Obesity Treatment Olsztyn

Obesity is listed in the International Classification of Diseases under code E66. In its 2024 recommendations, the Polish Society for the Treatment of Obesity describes it as a chronic disease that requires long-term care. Body weight may rise again after weight loss ends, because losing weight changes the mechanisms that regulate appetite and energy expenditure. The body uses less energy, and hunger and fullness signals can make a lower weight harder to maintain. Appetite regulation involves hormones such as ghrelin, which stimulates hunger, and leptin, which tells the brain how much fat tissue is stored. These changes differ from person to person and do not lead everyone to regain the weight they lost.

What is obesity and how does it develop?

Obesity is diagnosed when the body has accumulated so much fat tissue that this tissue begins to harm health. The disease develops gradually, usually over years in which the energy from food exceeds the body's energy expenditure. The surplus goes into fat cells, which grow larger at first, and when weight gain continues, the body produces new fat cells. Fat tissue also has hormonal functions: it releases leptin and substances involved in inflammatory processes. Visceral fat, stored around the abdominal organs, is the most harmful, because over time it weakens the tissues' response to insulin, which leads to insulin resistance. Obesity is associated with type 2 diabetes, high blood pressure, fatty liver disease and osteoarthritis.

Several factors contribute to the development of obesity. In twin studies genes explained 40 to 70 percent of the differences in body weight, and obesity is more common in people whose parents also have obesity. An inherited tendency leads to weight gain especially when high-calorie food is easy to get and everyday duties require little movement. Short sleep, chronic stress, eating in response to tension, pregnancy, menopause and quitting smoking also promote weight gain. With painful knees, pain shortens walking distance, and lower activity makes further weight gain easier. Some medicines and diseases, such as an underactive thyroid, can also increase body weight, so the doctor asks about medicines and diseases before setting the treatment plan.

What does the treatment plan look like?

The doctor makes the diagnosis, assesses complications and agrees a treatment plan with the patient. The plan may include medication, dietary changes, activity adapted to physical function and help with eating difficulties. A dietitian helps fit meals to the daily routine, and a psychodietitian (a dietitian trained in the psychology of eating) works on eating behaviours. The doctor decides individually how much specialist support is needed and how long medication is taken. The plan also allows for weeks when weight does not fall; such a period alone does not mean that treatment has failed.

The diagnosis of obesity is based on measurements and the medical history. BMI is calculated by dividing body weight by the square of height in metres. For a person 178 cm tall weighing 116 kg, BMI is 36.6. In adults, overweight begins at a BMI of 25, class I obesity at 30, class II at 35 and class III at 40. The thresholds are the same for women and men. BMI has limitations in people with a lot of muscle mass and does not show where fat is stored. The doctor therefore interprets the result together with the patient's health and physical function.

Waist circumference is measured after a relaxed breath out, halfway between the lowest rib and the top of the hip bone. For people of European origin, the International Diabetes Federation uses abdominal obesity thresholds of 80 cm in women and 94 cm in men; other ethnic groups have different thresholds. Fat around the abdominal organs is associated with higher metabolic risk, so two people with the same BMI may have different diabetes risks. The doctor asks about weight changes over the years, previous attempts to lose weight and periods of regain. With joint pain, the doctor also asks how far the patient can walk without pain, which knee or hip hurts, whether the patient uses a crutch and whether there is an orthopaedic diagnosis.

When can obesity medication be considered?

For many products, the criterion in adults is a BMI of at least 30, or a BMI of 27 to below 30 with a weight-related condition. Meeting the BMI threshold does not guarantee a prescription. The doctor assesses the indications of the chosen product, the patient's health and the safety of treatment. The summaries of product characteristics (SmPC) for Wegovy and Mounjaro list examples of such conditions: prediabetes or type 2 diabetes, high blood pressure, lipid disorders and obstructive sleep apnoea. The list gives examples only. Knee pain alone does not replace a diagnosis of a weight-related condition, and the doctor assesses diagnosed osteoarthritis individually. Xenical has a different threshold: a BMI of at least 30, or above 28 with risk factors. A person with a lower BMI can receive advice on diet and physical activity. Age alone does not rule out treatment, but restrictions differ between products: Saxenda is not recommended for people aged 75 and over.

At Nasz Gabinet we treat obesity in an online programme. The programme lasts 6 months and costs PLN 1,799, and the price includes 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 price does not cover the medicine, which the patient buys at a pharmacy with an e-prescription. Before the initial consultation, prepare a list of the painkillers you take for your joints. After assessing the history and the results, the doctor decides whether the patient can be treated in the programme; a complete set of test results does not by itself decide whether a medicine is prescribed. The patient books the consultations in the Nasz Gabinet app, and the schedule is counted from the first one.

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

Every week the patient enters their weight in the app, and every month their body measurements. The patient also takes a photo of the pen they used for the injection, and the medical team looks at this photo. The doctor checks these results before the check-up. The Polish Society for the Treatment of Obesity (PTLO) recommends treatment lasting a year or longer. After the programme the patient can therefore extend treatment with a continuation package: 3 months for PLN 350, with an e-prescription every month after a medical review and without video consultations.

In the injectable semaglutide regimen, increasing the dose to 2.4 mg usually takes 16 weeks, in steps every 4 weeks. Other medicines have their own dosing schedules. The doctor sets further dosing according to the product, tolerability and results. At check-ups, the doctor asks about nausea and food intake and assesses weight and blood pressure readings. Protecting muscle strength and mass matters from the start of treatment. With painful knees, seated or lying exercises may be easier than a long walk, but the choice of exercise depends on the patient's abilities. The doctor sets the date of repeat blood tests according to the patient's health and the course of treatment.

The doctor assesses the effectiveness and safety of the medicine throughout treatment. Individual medicines have different rules for continuation. In adults, Saxenda is stopped if weight loss has not reached 5% of starting weight after 12 weeks on 3 mg, Mysimba after 16 weeks without that result, and Xenical after 12 weeks without a 5% reduction from pre-treatment weight. If the effect is insufficient, the doctor reviews the course of treatment and considers changing the approach. The end of the programme does not automatically mean reducing the dose or stopping the medicine.

What don't we do in the obesity treatment programme?

• We do not postpone obesity treatment until joint surgery. It can run alongside joint investigations and preparation for a joint replacement, and the weight-loss target and date of surgery are agreed with the surgical team.
• We do not treat weight loss as the only treatment for joint pain. Pain needs its own diagnosis and treatment, and the doctor checks the painkillers you take for safety alongside obesity treatment.
• We do not recommend the same exercises for every patient. With knee or hip pain, activity is matched to physical function. Running and jumping may worsen symptoms, so the type and intensity of exercise are best agreed with a physiotherapist.

Which tests are needed and whether earlier results are recent enough depend on the medical history, other conditions and the planned medicine. Fasting glucose and glycated haemoglobin help assess blood sugar regulation, and creatinine with calculated eGFR shows kidney function. With an eGFR below 30 ml/min/1.73 m², meaning severe kidney impairment, liraglutide is not recommended. TSH helps investigate the thyroid but does not on its own establish the cause of obesity. The doctor orders a lipid profile, the liver enzymes ALT and AST, uric acid and a blood count according to indications. Raised liver enzymes alone are not enough to diagnose fatty liver disease. Have your existing results ready before the initial consultation, and the doctor will assess which of them are recent enough.

Prepare a list of all medicines and supplements, ideally with doses or photos of the packs. Glucocorticoids, insulin, sulfonylureas and some antiepileptic, antidepressant and antipsychotic medicines can affect body weight. Do not stop them on your own, especially glucocorticoids. Any change must be agreed with the doctor treating that condition, because a suitable alternative from the same class is not always available. During weight loss, the doctor monitors blood pressure and blood glucose and changes doses of blood pressure and diabetes medicines when the results require it.

Which joint symptoms need further investigation?

Joint swelling, morning stiffness lasting more than half an hour and pain in the small joints of the hands may call for rheumatological investigation, including CRP and ESR. CRP and ESR results alone do not establish the cause of pain. Sudden severe pain, swelling and redness in one joint need urgent medical assessment, because infection must be ruled out. Suspected joint infection needs immediate medical help. Gout is one possible cause of these symptoms, and a normal uric acid level during an attack does not rule it out. With long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), the doctor checks the blood count and kidney function and sets review dates according to risk. Vomiting, dehydration or reduced urine output require contacting a doctor before the scheduled check-up. An appropriately qualified doctor decides on X-rays and other imaging based on symptoms.

Obesity increases the load on the joints and may promote inflammation. Fat tissue produces substances involved in inflammation. However, mechanical load and metabolic processes explain only some of the causes of osteoarthritis in the knees, hips and hand joints. Weight loss can reduce pain and improve function, but it does not reverse structural changes that have already developed in a joint.

How much do everyday activities load the knee?

In the 2010 study by Kutzner and colleagues, forces were measured in five people with sensors built into their knee replacements. The table shows mean peak resultant forces as percentages of body weight. In the last column, the force is calculated for a person weighing 100 kg and expressed as the weight of the corresponding mass. This presentation shows force in kilograms, although the physical unit of force is the newton. The results come from a small group of people with implants, so for a healthy knee they are an approximation.

Of the activities shown in the table, the greatest force was measured when going down stairs. For a person weighing 100 kg, it corresponded to the weight of 346 kg. Measuring load alone does not show when pain will appear or how many kilograms a person needs to lose before feeling relief.

How do weight loss and exercise affect knee pain?

In 2005, Messier and colleagues assessed walking in 142 people with knee osteoarthritis. Each kilogram of weight lost corresponded, on average, to a fall of about 40.6 N in peak compressive force on the joint, a little more than four times the change in body weight. This is an average relationship in the study group and cannot be used to calculate how much pain will ease for an individual. The result does not contradict the table, because Kutzner measured force relative to body weight, while Messier measured the change in force with a change in weight.

The eighteen-month IDEA trial included 454 people aged at least 55, with a BMI of 27 to 41 and knee osteoarthritis confirmed on X-ray. In the diet and exercise group, participants lost an average of 10.6 kg, or 11.4% of body weight; in the diet-only group 8.9 kg; and in the exercise-only group 1.8 kg. The group combining diet and exercise reported less pain and better function than the other groups. Compressive forces on the knee were lower in the diet groups than in the exercise-only group. The weight-loss target is set individually: a smaller loss may also help, although losing 10% generally helps more than 5%. Exercise is recommended for people with osteoarthritis even when their weight is not falling.

What did the semaglutide trial show in people with knee osteoarthritis?

The STEP 9 trial, published in 2024, included 407 people with obesity and painful moderate knee osteoarthritis; average BMI was 40.3. After 68 weeks of semaglutide 2.4 mg, body weight fell by an average of 13.7%, compared with 3.2% in the placebo group. Pain on the WOMAC scale, which assesses osteoarthritis symptoms, fell by 41.7 points, compared with 27.5 points with placebo. Physical function on the SF-36 quality-of-life questionnaire improved by 12.0 points, compared with 6.5 points. Both groups received nutrition counselling and advice on physical activity, but the trial cannot show how much of the improvement in the placebo group came from that support. Adverse effects led 6.7% of people taking semaglutide and 3.0% of those on placebo to stop treatment. The trial did not show cartilage regrowth. Average results do not guarantee the same effect in every patient and do not automatically apply to other GLP-1 medicines.

How is a weight-loss target set before joint replacement?

Obesity may increase the risk of complications after joint replacement, including infection. An observational study by Spezia and colleagues, published in 2025, assessed 464 operations: 158 in people with a BMI of at least 45 and 306 in people with a BMI of 40 to 44.9. After BMI was reduced below 45, no significant difference in infection risk was found compared with the reference group, but the result was imprecise and does not allow the risk to be regarded as equal. In people with a BMI of at least 45 who did not reduce their BMI before surgery, infection risk was higher. An observational study does not set a BMI threshold that applies in every hospital. In their 2023 guideline, the American rheumatology and hip and knee surgery societies ACR and AAHKS conditionally advise against delaying indicated joint replacement solely to reach a specific BMI. The recommendation concerns people with advanced disease after unsuccessful non-surgical treatment, and the certainty of evidence was rated low. The surgical team agrees the weight-loss target, surgical risk and date of the operation with the patient.

Before anaesthesia or deep sedation, tell the surgical team about the medicine you take, the dose, the date of the last dose and any digestive symptoms. Joint recommendations from several scientific societies in 2024 allow the medicine to be continued in people without increased risk. The dose-escalation period, a high dose and stomach symptoms need further assessment. In that case, the anaesthetist, surgeon and prescribing doctor agree a preparation plan, which may include a liquid diet for at least 24 hours, a stomach ultrasound or a change in the type of anaesthesia. The team also decides when to restart the medicine after any break.

GLP-1 is a gut hormone involved in the body's response to meals, appetite regulation and insulin release. Semaglutide and liraglutide act on the GLP-1 receptor, and tirzepatide on both GIP and GLP-1 receptors. These medicines can bring a feeling of fullness after a smaller portion, reduce appetite and slow stomach emptying. Their modified structure makes them act longer than the natural hormone. Semaglutide and tirzepatide are injected once a week and liraglutide daily, under the skin of the abdomen, thigh or upper arm, following the product instructions. The liraglutide dose is increased at intervals of at least one week. Mounjaro treatment starts at 2.5 mg once a week; after four weeks the dose is increased to 5 mg, and the doctor makes further increases of 2.5 mg, at intervals of at least four weeks, if needed. Maintenance doses of Mounjaro in adults are 5, 10 or 15 mg.

How should trial results in percentages and kilograms be understood?

The STEP 1, SURMOUNT-1 and SCALE trials included adults without diabetes who had obesity, or overweight with weight-related conditions. They differed in population, medicine dose and length of follow-up. In STEP 1, semaglutide 2.4 mg reduced body weight by an average of 14.9% after 68 weeks, and placebo by 2.4%. In SURMOUNT-1, tirzepatide 15 mg reduced body weight by an average of 20.9% after 72 weeks, and placebo by 3.1%. For a starting weight of 116 kg, these percentages would correspond to about 17 and 24 kg. Converting average results shows the size of the effect in the trial, but an individual patient's weight may change differently and over a different period. In the SCALE trial, people taking liraglutide 3 mg lost an average of 8.4 kg after 56 weeks, about 8% of body weight, and those on placebo 2.8 kg. Results from separate trials cannot be compared directly, so they do not rank the effectiveness of the medicines for every person. The doctor assesses the effect and tolerability of the medicine during treatment.

How do we decide on further treatment and possibly stopping the medicine?

In the extended follow-up of the STEP 1 trial, some participants were assessed after semaglutide and the lifestyle programme had ended. Over the following year, they regained on average about two thirds of the weight they had lost, and many metabolic measures moved back towards pre-treatment values. The result shows the risk of weight regain after treatment ends. The trial did not test whether gradually reducing the dose prevents regain. The decision to continue, change or stop the medicine depends on the benefits, adverse effects and the patient's situation. After medication ends, weight, eating habits and health still need monitoring. Renewed weight gain is a reason for an appointment and a review of the treatment plan, and the doctor decides individually whether to restart the medicine.

Obesity treatment uses products including Wegovy, Mounjaro, Saxenda, Mysimba and Xenical; this section discusses these products. Mysimba contains two substances: naltrexone and bupropion. Ozempic, Rybelsus and Victoza have indications for type 2 diabetes, although they contain semaglutide or liraglutide, which are also found in obesity medicines. Indications are set for a product and its dose, so the same active substance may have different indications in different products.

How do the indications of obesity and diabetes medicines differ?

Wegovy and Saxenda are intended for weight management, while Mounjaro has indications both in type 2 diabetes and in weight management. Saxenda is used in adults at doses up to 3 mg a day, and Victoza for diabetes at doses up to 1.8 mg. Ozempic and Rybelsus are not indicated for obesity. Using a medicine outside its indications requires a separate decision by the doctor and does not give a right to reimbursement. The European Medicines Agency has also authorised a 7.2 mg injectable dose of Wegovy for adults with a starting BMI of at least 30 after at least four weeks on 2.4 mg, as well as an oral form for adults. The availability of these forms in Polish pharmacies needs to be checked separately.

What does the monthly cost of medication depend on?

The reimbursement list effective from 1 July 2026, including its update, does not include Wegovy, Mounjaro, Saxenda, Mysimba or Xenical for obesity treatment, so patients pay the full price. The monthly cost depends on the product, dose and pack size, and the current price is available from the pharmacy. Liraglutide products from other manufacturers may cost differently from Saxenda, and the price of Wegovy at doses up to 2.4 mg does not apply to the 7.2 mg dose or to tablets. The doctor selects the dose individually, and not every patient takes the highest one. Before starting treatment, discuss the expected cost of the medicine over the following months with the doctor; the price of the programme and of additional services is given in the clinic's price list.

When is an oral medicine considered?

Mysimba affects the regulation of appetite and food intake. In the COR-I trial, adults with obesity, or overweight with complications, lost an average of 6.1% of body weight after 56 weeks, compared with 1.3% in the placebo group. The medicine is stopped if weight loss has not reached 5% after 16 weeks. During continued treatment, the doctor assesses the benefits, cardiovascular safety and maintenance of the effect at least once a year. Mysimba is not used in conditions including uncontrolled high blood pressure, seizures, bipolar disorder, anorexia or bulimia, in people taking opioids, or during acute alcohol withdrawal. Emotional eating alone does not qualify someone for this medicine. Xenical is a 120 mg hard capsule containing orlistat. Orlistat acts in the gut and reduces the absorption of about one third of the fat in a meal. In one-year trials, people taking orlistat lost on average about 3 kg more than those on placebo. Unabsorbed fat can cause oily stools, especially after a fatty meal. The doctor considers an oral medicine for a person who meets the indications of that product and has no contraindications.

The doctor checks contraindications and warnings separately for each product. In the SmPC for semaglutide, the contraindication is hypersensitivity to the active substance or any of the excipients. Wegovy should not be used during pregnancy or breastfeeding. It is not recommended in severe gastroparesis, a condition in which the stomach empties very slowly, or in severe kidney or liver impairment. Different rules apply to Mounjaro: data in severe kidney or liver disease are limited and caution is needed, and the doctor decides individually about use during breastfeeding. Semaglutide is stopped at least two months before a planned pregnancy, and tirzepatide at least one month before. After previous pancreatitis, the doctor assesses the risk of treatment with caution. In people taking insulin or sulfonylureas, the doctor may change the doses of these medicines based on blood glucose readings to reduce the risk of hypoglycaemia, meaning low blood sugar. With NSAIDs taken for joint pain, hydration and monitoring of kidney function are particularly important, especially if vomiting occurs.

How long does nausea last, and what eases it?

In the pooled analysis of the STEP 1, 2 and 3 trials, nausea was reported by 43.9% of people taking semaglutide and 16.1% of those on placebo. The median duration of nausea was eight days, meaning that it was shorter for half of the people affected and longer for the other half. Diarrhoea occurred in 29.7% of people treated with semaglutide, vomiting in 24.5% and constipation in 24.2%. In the STEP 1 trial alone, 4.5% of people taking the medicine and 0.8% of those on placebo stopped treatment because of digestive symptoms. Symptoms usually worsen during dose escalation. Smaller portions, eating more slowly and limiting fatty foods can ease nausea, and if tolerability is poor the doctor decides on further dose increases. In trials of semaglutide for obesity, gallstones were reported in 1.6% of treated people, gallbladder inflammation in 0.6% and confirmed acute pancreatitis in about 0.2%. Rapid weight loss may promote the formation of gallstones.

Which symptoms need urgent medical help?

Vomiting that prevents you from keeping fluids down needs urgent medical help the same day. Severe, persistent abdominal pain spreading to the back may indicate acute pancreatitis: stop the medicine and seek urgent medical help. Yellowing of the skin or the whites of the eyes, or a marked fall in urine output, needs prompt medical assessment. Sudden deterioration or loss of vision needs urgent assessment by an eye specialist, including in people without diabetes. A very rare ischaemic injury to the optic nerve, known by the abbreviation NAION, has been reported with semaglutide. With these symptoms, do not wait for a scheduled review or for clinic opening hours. Symptoms that pose an immediate threat to health or life need urgent medical help. Unexplained rapid weight loss should also be discussed with the treating doctor.

How can you reduce the risk of buying a counterfeit medicine?

Buy prescription medicines only from a pharmacy. In a notice of 12 October 2023, Poland's Chief Pharmaceutical Inspector warned about counterfeit injection pens reported in Europe; the notice did not indicate that they were present on the Polish market. Avoid offers from classified ads, auction sites and private sellers. The batch number and two-dimensional code are safety features of the pack, but a patient cannot judge whether a medicine is genuine from the appearance of the code. Clarify any doubts about the pack or the origin of a product with a pharmacist before use.

When a medicine reduces appetite, meals still need to provide protein, vitamins and minerals. A dietitian helps fit meals to the daily routine, other conditions and tolerance of the medicine. A starting point may be a deficit of 500 to 750 kcal a day and 1 to 1.5 g of protein per kilogram of ideal body weight. The dietitian adjusts these values according to actual energy expenditure, nutritional status and other conditions, such as kidney disease. Muscle may be lost along with fat. With a painful knee, the strength of the quadriceps muscle at the front of the thigh matters for walking and joint stability. Vegetables, groats and wholegrain products provide fibre, which helps prevent constipation; the amount is increased gradually according to tolerance. At least 1.5 litres of fluid a day is usually recommended, and a person whose doctor has restricted fluids agrees the amount with that doctor.

Exercise improves function, strength and health even when body weight is not falling. Exercises with resistance bands or body weight help protect muscle, and their scope is adapted to pain and balance. With painful knees, options include straightening the leg while seated, exercises lying down, short walks, cycling or exercise in water. In water, the load on the joint is lower than when walking. A physiotherapist helps choose the type of exercise, its intensity and the bicycle set-up. A person with limited mobility can start with fifteen minutes of activity a day and gradually extend it.

How does a psychodietitian help during obesity treatment?

People may reach for food not only when hungry but also when stressed, after a sleepless night or to ease chronic pain. A medicine can reduce appetite, and a psychodietitian helps identify situations and emotions that prompt eating. Together, the patient and the psychodietitian look at issues such as evening eating after work, long gaps between meals and ways of easing tension without food. Binge eating or other symptoms of mental health disorders may require a consultation with a psychologist or psychiatrist. The scope of cooperation between specialists is set according to the patient's needs.

A gram of pure alcohol provides 7 kcal, and a gram of fat 9 kcal. Half a litre of beer may contain about 250 kcal, depending on the product, and 50 ml of 40% vodka about 110 kcal. Three such beers drunk in one evening can offset much of the planned daily energy deficit. While alcohol is being broken down, the body makes less use of other energy sources, including fat. Alcohol can also raise blood pressure, make eating harder to control and worsen sleep, even if it makes falling asleep easier.

With gout or a raised uric acid level, the doctor discusses alcohol with the patient separately. Beer raises uric acid levels both through the alcohol it contains and through purines, from which uric acid is formed. A gout attack most often affects the big toe but can also occur in the knee. Sudden swelling and redness of a joint need urgent assessment, because infection must be ruled out. Alcohol can worsen nausea, and in people taking insulin or sulfonylureas it increases the risk of hypoglycaemia, including at night. The doctor bases advice on alcohol on how much and how often the patient drinks, liver health, gout and the medicine taken, so the doctor asks about drinking habits.

Drinking beer every day, especially to ease pain or tension, is a reason to talk to a doctor and assess whether dependence is developing. Treatment of a drinking problem and obesity care can run in parallel. The Nasz Gabinet clinic also provides alcohol dependence treatment in Olsztyn and addiction therapy. Naltrexone is also used to treat alcohol dependence, in a different product and dose, whereas Mysimba, which combines naltrexone with bupropion, is not authorised for that indication. With alcohol dependence, the way drinking is stopped needs medical assessment.

Every consultation in the programme takes place online, which makes treatment easier for people with limited mobility. The doctor takes a history, assesses test results and home measurements, and decides whether there is enough information to assess suitability for treatment. If the assessment requires an examination of a joint, the thyroid or the skin, the doctor decides where and how urgently it should be done. Dark, velvety patches of skin in the armpits or groin may suggest insulin resistance but are not enough to diagnose it. At home, blood pressure is measured with a cuff that fits the arm circumference, because a cuff that is too narrow can give a falsely high reading.

The five medical reviews after months 1, 2, 3, 4 and 5 use app data without a call, including while the dose is being increased. The initial and final doctor consultations and the two psychologist consultations take place by video. Tests can be done at a laboratory close to home and the results sent before the consultation. If the doctor finds that medication is appropriate, an e-prescription is issued after the medical assessment. After joint surgery, a remote consultation involves no travel but does not replace orthopaedic reviews.

Under the reimbursement list effective from 1 July 2026, including its update, Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are not reimbursed for obesity treatment. Reimbursement of diabetes medicines has separate criteria that depend on the diagnosis. A primary care (POZ) doctor diagnoses and treats obesity and associated conditions, orders tests within their remit and refers patients to specialists. Coordinated care in POZ and the Moje Zdrowie programme provide certain educational consultations, including advice on diet. Check the scope of these consultations with your own POZ practice, because it does not always include individual dietary treatment.

The NFZ also funds orthopaedic treatment, joint replacement, physiotherapy, rehabilitation and bariatric surgery for people who meet the criteria for these services. Access depends on indications, a referral and the provider delivering the service. A POZ doctor orders tests recommended during a private appointment under the NFZ when they consider them indicated within their remit. Patients pay for private treatment and pharmacy medicines themselves. The obesity treatment programme at Nasz Gabinet costs PLN 1,799 for 6 months, and prices of additional services are listed in the price list. Anyone using private rehabilitation should include it in their budget.

According to the 2025 Polish bariatric consensus, surgery is considered at a BMI of at least 35, including without obesity-related conditions, and at a BMI of 30 to 34.9 if type 2 diabetes remains uncontrolled despite treatment. The 2022 recommendations of the international bariatric societies ASMBS and IFSO had already broadened the indications. Final eligibility is assessed by a bariatric centre, and separate criteria determine whether the NFZ funds the operation. Bariatric surgery and joint replacement are two separate procedures with different purposes.

Referral for a surgical consultation depends on BMI, associated conditions, physical function, nutritional status and previous treatment. More than a year of unsuccessful non-surgical treatment is not a prerequisite. A centre outside the patient's own province can also be chosen. Preparation for surgery may include weight loss, control of diabetes and blood pressure, correction of iron and vitamin D deficiencies, and a psychological consultation. After the operation, long-term care is needed, and the bariatric team sets the supplements and test schedule according to the type of operation. The team also pays attention to bone health and changes in the absorption of some medicines.

If the patient is also waiting for a joint replacement, the surgical teams decide the order of the operations together with the patient. They take into account pain severity, the ability to undergo rehabilitation, surgical risk and the need to improve nutrition. Bring records of previous obesity treatment and your weight measurements to the consultation. Obesity care continues after surgery, although its course changes. If weight rises again, the doctor may consider medication.

People living in Barczewo, Dywity, Olsztynek, Dobre Miasto, Biskupiec, Szczytno, Ostróda, Lidzbark Warmiński and Mrągowo do not need to travel to Olsztyn. Consultations with the doctor and the psychologist are held by video, and blood tests can be done at a laboratory close to home.

After knee or hip surgery, travel and stairs are difficult, and the programme can be followed from home. Consultations take place by video, while the five monthly medical reviews use app data without a call. It helps to plan the date of blood tests around rehabilitation.

In the NFZ treatment waiting-times search checked on 11 September 2026, the metabolic disease clinic category for the Warmian-Masurian province listed one clinic in Olsztyn, which sees patients aged up to 18. For August 2026, the NFZ reported 299 people waiting for that clinic and an average waiting time of 406 days. The average waiting time differs from the date of the next available appointment, which the clinic's registration desk provides. Adults can start obesity treatment under the NFZ with a POZ doctor and, where indicated, use services such as a diabetes clinic. Current dates and eligibility need to be confirmed with the chosen provider.

The list of bariatric centres kept by the Section of Metabolic and Bariatric Surgery of the Polish Society of Surgeons includes centres in Olsztyn, Ełk and Bartoszyce. An entry on the list does not show whether the centre has an NFZ contract or how long the wait is, so eligibility and dates need to be checked directly with the centre. The KOS-BAR pilot programme of care for patients treated with bariatric surgery ended on 30 June 2026, but bariatric operations are still performed under the NFZ. The price of a medicine depends on the product, dose, pharmacy and any entitlement to reimbursement.