of 30 or above. Between 27 and 29.9 there also has to be a complication of obesity: prediabetes, type 2 diabetes, high blood pressure, lipid disorders, fatty liver disease, sleep apnoea or overloaded joints. We also take patients whose BMI is in the normal range but 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; in them we diagnose abdominal obesity. Obesity medicine is not a separate medical specialty, and an obesity specialist is a doctor who holds PTLO certification. Obesity treatment here is run by doctors with a background in internal medicine.

The first medical appointment at our practice at ul. Narutowicza 78A costs PLN 250, and an online appointment costs the same. The doctor asks when the patient began to put on weight, how earlier attempts at losing weight ended, which medicines he takes regularly and what illnesses run in the family. He weighs the patient, measures height, waist circumference and blood pressure, looks through the results the patient has brought and orders the ones that are missing. A patient who meets the criteria for drug treatment and has a full set of tests leaves the first appointment with an e-prescription (Poland's electronic prescription) for the lowest dose of the medicine and with a date to see the dietitian.

Follow-up appointments then take place every 4 weeks, because that is the rhythm in which the dose of semaglutide and tirzepatide is increased. At each one the doctor asks about symptoms, judges how quickly the weight is coming down and issues a prescription for the next month. After 3 months the patient repeats the blood tests and comes into the practice, so that the doctor can compare the results from before treatment with the current ones and measure the waist. After six months we assess the effect and plan the months ahead, and after a year we decide together with the patient whether to continue the medicine or to reduce the dose gradually.

The PTLO takes the view that treatment should last at least six months for the effect to have a chance to hold, and in most patients it lasts for years.

What we do not do at Nasz Gabinet Lublin when we treat obesity

• We do not prescribe the medicine to anyone without a diagnosis of obesity or of abdominal obesity. A patient with a normal body weight and a normal waist circumference who wants to lose a few kilograms before a holiday does not meet the criteria and will not get a prescription.
• We do not treat children or adolescents. Patients under 18 are seen by paediatric clinics.
• We do not look after patients with cirrhosis of the liver. Advanced liver disease needs a hepatologist, and it is the hepatologist who decides on treatment, including whether the patient can take a medicine for obesity.

The set covers fasting glucose and glycated haemoglobin, 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. Glycated haemoglobin shows the average blood glucose of the past 3 months and settles whether the patient has prediabetes or diabetes already. From the eGFR the doctor reads how the kidneys are working, and the choice of medicine depends on that result. TSH shows whether the thyroid is working normally. The liver enzymes, GGT and the lipid profile point to liver damage and to disturbances of fat metabolism, and with simple fatty liver ALT and AST often stay normal.

From age, AST and ALT activity and the platelet count we calculate the FIB-4 index. It is used to rule out advanced liver fibrosis and needs no extra blood sample. A result below 1.3 in someone up to the age of 65 means low risk, and we order no further liver tests. 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 moves up to 2.0, because age alone inflates the index.

Tests more than six months old have to be repeated.

If the patient has results from a few weeks ago, from a GP surgery or from a workplace health check, we do not make him repeat them. He has the missing ones done at any laboratory in Lublin and sends us a photograph of the result before the appointment.

When another illness or a medicine is 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; it produces a rounded face, wide purple stretch marks and high blood pressure in a young person. 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.

It means that fat has built up in the liver cells, usually because of metabolic disturbances rather than alcohol. 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. In a patient with abdominal obesity that condition is met by definition, because waist circumference is itself one of those factors.

The new naming also separates the metabolic form from the alcohol-related one. 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, which is roughly up to seven and up to ten half-litre beers a week. Above that, 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. It follows from this division that in a patient who drinks regularly, weight loss alone will not stop the damage to the liver.

The liver gives no symptoms until the damage is advanced.

How 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. We refer to a hepatologist when FIB-4 is high 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 the ESSENCE trial showed

The European guidelines from 2024, issued jointly by the hepatology, diabetes and obesity societies, recommend that patients with fatty liver disease keep a deficit of 500 to 1000 kcal a day and lose 7 to 10 percent of their body weight. Simple fatty liver starts to reverse earlier, with a loss of a few percent, but for the inflammation to settle the patient has to lose more.

In the ESSENCE trial semaglutide at a dose of 2.4 mg was given for 72 weeks to patients with steatohepatitis and stage two or three fibrosis. The inflammation resolved without any worsening of fibrosis in 62.9 percent of those treated, against 34.3 percent on placebo, and fibrosis improved 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 Medicines Agency granted conditional marketing authorisation for semaglutide in this indication, for a product with a different trade name from the medicine used in obesity and only in patients without cirrhosis. At Nasz Gabinet Lublin we treat obesity, and the improvement in liver results follows from the weight loss; a patient with suspected advanced liver disease we look after together with a hepatologist.

The criteria are the ones we gave for the assessment: a BMI of 30, or of 27 with an illness caused by excess weight. We also add a medicine when 3 to 6 months of a changed diet and regular exercise have not brought body weight down by 5 percent; the PTLO then recommends drug treatment rather than another diet. The medicine will not replace a change of diet or exercise; what it does is make it possible for the patient to keep those changes up.

A GLP-1 analogue, or GLP-1 receptor agonist, mimics a hormone released by the gut after a meal. It acts in two places: it slows the emptying of the stomach, so the patient feels full for longer, and it stimulates the satiety centres in the hypothalamus, so in most patients the urge to eat between meals weakens. Semaglutide and tirzepatide are given once a week, liraglutide every day. Tirzepatide also acts on the receptor for a second gut hormone, GIP, and produces a greater weight loss. We raise the dose gradually, because the stomach needs a few weeks to get used to working more slowly; skipping that stage ends in nausea and in treatment being abandoned. If after 3 months on the target dose the weight loss does not reach 5 percent, we change the product, most often from semaglutide to tirzepatide. The PTLO lists five medicines authorised in Poland for the treatment of obesity: semaglutide, tirzepatide, liraglutide, naltrexone with bupropion and orlistat.

What the STEP 1 and SURMOUNT-1 trials mean for a patient weighing 95 kilograms

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 patient weighing 95 kg that means on average about 14 kg less on semaglutide and about 20 kg on tirzepatide. 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. These are averages from large groups: some participants lost a great deal more, others very little.

What happens to body weight after the medicine is stopped

Weight loss levels off at around week 60, when the smaller portions already cover the whole daily energy expenditure. The medicine still works, but it now holds the weight that has been reached instead of lowering it. Participants in STEP 1 who, once the trial ended, stopped receiving both the medicine and dietary support regained two thirds of the lost weight within a year, and with it their blood pressure and blood glucose rose again. That is why we plan stopping the medicine as a separate stage of treatment: gradually, with the weight stable and a food plan ready, and the care continues afterwards. In some patients the medicine stays for good, because obesity comes back.

The products authorised for obesity are Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. Ozempic, Rybelsus and Victoza are authorised for type 2 diabetes only, although they contain the same active substances as Wegovy and Saxenda. The trade name tells us the manufacturer and the indication the medicine was tested in; what it does is decided by the active substance and the dose.

Why the same substance has two names and two indications

A manufacturer can only obtain an authorisation for the group of patients and the dose it has studied. Semaglutide in doses up to 2.4 mg is sold as Wegovy and is authorised for obesity; this is the very product tested in STEP 1. The same semaglutide in doses up to 2 mg is Ozempic, and in tablet form Rybelsus, both intended for the treatment of type 2 diabetes. It is the same with liraglutide: 3 mg in Saxenda for obesity, up to 1.8 mg in Victoza for diabetes. Tirzepatide is the exception, because Mounjaro 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 authorised for obesity, because the others have not been studied in this group of patients.

What a month of treatment costs in a Lublin pharmacy

None of these five medicines is reimbursed for obesity, so the cost is set by the pharmacy price. A month of treatment with Xenical costs from about PLN 160 to 350, with Mysimba from about PLN 370 to 600. The injections are dearer: Wegovy costs from about PLN 550 to 890, Saxenda from about PLN 500 to 1250, Mounjaro from about PLN 800 to 1900. The prices come from September 2026. The difference in price comes above all from the dose, because the first weeks of treatment use the lowest doses, but it also depends on the pharmacy: an identical pack can cost twice as much in one Lublin pharmacy as in another, so before filling a prescription it pays to ask what the price is in a few of them.

Who we offer tablets instead of an injection

Tablets come into play when a GLP-1 analogue is contraindicated or the patient cannot tolerate it. The first option is naltrexone with bupropion, sold as Mysimba. Both components act on the reward system in the brain, the centres responsible for the pleasure of eating, so the medicine helps above all patients who eat to lift their mood rather than because they feel hungry. We do not give it in epilepsy or in uncontrolled high blood pressure, because bupropion makes seizures more likely and raises 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 6.1 percent of their body weight after 56 weeks, against 1.3 percent on placebo. The second option is orlistat, that is Xenical: it blocks 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 fatty diarrhoea after a fat-rich meal as a side effect.

We do not prescribe the medicine to a woman who is pregnant or breastfeeding. A woman planning a pregnancy stops semaglutide at least 2 months beforehand and tirzepatide at least a month beforehand. We do not start a GLP-1 analogue in anyone who has had pancreatitis, or in heart failure of NYHA class IV, the most severe, with breathlessness already at rest. The restrictions also depend on the substance: liraglutide is not recommended over the age of 75 or in severe kidney impairment, that is a filtration rate below 30 ml/min, which the doctor reads from the eGFR in the blood result. For semaglutide and tirzepatide the data on patients over 75 and on such a low filtration rate are sparse, so we take the decision individually, after assessing the patient's condition and the other medicines she takes. A woman on the contraceptive pill who starts tirzepatide uses a condom as well for 4 weeks after starting and after every increase in dose, because slower stomach emptying weakens the absorption of the pill.

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 we leave the patient on the lower dose for longer.

Which symptoms mean we do not wait for the next appointment

Severe pain in the upper abdomen radiating to the back, with vomiting, needs immediate medical assessment, because that is how pancreatitis begins. Pain under the right ribs with fever or yellowing of the skin points to gallstones, which were found in 1.6 percent of patients taking semaglutide and which 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 added ischaemic damage to the optic nerve to the summary of product characteristics for semaglutide as a very rare side effect. Vomiting or diarrhoea that lasts a whole day despite drinking fluids risks dehydration and puts a strain on the kidneys. Shaking hands, cold sweat and faintness in a patient taking insulin or a sulfonylurea are symptoms of low blood sugar: the patient first eats something sweet and then comes to us to have the doses adjusted.

Why the medicine is 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. In the same month Poland's Chief Pharmaceutical Inspectorate withdrew a falsified batch of a semaglutide medicine from the Polish market. 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 what he has been given. That is why our patients buy the medicine only in a pharmacy, on an e-prescription, and it is the doctor who increases the dose.

Protein above all, in every meal. 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, and once the medicine is stopped it is mainly fat that returns, because muscle does not rebuild itself. Less muscle means a lower energy expenditure at rest, which makes it easier to go back to the old weight once treatment ends. The dietitian agrees a deficit of 500 to 750 kcal a day with the patient, in line with the PTLO recommendation, and spreads the protein over three or four meals, because on the medicine the patient will not eat a large portion in one go. For the treatment of obesity the PTLO recommends 1 to 1.5 g of protein per kilogram of ideal body weight. Vegetables and protein are eaten at the start of the meal, carbohydrates at the end.

Training is there to 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 the World Health Organization standard, and two strength sessions a week. 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, and a patient who is out of breath after a few minutes of walking starts with 10 minutes a day and adds a few minutes each week.

What the specialist in the psychology of eating does when the medicine quietens hunger but the habit stays

The medicine puts out physical hunger, 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 specialist 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, which is between half and two thirds of the daily deficit the dietitian sets. The liver breaks down the alcohol first and only returns to burning fat several hours later, and alcohol itself sharpens the appetite for salty and fatty food.

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 will not be enough to bring the liver enzymes back to normal.

The medicine also changes how the patient tolerates alcohol. The stomach empties more slowly, so alcohol is absorbed with a delay and the patient judges less well how much he has drunk. Alcohol makes worse the nausea that follows the injection anyway. In someone taking insulin, alcohol raises the risk of low blood sugar. That is why in the weeks when the dose is going up we ask for abstinence, and later, if the patient does drink, for no more than one measure: about 250 ml of beer or 100 ml of wine.

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.

For the first appointment the patient comes to Nasz Gabinet Lublin at ul. Narutowicza 78A. In the practice the doctor weighs the patient on scales made for a high body weight, measures the waist and the blood pressure, examines the abdomen and looks at the skin in the folds, because that is where intertrigo shows and where acanthosis nigricans appears, the dark, velvety patches typical of insulin resistance. Anyone who cannot travel has the first appointment online and sends the test results and his own measurements of weight and blood pressure beforehand; the doctor then judges whether an examination in the practice is needed for the assessment.

Follow-up appointments every 4 weeks are held by video call, and the code for the e-prescription arrives by text message as soon as the appointment ends. The patient gives the weight and blood pressure measured at home and describes any symptoms, and the doctor sets the next dose. We ask the patient into the practice every 3 months, after the blood tests, and whenever there is persistent vomiting, severe abdominal pain or signs of dehydration. Whether appointments with the dietitian and the specialist in the psychology of eating are held in the practice or online is for the patient to choose.

The National Health Fund (NFZ) covers an appointment with a GP, blood tests, a metabolic clinic with a referral and bariatric surgery for people who meet the criteria. There is no reimbursement for the medicines used in obesity: semaglutide is reimbursed in type 2 diabetes only, and only when the criteria set out in the reimbursement announcement are met. A person without diabetes is not entitled to reimbursement, and the NFZ can demand that the doctor repay the amount. That is why a patient treated here for obesity pays the full pharmacy price for the medicine, whoever issued the prescription.

Nor will everyone get free dietary advice at a GP surgery. Coordinated care in primary 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, so a patient with none of those illnesses will not get a free dietary consultation or education at his own surgery. A metabolic clinic is a separate route, with a referral and a waiting list.

Here the patient pays PLN 250 for the first medical appointment, the same for an online appointment, and separately for appointments with the dietitian and the specialist in the psychology of eating and for the medicine at the pharmacy. In return there is no waiting for a date and the same doctor stays in contact throughout the treatment.

A patient with a BMI of 40, or with a BMI of 35 in whom obesity has already caused type 2 diabetes, high blood pressure, sleep apnoea or another illness, is eligible for surgery. In 2022 the international metabolic surgery societies lowered those thresholds to 35 without complications and to 30 with type 2 diabetes, but in Poland eligibility still starts at class II obesity with complications. Surgery is a separate method, with a different effectiveness and a different risk from drug treatment; for eligibility, though, earlier non-surgical treatment has to be documented.

Surgery does not end the treatment of obesity.

A patient who is eligible we refer to a surgical centre and look after up to the day of the operation: we document the non-surgical treatment so far, complete the tests and make sure the patient loses weight before the procedure, because a smaller liver makes the operation easier. The KOS-BAR pilot of comprehensive bariatric care, which a centre in the Lublin province also took part in, ended on 30 June 2026, and that care was not added to the list of services covered by public health insurance; the operation itself remains reimbursed under the general rules.

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 and has iron, vitamin B12, vitamin D and calcium checked regularly. We look after these patients together with the operating centre, particularly when body weight starts to return after two or three years.

Patients come to the practice on Narutowicza from Świdnik, Puławy, Lubartów, Łęczna, Kraśnik, Bychawa and Opole Lubelskie, and also from Zamość, Chełm and Biała Podlaska. The pattern is usually the same: the first appointment in the practice, blood tests done locally, follow-ups from home. The patient comes back to Lublin every 3 months, for an appointment with measurements and a discussion of the fresh results.

Remote follow-ups matter in a province where only two metabolic clinics work under the NFZ, both of them requiring a referral. A patient who works shifts or runs a farm travels in once a quarter and holds the remaining follow-ups by video call, from home.

According to the survey of the health of the Polish population carried out by Statistics Poland in 2019, obesity affects 20.3 percent of the residents of the Lublin province aged over 15, and overweight a further 37.3 percent. Together that gives 57.6 percent of people carrying excess weight, and the obesity figure is one of the highest in the country. Among those over 50, 68.6 percent of the region's residents are already 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 budget covers about 100 people a year against more than 1.5 million adult residents of the province, so for most patients it changes nothing.

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; in the whole province two metabolic clinics work under the NFZ.

Nasz Gabinet Lublin will not replace the provincial programme or an NFZ clinic. We look after an adult patient with obesity from diagnosis through drug treatment and work on eating to keeping the result, with no referral and no waiting for a date. The patient pays for this himself and knows the price before the first appointment.