Obesity treatment Opole

Obesity has its own code, E66, in the International Classification of Diseases, ICD-10. In its 2024 guidelines, the Polish Society for the Treatment of Obesity describes it as a chronic, relapsing disease requiring ongoing treatment. Patients coming to us for the first time have usually lost weight several times and returned to their starting point several times. After losing fat tissue, the body starts using less energy than would be expected for its new weight, releases more appetite-stimulating ghrelin, and loses leptin, which tells the brain about energy stores, along with the fat. Hunger after a diet is stronger than before it and persists for months.

At the first appointment, we also discuss what the patient cannot feel. Fat tissue accumulating around abdominal organs releases substances that sustain inflammation and reduces tissues' sensitivity to insulin, prompting the pancreas to release more of this hormone. Blood pressure, glucose and triglycerides rise, fat builds up in the liver, and the kidney's glomeruli remain under constant strain. None of these processes hurts. The first clue is usually an abnormal test done for an entirely different reason, sometimes ten years into the disease.

That is why we order tests even for patients who feel well. Feeling well with a BMI of 34 says nothing about the condition of the liver or kidneys.

Several factors beyond the meal plan also affect weight, and we ask about them at the first appointment. Oral glucocorticoids, or anti-inflammatory steroids, some antidepressants and antipsychotics, untreated hypothyroidism, night work and alcohol, whose calories almost nobody counts, all encourage weight gain. We manage treatment as an internal medicine physician manages high blood pressure: over years, with regular monitoring and changes to the plan when it stops working. We explain from the outset that there will be months with no weight loss.

Diagnosis requires body weight, height and a tape measure. A person who is 170 cm tall and weighs 95 kg has a BMI of 32.9, indicating class I obesity under the World Health Organization thresholds of 25, 30, 35 and 40, which apply to both sexes. We do not stop there, because at the same BMI the risk of complications is very different for someone carrying fat on their hips and someone carrying it inside their abdomen.

We therefore measure waist circumference halfway between the lowest rib and the iliac crest, 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 World Health Organization thresholds, 102 cm and 88 cm, mark the point beyond which metabolic complications become more likely. We also take a detailed weight history: weight around age twenty, when it began to rise and by how much, previous treatments, how many kilograms returned and how soon. This conversation takes several minutes and tells us more about the prognosis than the index alone.

BMI is most often misleading in three situations. In someone doing physical work or weight training, a high BMI comes from muscle mass and does not mean disease. After seventy, the opposite can happen: muscle decreases with age, fat increases, and BMI stays normal despite clear abdominal obesity. The third situation is swelling, for example in heart failure or kidney disease with proteinuria, which increases weight without any connection to fat tissue. In the first two situations, waist measurement and history resolve the issue; with swelling, a medical examination and test results are needed.

BMI thresholds at which medication can be prescribed

BMI alone is sufficient from 30. Between 27 and 29.9, medication can be prescribed only if the patient has a condition listed in the summary of product characteristics, the official product information. These include prediabetes and type 2 diabetes, high blood pressure, lipid disorders, obstructive sleep apnoea and cardiovascular disease. Below 27, we do not offer medication under any circumstances, even with a large waist and abnormal test results. Orlistat has its own higher threshold: a BMI of 30, or 28 with additional risk factors.

Age does not rule out treatment, but it determines the choice of medicine. We do not use liraglutide from age 75, and little is known about the other medicines in patients of this age. We assess kidney function separately, because low filtration rules out some products, while naltrexone with bupropion tablets are contraindicated in end-stage kidney failure.

Treatment is provided by internal medicine physicians certified by the Polish Society for the Treatment of Obesity. The first consultation, at our practice at Torowa 16 or by video call, lasts around an hour and costs PLN 250. We start by reviewing medicines and supplements, then measure weight, waist circumference and blood pressure, discuss test results and order missing tests, and finally decide on treatment. Patients with complete results who meet the criteria leave with an e-prescription for a starting dose and a dietitian appointment. We teach injection pen use during the same appointment, in person or on camera, including the rule about rotating injection sites.

We reach the target semaglutide dose over 16 weeks, increasing it four times at 4-week intervals. Tirzepatide has more dosing steps, and reaching the highest takes around 20 weeks. We increase liraglutide weekly, in line with its product information, and discuss the whole schedule in advance at one appointment. For weekly medicines, we meet by video before each dose change: the patient reports weight and blood pressure measured at home, describes tolerance and fluid intake, and the doctor sets the dose and sends the prescription code. We plan physical activity from the first week, initially walking and resistance exercises, because weight falls fastest in the first months, when muscle is most easily lost along with fat. In the fourth month we repeat blood and urine tests.

The assessment takes place around month seven, after three months on the full dose. We check whether weight has fallen by at least 5 percent of the starting value. Product information thresholds vary between medicines, from 4 to 5 percent and from twelve weeks to six months, so we use a common assessment point: three months at the full dose, in line with Polish Society for the Treatment of Obesity recommendations. A result below the threshold means changing the medicine or route of administration and tells us only that this medicine works poorly for this patient.

After this assessment, the dose stays unchanged, remote follow-ups take place every 8 weeks, and in-person appointments once a quarter. Patients treated entirely remotely, usually from outside Opole, receive the same care: home measurements, tests at a local laboratory and an in-person visit only when an examination is needed. After a year, we discuss the next steps: whether to continue medication for another period or start reducing the dose and, if so, how we will recognise the need to return to the full dose.

What we do not do in obesity treatment at Nasz Gabinet Opole

• We do not treat chronic kidney disease or start medicines that slow it, namely SGLT2 inhibitors or blood pressure medicines from the angiotensin receptor blocker and ACE inhibitor classes. A nephrologist or diabetes specialist manages these, while we are responsible for body weight, which influences the disease's progression.
• We do not renew prescriptions for non-steroidal anti-inflammatory drugs, common painkillers such as ibuprofen or diclofenac, taken daily for months. With reduced filtration or dehydration, they put strain on the kidneys, so the treating doctor determines pain treatment and we provide a rehabilitation referral.
• We do not independently manage patients on dialysis or after a kidney transplant. Obesity medication is possible, but the dialysis or transplant centre agrees the plan because it is responsible for immunosuppression and other medication doses.

Before prescribing, we ask for fasting glucose or glycated haemoglobin, a lipid profile, full blood count, liver tests, TSH and creatinine with calculated glomerular filtration rate, labelled eGFR on the results. A GP can order all these tests free of charge, and we accept results from the past three months without repeating them. Glucose and glycated haemoglobin show whether diabetes is already present, which changes both medicine choice and management. Raised liver enzymes suggest fatty liver, which requires ultrasound confirmation; normal results do not rule it out. Raised TSH suggests hypothyroidism, which makes weight loss harder; we confirm the diagnosis by measuring FT4.

Which urine test detects kidney damage before blood tests do

We add one test patients have usually never heard of: the albumin-to-creatinine ratio in a urine sample, abbreviated ACR. It measures albumin, a protein that almost never passes through healthy glomeruli. We always interpret it together with eGFR from the basic panel because the 2024 KDIGO guidelines, the global basis for diagnosing chronic kidney disease, use precisely this pair. Each test detects something different, and filtration can be normal despite markedly increased albumin excretion. A standard urinalysis detects only large quantities of protein, a much later stage.

Beyond the basic panel, we add tests only if they will change the decision. We refer for abdominal ultrasound with raised liver enzymes or suspected gallstones. We suggest an electrocardiogram and cardiology consultation for an irregular pulse, breathlessness or chest pain. We do not order fasting insulin or insulin resistance indices because they do not change management and the result itself can worry patients unnecessarily. We also do not order IgG-based food intolerance tests: allergy societies advise against them, and they usually lead to excluding a dozen or more foods without justification.

We repeat eGFR and ACR in the fourth treatment month and then annually, more often with reduced filtration as described in the next section's table. An incretin medicine, a GLP-1 analogue or tirzepatide, can cause vomiting and diarrhoea; knowing the baseline lets us see immediately after such an episode whether creatinine has returned to its previous value. The product information for naltrexone with bupropion tablets requires eGFR testing before treatment in patients with diabetes and older people; we request it for everyone, regardless of the chosen medicine.

The kidneys of a person with obesity work differently from those of a lean person from the outset. Greater body mass means greater blood flow through the glomeruli and higher pressure inside them, which raises filtration above normal during the first years. This looks good on test results and is therefore misleading; it ultimately causes enlarged glomeruli, progressive scarring and protein leakage into urine. A distinct form diagnosed by biopsy is obesity-related glomerulopathy, damage to the glomeruli caused by obesity itself. In a US study of 6818 kidney biopsies, its share increased from 0.2 percent in 1986-1990 to 2.0 percent in 1996-2000, and patients' average BMI was 41.7.

How the risk of end-stage kidney failure rises with each obesity class

The scale is illustrated by a study of 320,252 adults in a Californian healthcare system, followed for an average of 26 years and linked to a dialysis patient registry. Compared with normal-weight people, the risk of end-stage kidney failure, requiring dialysis or transplantation, was 1.87 times higher with overweight, 3.57 times higher with class I obesity, 6.12 times higher with class II obesity and seven times higher at a BMI of 40 or more. The association remained after accounting for blood pressure and diabetes, meaning obesity harms the kidneys directly, not only through these two diseases. A review of 39 studies involving 630,677 people with normal kidney function at baseline found lower but still unfavourable figures: obesity raised the risk of filtration falling below 60 ml/min/1.73 m² by 28 percent and the risk of albumin appearing in urine by 51 percent.

How we interpret kidney results and what they mean for treatment

Whose kidneys we check most urgently

We issue no first prescription without eGFR and ACR results, and in several groups we treat these tests as especially urgent and use them to determine how quickly to increase the dose. These include people with type 2 diabetes, high blood pressure treated for years, a history of kidney stones or kidney disease in parents or siblings, because some kidney diseases are inherited. The same rule applies to long-term users of non-steroidal painkillers, people with previous acute kidney injury, for example after severe dehydration or a contrast examination, and patients over seventy, whose filtration falls with age alone. We also start these patients at a lower dose and lengthen the intervals between increases.

What weight loss changes in the kidneys

Most is known about semaglutide. In FLOW, involving 3533 patients with type 2 diabetes and chronic kidney disease, 1 mg weekly reduced the risk of dialysis, kidney transplantation, halving of filtration or death from kidney or cardiovascular causes over 3.4 years by 24 percent. The trial stopped early because the interim analysis already showed a clear result. For people without diabetes, evidence comes from the kidney analysis of SELECT, which used semaglutide 2.4 mg for over three years: the same set of events occurred in 1.8 percent of treated patients versus 2.2 percent on placebo, a 22 percent lower risk. In a separate small randomised trial of 101 people with chronic kidney disease and a BMI of 27 or more, semaglutide reduced albumin excretion by 52 percent over 24 weeks. After bariatric surgery, a study following 4322 operated and 30,919 non-operated patients found half the risk of severe kidney events over an average of six years, showing that sustained weight reduction itself accounts for this effect, regardless of how it was achieved.

Which medicines we do not use with impaired kidney function

The poorer the kidney function, the fewer medicines we can use. Semaglutide needs no dose change in mild or moderate impairment, but is not recommended below an eGFR of 30 or in dialysis patients. In line with its product information, we do not use liraglutide below a creatinine clearance, a measure of kidney blood clearance, of 30 ml/min. Tirzepatide alone needs no dose modification even in end-stage failure, although clinical practice data in this group are limited. Oral naltrexone with bupropion is contraindicated in end-stage kidney failure, and its maximum dose falls to two tablets daily in moderate or severe impairment. Orlistat poses a different kidney problem: it increases oxalate excretion, risking stones and crystal deposits in the kidneys in people with chronic kidney disease or dehydration. In June 2026, the US medicines regulator added a kidney damage warning to the labelling of the over-the-counter orlistat dose, which is also available without prescription in Poland.

GLP-1 analogues mimic a gut hormone released after a meal. They slow stomach emptying, prolonging fullness, and act on hunger centres in the hypothalamus, so the patient stops thinking about food between meals. Tirzepatide additionally stimulates a second gut hormone receptor, known as GIP, so it is a dual-action medicine rather than a GLP-1 analogue and produces greater weight loss. None acts as an occasional appetite suppressant. They restore the satiety signal that weakens after each diet, which is why they work for as long as they are taken.

In STEP 1, semaglutide 2.4 mg weekly produced a 14.9 percent weight reduction after 68 weeks versus 2.4 percent in the placebo group; both groups followed a lifestyle change programme. In SURMOUNT-1, tirzepatide produced a reduction of 15 to 20.9 percent after 72 weeks, depending on dose. Daily liraglutide produces a smaller result, around 8 percent, and remains in use mainly where a weekly product is unavailable or poorly tolerated.

How many kilograms the trial percentages represent

We convert trial percentages into kilograms with the patient, because a percentage and a kilogram mean different things to them. At 95 kg, semaglutide produces around 14 kg of loss over 68 weeks, and tirzepatide 14 to 20 kg over 72 weeks, of which around 2 kg comes from dietary change alone, as that was the loss in the group without medication. Results vary widely in both directions: some patients lose much more, while around one in seven participants in this trial did not reach the 5 percent threshold, and we change the medicine for such patients. That is why we assess effectiveness only after three months at the full dose.

Can medication be stopped without regaining weight?

A year after stopping medication and ending care, STEP 1 participants had regained two thirds of the lost weight, while blood glucose, blood pressure and lipids returned to pretreatment values. Medication can be stopped, but gradually, after a period of stable weight, while maintaining follow-ups, an eating plan and resistance training. If weight rises again, we restart treatment instead of waiting for all the weight to return. This matters additionally in kidney disease, because regaining weight means renewed strain on the glomeruli.

Five products licensed for obesity treatment are available in Polish pharmacies. None is reimbursed for this indication, so patients pay the full price. Wegovy contains semaglutide, given weekly in increasing doses up to 2.4 mg. Mounjaro contains tirzepatide, also weekly, up to 15 mg. Saxenda contains daily liraglutide. Mysimba is naltrexone with bupropion in tablets, while Xenical contains orlistat, which inhibits absorption of some dietary fat.

Ozempic and Rybelsus contain the same substance as Wegovy but are licensed for type 2 diabetes, not obesity, and are reimbursed for patients with diabetes for that indication. If a patient asks about a product outside this list, we check the medicinal products register before suggesting anything; some such products have no marketing authorisation in Poland. Cheaper equivalents are unavailable except for orlistat because the other substances are patent-protected.

The cost of a month's treatment at an Opole pharmacy

Monthly semaglutide costs range from PLN 550 to 890 and tirzepatide from PLN 800 to 1900. Full-dose liraglutide costs PLN 500 to 1250 monthly, naltrexone with bupropion tablets PLN 370 to 600, and orlistat PLN 160 to 350. These prices were checked in September 2026; they differ between pharmacies and change over time, and for each product patients pay the top of the range only at the target dose. We advise caution when seeking the cheapest offer: counterfeit semaglutide was detected in several European countries in 2023, including Poland and legally operating pharmacies. The liquid in counterfeit pens contained insulin, which can cause severe hypoglycaemia in a person without diabetes.

Who we offer an oral product to

We use tablets in two situations: when patients do not agree to injections, and when stomach symptoms after a GLP-1 analogue prove intolerable. Naltrexone with bupropion reduces the pleasure of eating, and we consider it for patients who eat in response to tension, but it has a long list of contraindications: epilepsy, uncontrolled high blood pressure, opioid use and end-stage kidney failure. Orlistat has the weakest effect and requires a reduced-fat diet, otherwise it causes fatty diarrhoea. It also reduces absorption of vitamins A, D, E and K, and in kidney disease carries the additional risk of oxalate stones.

Pregnancy is an absolute contraindication to semaglutide; breastfeeding and plans for pregnancy soon also rule out treatment. We recommend effective contraception during treatment for women of childbearing age and stopping the medicine at least two months before planned conception. We also do not initiate it ourselves after acute pancreatitis or with a family history of medullary thyroid cancer or multiple endocrine neoplasia type 2. The latter two precautions come from the US semaglutide labelling; the European product information does not list them, and we take greater care here. Gallbladder disease, diabetic retinopathy during insulin treatment and chronic kidney disease require caution. Kidney disease does not rule out treatment but changes the choice of medicine and testing frequency.

In the first weeks, symptoms mainly affect the stomach and intestines. Nausea occurs in nearly half of patients; vomiting and diarrhoea are less common. Most symptoms settle within a few weeks, and slower dose increases ease them. Constipation affects around one person in four. Gallstones are a rarer complication and occur more often with rapid weight loss. With severe vomiting or diarrhoea, we ask patients to contact us before the next dose, because dehydration accounts for most cases of worsening kidney function during treatment, and the product information for all three injectable medicines warns about it.

We review the medication list separately because several doses need changing when treatment starts. Insulin and sulfonylureas used with a GLP-1 analogue risk hypoglycaemia, and their doses usually need reducing, as determined by the diabetes specialist. Blood pressure medicines often become too strong after a loss of a dozen or more kilograms, so we collect home readings and write to the treating doctor suggesting an adjustment. For women taking oral contraception who start tirzepatide, we also recommend a barrier method for four weeks after starting and after each dose increase, because delayed stomach emptying can reduce pill absorption.

Warning signs for which we ask patients to contact us without waiting for a follow-up

Severe belt-like abdominal pain radiating to the back, especially with vomiting, can indicate acute pancreatitis. Sudden pain under the right rib cage with fever or yellowing of the skin points to gallbladder disease. Two kidney-related symptoms concern us: a substantial fall in urine output and increasing swelling of the feet and lower legs, particularly after several days of vomiting or diarrhoea. Severe belt-like abdominal pain with vomiting, complete absence of urine or impaired consciousness means going to an emergency department without waiting to contact us. For the other symptoms listed, we ask patients to call that same day and, outside practice hours, to attend the out-of-hours and holiday healthcare service.

The medicine reduces hunger but does not decide what the patient eats when they finally sit down at the table. The dietitian designs meals around working hours and preferences, with a daily deficit of 500 to 750 kcal calculated from actual requirements. A larger deficit produces faster early weight loss but at the cost of muscle, nutritional deficiencies and poorer tolerance, leaving no long-term benefit. We monitor protein separately, at 1 to 1.5 g per kilogram of ideal weight, meaning the weight corresponding to a BMI of around 25, calculated by the dietitian at the appointment. This amount applies to patients with normal kidney results; in diagnosed kidney disease, the nephrologist sets protein intake. We spread protein across all meals because reduced appetite makes it especially easy to eat too little of it.

How much fluid and salt when the kidneys are under strain

When kidney results are abnormal, we set fluid and salt intake differently from usual. We ask patients to drink around two litres daily unless their nephrologist advises otherwise and, on days with vomiting, diarrhoea or hot weather, in small portions but no less than usual. Dehydration during incretin treatment is the quickest way to worsen filtration. We ask patients not to exceed 5 g of salt a day, one level teaspoon, including salt hidden in bread and processed meats, because lower blood pressure means less glomerular strain. We do not use high-protein diets, popular in online weight-loss plans, at all in kidney disease. With a history of oxalate stones, we additionally limit oxalate-rich foods, particularly spinach, rhubarb and nuts.

We plan activity around the patient's current weight. At a BMI above 35, walking and a stationary bike put much less strain on joints than running, and swimming the least, because the body weighs less in water. The eventual recommendation is 150 minutes of moderately intense exercise weekly and two resistance sessions to protect muscle during weight loss. We return to running only below a BMI of 30, which for most patients means losing a dozen or more kilograms. Someone who has not exercised starts by measuring their current steps and adds a thousand steps each week; everyone has this number on their phone and shows it at follow-ups.

What a specialist in the psychology of eating does and when we suggest this support

We involve a specialist in the psychology of eating when food serves a purpose beyond nourishment. This includes evening overeating without physical hunger, eating after an argument or a pressured working day, loss of control while eating and shame afterwards. Extreme diets in the past are also common, as is treating every day as a test in which one unplanned meal cancels out a week's work. Work with the specialist involves recognising situations that trigger overeating and preparing another response. If binge eating disorder is suspected, we refer to a psychotherapist because simply cutting calories worsens these episodes.

Alcohol makes obesity treatment harder for several reasons. It begins with calories nobody records in their diary: half a litre of beer provides 200 to 250 kcal and a glass of wine around 120 kcal, so an evening with four beers cancels out the deficit from one and a half to two days. Alcohol also weakens control over eating, often adding a second dinner. It worsens medication side effects, including nausea and stomach irritation, and with delayed stomach emptying discomfort lasts longer than usual.

Alcohol causes additional harm in kidney disease. It has a diuretic effect, while regular drinking raises blood pressure, the main cause of glomerular damage. Drinking in the evening after a day of vomiting worsens dehydration. We do not require abstinence or judge anyone for drinking. We do ask for the real weekly number of servings, each defined as 10 g of pure alcohol, approximately 250 ml of beer, 100 ml of wine or 30 ml of vodka. This number determines whether the planned rate of weight loss is achievable at all.

Sometimes a conversation about weight turns to drinking, revealing that the problem is alcohol itself rather than its calories. We do not avoid the subject: while drinking continues, obesity treatment has little chance of success. We then suggest addiction treatment first and weight reduction afterwards. At the same practice, we provide alcohol addiction treatment in Opole and addiction therapy, so patients do not need to seek help elsewhere and tell their whole story again.

The first consultation can take place remotely, and some patients start this way, especially those with a complete set of recent tests. The doctor reviews results, takes a history, assesses contraindications and issues an e-prescription, while the patient supplies their own weight, waist circumference and blood pressure readings. We need a morning bathroom-scale weight after using the toilet, plus two blood pressure readings one to two minutes apart, taken after five minutes of sitting quietly.

We ask patients to attend Torowa 16 when home measurements are unreliable, because a self-measured waist can differ by several centimetres from a measurement taken by staff. We also ask them to attend if we suspect a condition requiring palpation or examination with a stethoscope, such as swelling, skin changes in folds or an abnormal heart rhythm, or if an injection pen demonstration on camera is not enough.

A video consultation costs the same as an in-person appointment and ends with the same decision: a prescription or a refusal to prescribe.

In practice, the first year consists of five in-person appointments, the initial consultation and four quarterly visits, with video follow-ups between them every 4 weeks during dose escalation and every 8 weeks afterwards. Remote follow-ups cover tolerance, blood pressure and weight, which patients record weekly at home so we see the trend rather than one measurement before the visit. Patients provide blood and urine samples at the laboratory nearest home and send results before the consultation.

Public health insurance covers less in obesity than patients expect. A GP orders the tests we request before treatment free of charge, including creatinine and urinalysis; the albumin-to-creatinine ratio is not always within their funded scope and may need to be paid for, costing a dozen or so zlotys. Insured people aged 35 to 65 without diagnosed cardiovascular disease, diabetes or chronic kidney disease are entitled to a cardiovascular prevention programme once every five years: measurements, lipid profile, glucose and risk assessment at their own primary care doctor without referral. Since 2025, an adult health assessment under the Moje Zdrowie programme has also been available from age 20.

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

Primary care practices have been able to provide coordinated care since 2022. One pathway is nephrology: the GP orders a broader panel of tests, discusses results with a specialist and manages early kidney disease without sending the patient to an outpatient specialist clinic, although relatively few practices currently offer this. There is no separate coordinated pathway for obesity alone, though obesity is a risk factor qualifying patients for preventive tests.

No medication is reimbursed for obesity treatment. Semaglutide is reimbursed only for type 2 diabetes when the listed criteria are met; it cannot be prescribed at a reimbursed price to someone without diabetes. Bariatric surgery after assessment at a centre is publicly funded, as is treatment of complications, including dialysis, one of the most expensive procedures in the system. Public funding thus covers obesity complications and surgery, while medication remains entirely the patient's responsibility.

We suggest surgical referral in two situations. The first is a BMI of 40 or more when non-surgical treatment over a dozen or more months has not produced a lasting result. The second is a BMI of 35 or more with a weight-related illness, especially type 2 diabetes, sleep apnoea or severe high blood pressure. In 2022, the international federation of metabolic surgery societies and the US society lowered eligibility thresholds, allowing surgery from a BMI of 35 regardless of associated diseases and from 30 with metabolic disease, including type 2 diabetes poorly controlled despite treatment. We refer according to thresholds accepted by Polish surgical centres because they determine eligibility for publicly funded operations.

In kidney disease, surgery has an additional purpose: sustained weight reduction relieves glomerular strain for longer than medication alone generally achieves. In advanced kidney failure, surgery can be a condition for joining a transplant waiting list because transplant centres use upper BMI limits. The dialysis centre and surgeon then make the decision, while we prepare the patient and care for them between consultations.

Many months usually pass between referral and surgery, and we do not waste them. We manage weight reduction because a smaller liver and less visceral fat make surgery easier, and centres often require documented loss before admission. We also monitor kidney results and blood pressure, which determine anaesthetic eligibility.

Preparation includes internal medicine, psychological and dietary assessments, and after surgery lifelong treatment begins: vitamin and mineral supplements, follow-ups and a diet with a different structure. After several years, some patients return to medication as part of the weight returns. Before any general anaesthetic, including for a procedure unrelated to obesity, the anaesthetist must know about the incretin medicine because delayed stomach emptying changes preoperative fasting rules, and some anaesthesiology societies recommend skipping the weekly dose before planned anaesthesia. The decision belongs to the anaesthetist, so we ask patients to contact us as soon as they receive a surgery date.

Our practice at Torowa 16 sees patients from across the province and neighbouring districts. Patients come from Krapkowice, Strzelce Opolskie, Kędzierzyn-Koźle, Brzeg, Nysa, Kluczbork, Namysłów, Prudnik, Głubczyce and Olesno. We schedule the first appointment and four quarterly checks in person and provide the rest remotely, making five journeys a year.

The rest of treatment happens closer to home. Patients provide blood and urine samples at a local laboratory, fill prescriptions at any pharmacy and attend remote follow-ups in the afternoon to avoid work conflicts. For shift workers, we adapt appointments to the rota, which we ask about when booking. We mainly request tests a GP can provide free; if a test outside their scope is needed, we discuss the cost before suggesting it.

We advise allowing extra time for the first journey, because the appointment lasts around an hour and a substantial delay usually means rescheduling.

The province has one NFZ metabolic disease clinic, and appointments there or at endocrinology or diabetes clinics require a referral and a wait. No referral is needed with us, and we can usually book an initial appointment within a few days, including for patients from outside Opole.

The Opole province has one NFZ metabolic disease clinic, in Opole. It does not publish waiting list numbers or waiting times in the NFZ treatment availability directory, so patients ask reception about appointments and need a GP referral. Patients from Nysa, Kędzierzyn-Koźle or Brzeg travel just as far to it as to us. Outside the province, the nearest alternatives are two clinics in Wrocław, where average waits in July and August 2026 were 139 and 250 days, and a clinic in Gliwice with a 74-day wait and 120 people waiting. A patient with type 2 diabetes can also attend a diabetes clinic, which treats obesity alongside diabetes.

A patient from Opole therefore chooses between a referral and an appointment at the region's only clinic and private treatment without referral; the pharmacy medicine costs the same through either route.