Obesity treatment Opole

Obesity has the code E66 in the International Classification of Diseases, ICD-10. The Polish Society for the Treatment of Obesity describes it as a chronic, relapsing disease in its 2024 guidelines. After weight loss, appetite and energy expenditure can change, which makes a lower weight harder to maintain. Leptin, a hormone that signals energy stores to the brain, falls as fat tissue is lost, but hunger and fullness signals change to a different extent in different people. This is why obesity treatment often requires long-term care.

How does obesity develop and what promotes it?

In obesity the body stores more fat tissue than is safe for health. The disease develops when, over months and years, meals and drinks provide more energy than a person uses. Fat cells store the surplus and first increase in volume, and with longer weight gain new cells are added. Fat stored around the abdominal organs is the most harmful, because it releases substances that sustain chronic inflammation and reduces the tissues' sensitivity to insulin.

Obesity usually develops from several causes. Twin studies indicate that 40 to 70 percent of the differences in body weight between people depend on genes, and obesity often affects several members of one family. A genetic tendency leads to weight gain when high-calorie food is easy to get and work and commuting are done sitting down. Short sleep, chronic stress, night work, pregnancy, menopause, quitting smoking and alcohol also promote weight gain. Oral glucocorticoids, used among other things after a kidney transplant, and some antidepressants and antipsychotics can also increase body weight. An underactive thyroid contributes to weight gain as well, although it usually does not explain all of the obesity. We ask about all these factors at the initial consultation.

Why get tested if I have no symptoms?

Tests can detect some complications of obesity before symptoms appear. Obesity increases the risk of conditions including type 2 diabetes, high blood pressure, fatty liver and chronic kidney disease. A higher risk does not mean that everyone with obesity will develop all of these conditions.

Feeling well, including with a BMI of 34, does not replace a health assessment. The doctor decides which tests are needed based on the medical history and measurements.

What if my weight stops falling?

Long-term treatment includes periods without weight loss; the doctor then assesses whether the treatment plan needs to change. That is why at the initial consultation we discuss previous attempts to lose weight and how weight changed after they ended. The weekly weight measurements that the patient records in the app also help with this assessment.

BMI is calculated from weight and height. Someone who is 170 cm tall and weighs 95 kg has a BMI of 32.9, which is class I obesity under the WHO classification. In adults, overweight starts at a BMI of 25 and the obesity classes start at 30, 35 and 40. The index does not show where fat is stored, and it does not cover every risk factor.

The waist is measured halfway between the lowest rib and the top of the hip bone, after a normal breath out. For people of European ancestry, the International Diabetes Federation uses thresholds of 94 cm in men and 80 cm in women. The higher WHO thresholds, 102 cm and 88 cm, indicate a clearly increased risk of metabolic complications. We also ask when weight began to increase, which treatments the patient has already tried and how weight changed after they ended.

With high muscle mass, BMI can overestimate body fat, but the type of work someone does does not settle the diagnosis. In older people, BMI can stay in the normal range despite abdominal obesity because muscle is lost with age. Swelling, for example in heart failure or kidney disease, increases weight without any gain in fat. The doctor therefore considers waist circumference, the medical history and relevant test results.

When can obesity medication be started?

In adults, the standard indications for Wegovy, Mounjaro, Saxenda and Mysimba include a BMI ≥30, or a BMI ≥27 with a weight-related condition. Depending on the product, these conditions include abnormal blood glucose, high blood pressure, lipid disorders or obstructive sleep apnoea. Xenical has a threshold of BMI ≥30, or >28 with risk factors. Meeting the threshold does not guarantee a prescription: the doctor checks the chosen product's indications, contraindications and interactions with other medicines.

Age also affects the choice of medicine. Saxenda is not recommended from the age of 75. Mysimba is not recommended over the age of 75 and requires caution over 65. Data on Wegovy and Mounjaro in people aged 85 and over are limited. Age does not set one dose-reduction schedule for all medicines. Kidney function is assessed separately because Mysimba is contraindicated in end-stage kidney failure.

Obesity treatment at Nasz Gabinet is a six-month online programme for PLN 1,799. Medicines are not included in this price; the patient buys them at a pharmacy with an e-prescription. At the initial consultation the doctor asks about previous treatment, illnesses, medicines and supplements. The patient measures weight, waist circumference and blood pressure at home beforehand and prepares test results. After reviewing the medical history and the results, the doctor decides whether the patient can be treated in the programme. The doctor also agrees a treatment plan, including possible medication and the need for dietary advice. For an injectable medicine, the doctor explains how to use the pen and rotate injection sites.

The price of the programme 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 patient books the consultations in the Nasz Gabinet app. Dates in the schedule are counted from the initial consultation.

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

The doctor issues an e-prescription after each such review. The patient enters their weight in the app every week and their body measurements every month. After each injection, a photo of the pen is taken for the medical team. The doctor knows these results before the check-up. The Polish Society for the Treatment of Obesity (PTLO) recommends that treatment last at least a year, which is why we offer a continuation package once the programme ends. It costs PLN 350 for 3 months and includes an e-prescription every month after a medical review, without video consultations.

Doses are increased in line with the summary of product characteristics (SmPC), the official information for each product, and according to tolerance. In the Wegovy schedule, the 2.4 mg dose is reached after 16 weeks, but the current SmPC also describes a higher maintenance dose. Mounjaro starts at 2.5 mg once weekly, and after four weeks the dose is increased to 5 mg. Further increases of 2.5 mg, at intervals of at least four weeks, depend on need; adult maintenance doses are 5, 10 and 15 mg. The Saxenda dose is increased at intervals of at least one week. The highest dose is not the goal for every patient.

We assess effectiveness and tolerance according to the rules described for each product. In adults, Mysimba is stopped if weight has not fallen by at least 5% after 16 weeks of treatment. For Xenical, the same threshold is checked 12 weeks after starting treatment, and for Saxenda after 12 weeks on the 3 mg dose. Check-ups also cover blood pressure, eating, physical activity and symptoms that may indicate dehydration.

The doctor sets the timing of follow-up tests individually, and the patient has them done at a laboratory closer to home. Treatment does not end automatically after the programme or after a year. The doctor decides whether to continue the medicine based on its benefits, tolerance and the plan for maintaining the result.

How do we account for kidney disease and other medicines?

• Obesity treatment needs to be coordinated with existing treatment for chronic kidney disease (CKD). Decisions about SGLT2 inhibitors, angiotensin receptor blockers and ACE inhibitors in CKD are made by the doctor responsible for kidney care, who can also be a primary care (POZ) doctor. Patients do not change these medicines themselves.
• The medication review includes non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac. With daily use, reduced kidney filtration or dehydration, the doctor assesses kidney safety particularly carefully. Pain treatment and any rehabilitation are chosen according to the cause of the pain.
• For people on dialysis or after a kidney transplant, the obesity treatment plan must be agreed with the centre that provides dialysis or post-transplant care. That centre also assesses immunosuppressive treatment and the need to monitor other medicines.

Have the test results you already hold ready for the initial consultation. There is no need to arrange a full panel of tests yourself before the consultation. Useful tests for assessing obesity include fasting glucose or glycated haemoglobin, a lipid profile and creatinine with eGFR, an estimate of kidney filtration. The doctor orders a full blood count, liver tests, TSH and further tests when indicated. A glucose or glycated haemoglobin result can diagnose diabetes and affects the choice of treatment. Abnormal liver tests or TSH may require further investigation, such as an abdominal ultrasound or FT4; a single result does not explain the cause of an abnormality.

Why do we check urine albumin alongside eGFR?

ACR is the albumin-to-creatinine ratio in a urine sample. The test detects increased albumin excretion, which can occur even when eGFR is normal. The two results describe different aspects of kidney function, so KDIGO 2024 guidelines assess them together. A standard urinalysis does not replace a quantitative albumin measurement.

An abdominal ultrasound may be needed if liver disease or gallstones are suspected. An irregular pulse, breathlessness or chest pain requires medical assessment and further investigation. Fasting insulin and insulin resistance indices are not routinely needed to assess eligibility for obesity treatment, although the doctor may order them for other reasons. IgG food intolerance tests have no role in planning a diet.

Whether a result is still current depends on changes in health and medication. A creatinine result from three months ago does not describe kidney function after an episode of dehydration. The doctor sets how often eGFR and ACR are checked according to risk and previous results. Mysimba's SmPC requires an eGFR assessment before treatment in people at increased risk of kidney impairment, particularly older people and people with diabetes. A primary care doctor orders NFZ-funded tests when they are indicated and fall within the scope of that doctor's services; a recommendation from a private consultation does not guarantee that the whole set will be free.

Obesity can increase blood flow and pressure in the glomeruli, the kidney's filtering units. Excessive filtration, or hyperfiltration, is one possible mechanism of kidney damage, but it does not lead to kidney disease in everyone with obesity. Obesity-related glomerulopathy is a form of glomerular damage diagnosed by kidney biopsy. In a US study of 6818 biopsies, its share rose from 0.2% in 1986-1990 to 2.0% in 1996-2000, and patients' average BMI was 41.7. These data come from biopsy studies and do not describe how common the disease is among people living in Opole.

How was BMI associated with the risk of end-stage kidney failure in a study?

In a cohort of 320,252 adults from California followed for an average of 26 years, the risk of end-stage kidney failure, meaning the need for dialysis or a transplant, was compared with that of people with a normal weight. The relative risk was 1.87 with overweight, 3.57 with class I obesity, 6.12 with class II obesity and 7.07 with a BMI ≥40. The association remained after accounting for selected other factors, including blood pressure and diabetes. As an observational study, however, it does not prove that obesity alone causes kidney failure.

A meta-analysis of 39 cohorts, including 630,677 people with normal kidney function at the start of follow-up, found that obesity was associated with a higher risk of eGFR falling below 60 ml/min/1.73 m² (RR 1.28) and of developing albuminuria (RR 1.51). These are relative increases in risk of 28% and 51%. Results varied between studies, and the meta-analysis figures do not predict the outcome for an individual patient.

How do we interpret kidney results, and what do they mean for treatment?

A diagnosis of chronic kidney disease requires changes lasting at least three months. A new abnormal result is still assessed without waiting for that period to pass. The doctor decides whether urgent investigation, a repeat test or a comparison with earlier results is needed.

Who needs particular attention to kidney function?

Kidney function needs careful monitoring in people with type 2 diabetes, high blood pressure, kidney stones or a family history of kidney disease, as well as in people taking NSAIDs long term and patients who have had acute kidney injury, for example after severe dehydration. Age is one risk factor, but it does not by itself mean a CKD diagnosis. A past contrast examination does not automatically mean kidney damage either. The doctor chooses the product and the pace of dose increases according to kidney function, tolerance and the SmPC; there is no single reduced starting dose for the whole at-risk group.

What do studies show about obesity treatment and kidney protection?

The FLOW trial included 3533 people with type 2 diabetes and CKD. In people taking semaglutide 1 mg once weekly, the risk of a composite endpoint was 24% lower in relative terms than with placebo, over a median follow-up of 3.4 years. The endpoint included kidney failure (dialysis, transplantation or sustained eGFR <15), a sustained eGFR decline of at least 50%, and death from kidney or cardiovascular causes. The 24% applies to the whole composite endpoint and does not mean the same reduction in the risk of each event. The trial was stopped early, after a planned interim analysis.

The kidney analysis of the SELECT trial involved people with overweight or obesity, established cardiovascular disease and no diabetes. It assessed a different composite endpoint, which also included persistent macroalbuminuria; cardiovascular death was not one of its components. An endpoint event occurred in 1.8% of people receiving semaglutide 2.4 mg and 2.2% of people receiving placebo, with a hazard ratio (HR) of 0.78. The absolute difference was 0.4 percentage points and the relative risk reduction was 22%. The benefit came mainly from changes in macroalbuminuria and sustained eGFR decline of at least 50%; the result does not mean 22% fewer people needed dialysis.

In a separate randomised trial of 101 people with CKD, a BMI ≥27 and no diabetes, semaglutide reduced the urine albumin-to-creatinine ratio (UACR) by 52.1% compared with placebo after 24 weeks. In the treated group itself, the fall from baseline was about 48.6%. The trial measured albumin excretion and did not assess whether dialysis or deaths decreased.

In a bariatric cohort, 4322 people who had surgery were compared with 30,919 people who did not, followed for an average of 6.1 years. Surgery was associated with a lower risk of a composite kidney outcome: the HR was 0.47 in people with diabetes and 0.52 in people without diabetes. This observational study cannot establish how much of the benefit came from weight loss and does not directly compare surgery with modern medication.

How does kidney function affect the choice of medicine?

Wegovy needs no dose change in mild or moderate kidney impairment, but it is not recommended at eGFR <30 ml/min/1.73 m². Saxenda is not recommended at a creatinine clearance <30 ml/min. Mounjaro needs no dose adjustment even in end-stage kidney failure, but experience in this group is limited and treatment requires caution. Mysimba is contraindicated in end-stage kidney failure, and in moderate or severe impairment its maximum dose is two tablets a day. These rules apply to the products named and their indications, so they are not automatically transferred to other semaglutide medicines.

Orlistat can increase oxalate excretion in the urine and lead to oxalate nephropathy, a build-up of crystals in the kidneys. This risk needs particular attention in CKD and dehydration. In June 2026, the US Food and Drug Administration (FDA) added a warning to the labelling of orlistat 60 mg sold without a prescription in the USA, after reviewing 12 reports from 2007-2023. The reports cannot show how often this complication occurs. The European SmPC for Xenical also describes the kidney risk.

GLP-1 and GIP are gut hormones involved in the body's response to a meal. Semaglutide and liraglutide act on the GLP-1 receptor, and tirzepatide on the GIP and GLP-1 receptors. These medicines affect appetite and fullness and slow stomach emptying. They can make it easier to eat smaller portions, but the strength of this effect varies between patients.

In the STEP 1 trial, adults with overweight or obesity without diabetes who took semaglutide 2.4 mg once weekly lost an average of 14.9% of their body weight after 68 weeks, compared with 2.4% in the placebo group. Both groups received support with lifestyle changes. In the SURMOUNT-1 trial, also in people without diabetes, tirzepatide produced an average weight loss of 15% to 20.9% after 72 weeks, depending on the dose, compared with 3.1% in the placebo group. In the SCALE trial, liraglutide 3 mg daily produced a loss of about 8% after 56 weeks, compared with 2.6% in the placebo group. The trials were conducted separately, so their results are not a direct comparison of the products.

How many kilograms do the trial percentages represent?

For a starting weight of 95 kg, the average STEP 1 result corresponds to about 14.2 kg, and the SURMOUNT-1 results to about 14.3-19.9 kg. The placebo group averages would correspond to about 2.3 kg and 2.9 kg respectively. This is an arithmetic conversion of average group results. It does not predict weight loss for an individual, and it does not separate the effect of diet from the effect of the medicine. Individual results vary, and the timing of assessments and decisions about further treatment depend on the product.

Can medication be stopped without regaining weight?

Weight can rise again after the medicine is stopped. In the STEP 1 extension, the subgroup studied regained an average of about two-thirds of the weight lost within a year of stopping treatment, and some of the metabolic benefits were reversed. Participants had stopped both the medicine and the lifestyle programme at that point. The finding does not prove that tapering the dose according to a particular schedule prevents weight regain. The doctor decides whether to continue or end treatment after assessing its benefits, tolerance and the further plan, which covers eating, activity and follow-ups. If weight rises again, the doctor discusses further treatment with the patient, particularly when the patient has kidney disease.

This page discusses five products used in obesity treatment: Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. The list does not include every medicine on the market. Wegovy contains semaglutide, Mounjaro tirzepatide and Saxenda liraglutide. Wegovy and Mounjaro injections are given once a week, and Saxenda daily. Mysimba is a tablet containing naltrexone and bupropion. Xenical is a capsule containing 120 mg of orlistat, which reduces the absorption of some dietary fat.

Current Wegovy documentation also describes a 7.2 mg dose for adults with a starting BMI ≥30, used if needed after at least four weeks on 2.4 mg, as well as an oral form. Authorisation does not mean that a particular dose or form is available in Polish pharmacies. Ozempic and Rybelsus also contain semaglutide, but they are indicated for type 2 diabetes; they are not authorised for obesity treatment. Any reimbursement conditions are checked for the particular product and patient.

What determines the cost of a medicine at the pharmacy?

The price depends on the prescribed product, the dose and the pack size. To compare costs, check how many doses or capsules a pack contains and how long it lasts; four weeks is not always a full month. Prices differ between pharmacies and change over time, and the monthly cost of treatment can also change after a dose change. You pay for the medicine separately, on top of the price of the treatment programme.

Buy medicines only from a legally operating pharmacy. In 2023, warnings were issued about falsified Ozempic pens in the European medicine distribution chain. In an announcement of 19 October, Poland's Chief Pharmaceutical Inspectorate reported at the time that no such pens had been detected in Poland.

Who might be offered an oral medicine?

The doctor may consider tablets or capsules for people who do not want injections and for people who did not tolerate previous treatment well. Mysimba acts on appetite and reward mechanisms but does not replace treatment for eating disorders. Its contraindications include current or past seizures, uncontrolled high blood pressure, opioid use, abrupt alcohol withdrawal and end-stage kidney failure. Orlistat can cause oily stools, particularly after a fatty meal, and reduce the absorption of vitamins A, D, E and K. When choosing orlistat, the doctor also considers the risk of oxalate stones and oxalate nephropathy.

Semaglutide is not used in pregnancy and should be stopped at least two months before a planned conception; tirzepatide should be stopped at least one month beforehand. Women of childbearing age discuss effective contraception during treatment with the doctor. Wegovy and Saxenda are not used during breastfeeding, while the current Mounjaro SmPC allows an individual assessment. Previous pancreatitis requires caution and a doctor's assessment before a medicine is chosen. Tell the doctor about medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN2) in you or your family. The US labelling for semaglutide lists these conditions as contraindications, but the European SmPC does not; the doctor takes this information into account when choosing a medicine.

The doctor takes gallbladder disease, diabetic retinopathy and CKD into account in the treatment plan. Nausea, vomiting, diarrhoea and constipation are possible side effects, and how often they occur varies between products. Symptoms may ease over time; if they get worse, the doctor reviews the dose and further treatment. Vomiting and diarrhoea can lead to dehydration and a decline in kidney function.

The doctor assesses whether doses of insulin, sulfonylureas or blood pressure medicines need to change. Insulin and sulfonylureas taken together with semaglutide, liraglutide or tirzepatide increase the risk of low blood sugar, and weight loss can lower blood pressure, so home glucose and blood pressure readings are helpful. Do not change the doses of other medicines yourself. Women using oral contraception should discuss with the doctor what to do in case of vomiting or diarrhoea and, with tirzepatide, whether an additional method of contraception is needed at the start of treatment and after a dose increase.

Symptoms requiring an urgent consultation or medical help

Severe abdominal pain spreading to the back, particularly with vomiting, can be a sign of acute pancreatitis. Do not take the next dose; this symptom requires urgent medical help. Severe abdominal pain with vomiting, passing no urine at all or impaired consciousness also require urgent medical help, without waiting to contact the practice. Sudden loss or marked worsening of vision while taking semaglutide requires an urgent medical assessment.

Pain under the right ribs with fever or yellowing of the skin, persistent vomiting or diarrhoea, difficulty drinking, markedly less urine or increasing swelling require urgent contact with a doctor. Do not wait for a routine follow-up with these symptoms. Outside the practice's opening hours, use the out-of-hours medical service. Decide about the next dose and other medicines together with a doctor.

A smaller appetite while taking a medicine does not replace a nutrition plan. The diet is matched to the patient's health, working hours and ability to maintain changes. A deficit of 500-750 kcal a day can be a reference point, but its size is set individually. An overly restrictive plan can contribute to nutritional deficiencies and muscle loss, so the nutrition plan takes meal composition and treatment tolerance into account.

With normal kidney function, an approximate protein intake is 1-1.5 g per kilogram of reference body weight and needs to be adjusted to the patient. In this calculation, reference body weight is simplified to the weight corresponding to a BMI of about 25; a dietitian may use a different method. With CKD, protein intake is set with a nephrologist, taking into account the stage of the disease, nutritional status and dialysis. Spreading protein across all meals can make it easier to eat enough when appetite is reduced.

How much fluid and salt with kidney disease?

Fluid intake is set individually, especially with CKD, heart failure or a prescribed fluid restriction. Persistent vomiting or diarrhoea requires contact with a doctor, and being unable to drink or passing markedly less urine requires an urgent medical assessment. Limiting salt to about 5 g a day applies to the whole diet, including salt in bread and processed meat. With kidney disease, do not start a high-protein diet without agreeing it with a doctor. With oxalate kidney stones, advice about foods such as spinach, rhubarb and nuts depends on test results and the whole diet.

The type of activity and how quickly it increases are matched to fitness, pain and coexisting conditions. With joint pain, walking, a stationary bike or exercise in water may be easier. An approximate goal is 150 minutes of moderate activity a week and resistance exercise twice a week, adapted to the patient's abilities. BMI alone does not decide whether someone can run. A person who has not exercised so far starts at their current activity level and increases it gradually.

What does a psychodietitian do, and when do we suggest this support?

A psychodietitian (a dietitian trained in the psychology of eating) helps with problems such as eating under stress, overeating in the evening, feeling out of control around food and shame after a meal. Together with the patient, the specialist identifies situations that trigger these difficulties and works on different responses to them. Suspected binge-eating disorder requires assessment by an appropriate specialist and treatment, such as psychotherapy; support from a psychodietitian alone does not replace that treatment. Restrictive diets can make binge eating worse. The six-month programme includes two online consultations with a psychologist. Dietitian and psychodietitian consultations are not included.

Alcohol supplies energy that needs to be included in the diet's energy balance. Half a litre of beer contains about 200-250 kcal and a glass of wine about 120 kcal, depending on the serving size and type of drink. Four beers therefore provide about 800-1000 kcal. Alcohol can also make it harder to control how much you eat and can worsen stomach symptoms, although reactions differ between people.

With kidney disease, blood pressure and hydration are particularly important. Alcohol has a diuretic effect, and regular or heavy drinking can raise blood pressure. Drinking alcohol during vomiting or diarrhoea increases the risk of dehydration. Tell the doctor how much alcohol you actually drink; a 10 g unit of pure alcohol is roughly 250 ml of beer, 100 ml of wine or 30 ml of vodka, depending on the strength of the drink. This information helps the doctor choose safe treatment, especially when considering Mysimba.

If drinking suggests dependence, the obesity treatment plan is coordinated with the assessment and treatment of dependence, with the patient's safety in mind. A person with alcohol dependence should not stop drinking suddenly without a medical assessment. Drinking alcohol does not in itself mean that weight loss will fail. You can read about addiction treatment at Nasz Gabinet on our pages about alcohol addiction treatment in Opole and addiction therapy.

The initial and final doctor consultations and the two psychologist consultations take place by video. The five monthly medical reviews use the data in the app and do not involve a call. During a video consultation, the doctor takes a medical history, reviews results and plans treatment, including considering medication after an eligibility assessment. Prepare home measurements of weight, waist circumference and blood pressure. Weight is best measured under similar conditions, in the morning after using the toilet. Measure blood pressure after five minutes of sitting quietly, twice, one to two minutes apart.

Describe any swelling, skin changes or an irregular heartbeat to the doctor at the consultation. Home measurements help with the assessment but do not replace every examination. After the initial consultation the patient receives a plan for further care, which can include additional tests, changes to eating, a specialist consultation or medication.

There is no need to travel to Opole for treatment. Blood and urine tests can be done at a laboratory closer to home, with the results sent before the consultation. The measurements recorded in the app show the doctor how treatment is progressing between consultations.

Primary care (POZ) can be the first place for an assessment. A family doctor orders NFZ-funded tests when they are indicated and fall within the scope of that doctor's services. A list of tests from a private consultation does not guarantee that the whole set, including ACR, will be free. Ask your primary care practice or laboratory whether a particular test is available and what it may cost.

The cardiovascular disease prevention programme (CHUK) is intended for people aged 35 to 65 who meet the programme's conditions, including having no diagnosed cardiovascular disease, diabetes or CKD. It covers a risk assessment, measurements and selected tests; previous participation in other prevention programmes also matters. The Moje Zdrowie programme, available from the age of 20, includes an adult health check and may include educational advice on diet. The primary care practice decides on eligibility for the programme and on appointment dates.

What is the nephrology pathway in coordinated care, and does it include obesity?

In a primary care practice that provides the relevant coordinated care services, the doctor can extend CKD investigations and obtain a nephrologist's advice. The primary care doctor can also start and adjust CKD treatment as part of this care. Coordinated care has no separate pathway for obesity alone. Free educational advice on nutrition is still possible in the Moje Zdrowie programme, although it does not mean full individual dietary therapy in every practice.

According to the reimbursement list in force from 1 July 2026 and its update, Wegovy, Mounjaro, Saxenda, Mysimba and Xenical were not reimbursed for obesity treatment. Reimbursement of a medicine in diabetes depends on the indications and conditions set out in the list for the particular product. The NFZ does fund treatment of coexisting diseases and bariatric surgery after eligibility assessment at a surgical centre. The private obesity treatment programme at Nasz Gabinet costs PLN 1,799 for 6 months; the cost of medicines and tests needs to be added separately.

The 2025 Polish bariatric consensus considers a BMI ≥35 an indication for surgery, regardless of overt obesity-related diseases. At a BMI of 30-34.9, surgery can be considered, for example, in people with type 2 diabetes that remains poorly controlled despite treatment. Speaking to a surgeon does not require months of unsuccessful medication first. Clinical criteria, funding for surgery and individual eligibility are separate matters, and the surgical centre decides on the operation.

In appropriately selected patients, surgery can improve the kidney outlook. However, the observational study described above does not prove that surgery protects the kidneys for longer than modern medicines. With advanced CKD or preparation for a kidney transplant, the surgeon needs to work with the nephrologist and the transplant centre. BMI can matter in transplant eligibility, but bariatric surgery is not a universal condition for joining the waiting list.

The scope of preparation for surgery and the expected weight loss before the operation depend on the centre. Preparation includes internal medicine, dietary and psychological assessments and, with CKD, an assessment of kidney function and other treatment. Waiting times for surgery need to be checked with the chosen centre.

After surgery, long-term follow-ups, appropriate nutrition and vitamin and mineral supplements are needed, matched to the type of operation and test results. Some patients need medication again when weight returns. Before general anaesthesia or deep sedation, tell the procedural team well in advance that you take semaglutide, liraglutide or tirzepatide. These medicines slow stomach emptying, so the team sets the preparation, fasting rules and any dosing changes individually. Do not stop the medicine yourself.

We also run the online programme for residents of Krapkowice, Strzelce Opolskie, Kędzierzyn-Koźle, Brzeg, Nysa, Kluczbork, Namysłów, Prudnik, Głubczyce and Olesno. The doctor and psychologist consultations take place by video, so the distance from Opole does not change the course of treatment. The five monthly medical reviews use app data without a call.

Blood and urine tests can be done closer to home, and prescriptions can be dispensed at a pharmacy of your choice. Check available consultation times in the Nasz Gabinet app, taking your work schedule into account. NFZ-funded tests require an indication and the appropriate scope of primary care services; check the cost of other tests with the laboratory before having them.

Before the initial consultation, prepare your medical records and a list of the medicines you take.

NFZ-funded care can include primary care and clinics relevant to the diagnosed conditions, such as a diabetes or nephrology clinic. The next section describes the availability of metabolic disease clinics and their admission conditions.

In September 2026, the NFZ directory of treatment waiting times listed one metabolic disease clinic for stable cases in the Opole province. This clinic is in Opole and treats obesity. According to data for August 2026, 55 people were waiting for it, and the average waiting period was 289 days. The directory did not give a first available appointment or the age of patients accepted. An average waiting period is not an appointment date offered to a new patient, so available dates, referral requirements and admission conditions need to be confirmed with the clinic's reception.

In neighbouring provinces, the directory listed for this category a clinic in Wrocław with 366 people waiting and an average waiting period of 250 days, and a clinic in Gliwice with 120 people waiting and an average waiting period of 74 days, among others, based on data for August 2026. No patient age range was given for either clinic. The second Wrocław clinic in this category accepts patients aged 0-18, so it is not a treatment option for an adult from Opole. The metabolic disease clinic category does not cover every route to NFZ-funded obesity treatment: primary care and clinics for coexisting diseases are also involved in care. The cost of a medicine depends on the product, dose, pharmacy and any reimbursed indication.