Obesity treatment Poznań

Obesity has the ICD-10 code E66 and, according to the Polish Society for the Treatment of Obesity guidelines from 2024, is a chronic disease that does not resolve on its own and returns when treatment is interrupted. Obesity involves both fat tissue and the brain. Leptin from fat tissue and GLP-1 released by the gut after a meal reach the hypothalamus, the part of the brain responsible for hunger and fullness. In a healthy person, both suppress appetite. In someone with obesity, the hypothalamus stops responding to leptin, so despite abundant fat stores it sends out hunger signals, and after every diet it lowers the metabolic rate and raises levels of ghrelin, the hunger hormone. A patient who has lost 10 kg through dieting then faces stronger hunger than before the diet and a body that burns fewer calories, until the weight returns.

The reward system is also involved: the same system on which alcohol and nicotine act. Sweet and fatty food releases dopamine in this system, and people seek that reward more often when stressed, feeling low or after a sleepless night. Cortisol, the stress hormone, also encourages fat to accumulate inside the abdomen, where it does the most harm. For some patients, obesity therefore starts at a moment they remember clearly: after an episode of depression, starting psychiatric medication, losing a job or years of shift work.

At Nasz Gabinet Poznań we treat obesity in adults in the same way as high blood pressure or diabetes: over years, with follow-ups and a change of medicine when it stops working. The doctor diagnoses the disease and assesses eligibility for medication, the dietitian plans meals, and the specialist in the psychology of eating addresses emotional eating, which medication does not resolve. Additional treatment considerations apply to patients who have gained weight on psychiatric medication or have depression.

Diagnosis begins with BMI, which is body weight in kilograms divided by height in metres squared. A man who is 178 cm tall and weighs 98 kg has a BMI of 31, indicating class I obesity. PTLO uses the WHO thresholds: overweight from 25, class I obesity from 30, class II from 35 and class III from 40. The second measurement is waist circumference. From 80 cm in women and 94 cm in men, we diagnose abdominal obesity according to International Diabetes Federation criteria, regardless of BMI. Fat accumulated around the liver and intestines releases inflammatory substances and leads to diabetes and heart disease more quickly than fat under the skin.

The third area we ask about in detail is weight history: how much the patient weighed at age 20, when they began gaining weight, how many kilograms they gained in the first year after starting an antidepressant or antipsychotic, and whether weight gain began after depression, pregnancy, stopping smoking or moving into sedentary work. Someone who gained 10 kg in six months after starting medication prescribed by a psychiatrist needs different treatment from someone who gained weight slowly over 20 years. We also ask about binge eating, because PTLO recommends screening everyone with obesity for eating disorders and depression.

Which BMI and waist measurements qualify patients for treatment at our practice on ul. Górki

At a BMI of 30 or more, the BMI alone is sufficient. At a BMI of 27 or more, there must also be a complication already caused by obesity: high blood pressure, prediabetes or type 2 diabetes, lipid disorders, fatty liver, sleep apnoea or pain in weight-bearing joints. Someone with a BMI between 25 and 27 qualifies if their waist measurement exceeds the abdominal obesity threshold and blood tests show insulin resistance. A patient gaining weight on psychiatric medication usually meets one of these conditions sooner than others, but receives obesity medication only after consultation with the doctor managing their psychiatric treatment. Obesity medicine is not a separate medical specialty; an obesity physician is a doctor with PTLO certification, and at Nasz Gabinet Poznań obesity is treated by internal medicine physicians who also routinely care for patients with addictions and mood disorders.

The first medical appointment, at the practice or online, costs PLN 250 and lasts longer than a standard internal medicine consultation because half the time is spent taking a history. The doctor asks about weight changes, all medicines and their doses, sleep, mood, binge eating, alcohol, family illnesses and the outcomes of previous weight-loss attempts. They then weigh the patient, measure height, waist circumference and blood pressure, review test results and order any missing tests. Patients with all the results who meet the criteria leave with an e-prescription for the lowest dose, a dietitian appointment and instructions for their first injection. Patients gaining weight on psychiatric medication also receive a letter for the doctor who prescribed it.

Follow-ups take place every 4 weeks, matching the schedule for increasing semaglutide and tirzepatide doses. The doctor asks about nausea, constipation, fluid intake, mood and sleep, checks the rate of weight loss and issues a prescription for the next month. After 3 months, the patient repeats blood tests and attends the practice for measurements. After six months, we check whether they have lost at least 5 percent of their starting weight, the threshold PTLO recognises as evidence of effectiveness. After a year, we decide whether the medicine will continue indefinitely or whether to start gradually reducing the dose. At every follow-up, we additionally ask patients with depression or taking psychiatric medication about their mood, as recommended by the summary of product characteristics for naltrexone with bupropion; mood can also deteriorate during weight loss for reasons unrelated to the medicine.

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

• We do not stop psychiatric medicines or change their doses. If olanzapine, mirtazapine or another psychiatric medicine is responsible for weight gain, our doctor describes the situation in a letter to the psychiatrist and leaves the decision about an alternative to them.
• We do not start obesity treatment during alcohol or benzodiazepine withdrawal. Naltrexone with bupropion is contraindicated then, and vomiting and dehydration from a GLP-1 analogue would compound withdrawal symptoms; the patient completes detoxification first and starts obesity treatment once their condition is stable.
• We do not see patients under 18. Children and adolescents with obesity are treated in paediatric clinics, and a regional government programme has also been running in Wielkopolska since September 2025.

Before the first prescription, we need fasting glucose and glycated haemoglobin, a lipid profile, ALT and AST liver tests, creatinine with calculated eGFR, TSH, uric acid and a full blood count. Glycated haemoglobin shows average blood sugar over the past 3 months, making it better at distinguishing prediabetes from diabetes than a single glucose measurement. eGFR shows how effectively the kidneys filter blood, and this figure determines which medicine can be given. TSH rules out hypothyroidism, liver tests show whether fat has damaged the liver, and the lipid profile measures cholesterol and triglycerides. In a patient taking an antipsychotic, we repeat the lipid profile and glucose even if they have recent results, because clozapine and olanzapine raise blood sugar and triglycerides independently of weight. We accept results up to six months old from a clinic or routine health checks without repeating them; the patient has any missing tests done at a laboratory of their choice and sends us a photograph.

The medication list matters to us as much as the blood results. We ask patients to bring the packaging or photographs of the packaging for everything they take, including non-prescription products and supplements. We check doses, how long they have been taking them and who prescribed them, because we choose obesity medication to minimise interactions with their existing treatment. Bupropion, a component of the obesity medicine combining naltrexone and bupropion, interacts with many psychiatric medicines.

When we write to a psychiatrist or endocrinologist before starting obesity medication

Before diagnosing primary obesity, we rule out three groups of causes. The first is hormonal disease. We confirm hypothyroidism by measuring FT4 after an elevated TSH result and treat it first. Rare Cushing's syndrome, with excess cortisol, is recognised by a rounded face, purple stretch marks and high blood pressure in a young person. The second is non-psychiatric medication: steroids, insulin, sulfonylureas, which are older diabetes tablets, and some anti-epileptic medicines. The third, most common in our practice, is psychiatric medication. In each case, the doctor writes to the specialist managing the patient, states how many kilograms were gained over how many months and asks about a medicine with less effect on weight. PTLO recommends switching to such a medicine if the patient's condition allows, leaving the decision to the doctor familiar with the underlying illness. We start obesity treatment immediately or wait for the specialist's response, depending on how long the patient can wait.

Obesity increases the risk of depression, and depression increases the risk of obesity. In a meta-analysis of 15 studies following people over years, people with obesity had a 55 percent higher risk of developing depression, while those with depression had a 58 percent higher risk of obesity. Untreated depression, particularly atypical depression with excessive sleepiness and increased appetite, itself causes weight gain. PTLO lists it among the causes of weight gain and recommends that doctors treating obesity check the patient's mood at every appointment and use a screening scale, such as the Beck Depression Inventory, if depression is suspected. At Nasz Gabinet Poznań we assess mood at the first appointment and every follow-up. Patients with symptoms of depression are referred to a psychiatrist, and we then treat obesity alongside depression.

The second issue is medication: many psychiatric medicines increase appetite and body weight, yet patients are often simply told to eat less. The table below shows which cause the most weight gain, based on two large meta-analyses: a 2020 network analysis of 100 trials involving 25,952 patients with schizophrenia and a 2010 review of 116 antidepressant studies.

What we do when a patient gains weight on psychiatric medication they cannot stop

Some patients have to continue olanzapine or clozapine because only these medicines keep their mental illness under control. PTLO advises that such patients receive a medicine licensed for obesity treatment as well as dietary care. Liraglutide has been studied most extensively in this group: in a Danish trial from 2017, 103 patients with schizophrenia taking clozapine or olanzapine, with overweight or obesity and prediabetes, were randomly assigned to liraglutide or placebo for 16 weeks. Treated patients lost 5.3 kg more than the placebo group, and 63.8 percent regained normal glucose tolerance, compared with 16 percent on placebo. Psychotic symptoms did not worsen. Semaglutide and tirzepatide have so far been investigated in this group only in initial, smaller studies; they work in the same way, and we use them in agreement with the psychiatrist. Another option patients ask about is metformin: in a meta-analysis of 20 studies involving 1070 patients, it reduced antipsychotic-related weight gain by an average of 3.3 kg. Metformin is not licensed for this indication, so the psychiatrist or diabetes specialist decides whether to introduce it, and we send that doctor the test results.

When obesity medication alone is not enough for binge eating

Binge eating disorder is diagnosed when, at least once a week for 3 months, a patient eats substantially more in a short period than most people would in that time, feels unable to stop and does not vomit or fast after the episode. In a US population study of 9282 people, the disorder occurred during the lifetime of 3.5 percent of women and 2 percent of men, more often than bulimia and anorexia combined, and was most strongly associated with class III obesity. Most affected people had never received treatment. A GLP-1 analogue reduces hunger between episodes in this group but does not treat the episodes themselves, which are triggered by tension, loneliness or an overly restrictive diet during the day. According to the British NICE guidelines, the first-choice treatment is cognitive behavioural therapy focused on eating disorders, initially as guided self-help using a manual with therapist support and, if that does not work, as individual therapy. No medicine is licensed for this disorder in the European Union; lisdexamfetamine is licensed for it in the United States, while in Poland it is licensed only for ADHD. Three specialists care for a patient with binge eating: the doctor manages obesity medication and tests, the specialist in the psychology of eating works on meal patterns, and the psychotherapist treats the episodes themselves. We do not give naltrexone with bupropion to anyone ever diagnosed with bulimia or anorexia, because the product information prohibits it.

Do obesity medicines worsen mood or cause suicidal thoughts?

For GLP-1 analogues, no. Following reports from Iceland, the European Medicines Agency reviewed semaglutide, liraglutide, dulaglutide, exenatide and lixisenatide over 9 months and concluded in April 2024 that available data did not indicate a causal link between these medicines and suicidal thoughts or self-harm. Naltrexone with bupropion is different. Bupropion is an antidepressant, and the product information warns that antidepressants increase the risk of suicidal behaviour in people under 25 and recommends close observation at the start of treatment and after every dose change. The medicine is contraindicated in people with a history of bipolar disorder, epilepsy or previous seizures, and during alcohol or benzodiazepine withdrawal. For depression, we suggest a GLP-1 analogue or, if this is contraindicated, orlistat; we consider naltrexone with bupropion only once the treating psychiatrist confirms that there are no contraindications and that they will monitor the patient. Whatever the medicine, we ask the patient or a family member to call us if insomnia, irritability or a sudden drop in mood develops during weight loss.

Obesity medication is offered to patients meeting the eligibility criteria described above and to those who have not lost 5 percent of their weight after 3 to 6 months of working with a dietitian; PTLO recommends adding medication at that point rather than cutting calories further. Five medicines are licensed for obesity treatment in Poland: semaglutide, tirzepatide, liraglutide, the combination of naltrexone and bupropion, and orlistat. The first three are GLP-1 analogues, copies of a hormone released by the gut after a meal. The medicine slows stomach emptying, so fullness after eating lasts longer. It also strengthens the satiety signal in the hypothalamus, and the patient stops thinking about food constantly. Tirzepatide additionally stimulates the receptor for another gut hormone, GIP, and produces greater weight loss. Semaglutide and tirzepatide are injected once a week and liraglutide daily, while the dose is increased every 4 weeks because the stomach needs to adjust to working more slowly.

What percentage of body weight patients lose in the first year and how we recognise that the medicine is not working

In the STEP 1 trial, participants taking semaglutide 2.4 mg lost an average of 14.9 percent after 68 weeks, compared with 2.4 percent in the placebo group. On tirzepatide 15 mg, SURMOUNT-1 participants lost 20.9 percent after 72 weeks, compared with 3.1 percent on placebo. Liraglutide 3 mg in the SCALE trial reduced weight by 8.4 kg after 56 weeks, compared with 2.8 kg in the placebo group. A patient weighing 98 kg can therefore expect a reduction of around 15 kg on semaglutide and around 20 kg on tirzepatide, although each trial included people who lost twice as much and others who lost almost nothing. After 3 months at the target dose, we check whether the patient has lost 5 percent of their weight; if not, we change the medicine, most often from semaglutide to tirzepatide. Around week 60, weight loss stops because the smaller portions provide as much energy as the body uses each day; the medicine still works, but now maintains the new weight rather than reducing it.

How we withdraw medication once weight has stabilised

STEP 1 participants who stopped receiving the medicine and dietary care after the trial regained two thirds of their lost weight within a year, and their blood pressure and blood sugar rose again. We therefore plan withdrawal as a separate stage: we reduce the dose gradually once weight is stable, with a meal plan and an exercise plan in place, and monitor the patient for several months after the last injection. For someone gaining weight on psychiatric medication they must continue taking, stopping obesity medication usually makes little sense because the cause of weight gain remains; they stay on the lowest effective dose for as long as psychiatric treatment continues.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are licensed for obesity treatment. Ozempic, Rybelsus and Victoza are licensed only for type 2 diabetes, although they contain the same active substances as Wegovy and Saxenda. What a medicine may be prescribed for is determined by the indication in its summary of product characteristics, not by the substance alone.

Ozempic and Wegovy contain the same semaglutide, but only one may be prescribed for obesity

Semaglutide in doses up to 2 mg is called Ozempic, and in tablet form Rybelsus; both are licensed for type 2 diabetes. Under the name Wegovy, the same semaglutide at doses up to 2.4 mg was studied in obesity in the STEP 1 trial. Saxenda is liraglutide 3 mg for obesity; at doses up to 1.8 mg the same medicine is called Victoza and treats diabetes. Tirzepatide, as Mounjaro, is licensed for both diseases. A person without diabetes receiving Ozempic is taking it outside its licensed indication and at a dose that has not been studied in obesity; if the prescription was reimbursed, the NFZ can ask the doctor to repay the reimbursement. Ozempic has appeared on Poland's list of medicines at risk of shortages, so dispensing a pack to someone without diabetes meant that it was unavailable to someone who needed it to control their blood sugar. For patients without diabetes, we prescribe a product licensed for obesity treatment.

Monthly treatment costs, from orlistat to tirzepatide

The patient pays for the medicine because the NFZ does not reimburse any of these five products for obesity treatment. Xenical is the cheapest: according to pharmacy prices from September 2026, a month of treatment costs around PLN 160 to 350. Mysimba costs around PLN 370 to 600, Wegovy around PLN 550 to 890, Saxenda around PLN 500 to 1250, and Mounjaro around PLN 800 to 1900. The wide range for Saxenda reflects the availability of cheaper liraglutide alternatives alongside the original product. In each range, the lower amount refers to starting doses in the first weeks and the higher amount to the target dose reached after several months. Prices for the same pack vary by several dozen zlotys between pharmacies, so it is worth comparing several Poznań pharmacies or an online price comparison site before filling the e-prescription.

When we choose Mysimba or Xenical instead of an injection

Mysimba, or naltrexone with bupropion, acts on the brain's reward system and satiety centre; in the COR-I trial, participants lost 6.1 percent after 56 weeks, compared with 1.3 percent in the placebo group. The product information requires stopping it if weight has not fallen by 5 percent after 16 weeks. Many contraindications concern nervous system disorders; we describe these in the section on depression and psychiatric medication. We also do not use it in uncontrolled high blood pressure, in people taking opioids or in severe liver disease. Xenical, or orlistat, binds around one third of the fat from a meal in the intestine; patients lose 2 to 3 kg more over a year than on placebo, but a fatty meal causes oily stools that can be difficult to control. We choose tablets when a GLP-1 analogue is contraindicated, poorly tolerated or the patient does not accept injections; for patients taking psychiatric medication, orlistat has the advantage of not acting in the brain or interacting with these medicines.

The most common symptoms affect the digestive tract: nausea, vomiting, diarrhoea or constipation occur in more than one patient in ten, usually in the week after a dose increase, and ease as the body adjusts. In STEP 1, 4.5 percent of participants stopped treatment because of them. Smaller portions and avoiding fatty dishes on injection day help, along with a glass of water between meals and vegetables at every meal for constipation. Patients who tolerate a new dose poorly stay on the previous dose longer; anyone vomiting for more than a day despite drinking should call us that same day because of the risk of dehydration. Patients taking psychiatric medication need to be especially careful: vomiting and diarrhoea alter absorption of oral medicines, and lithium levels can rise, which matters because lithium has a narrow safety margin.

Contraindications to GLP-1 analogues and naltrexone with bupropion

GLP-1 analogues are not given during pregnancy or breastfeeding; a woman planning pregnancy stops semaglutide at least 2 months before conception and tirzepatide at least one month before. We do not start treatment after pancreatitis, with a family history of medullary thyroid cancer or in heart failure with breathlessness at rest. We do not give liraglutide when kidney function is poor (eGFR below 30 ml/min) or after age 75; little is known about semaglutide and tirzepatide in these circumstances, so we decide individually. A woman taking the contraceptive pill who starts tirzepatide also uses condoms for 4 weeks after the first dose and for 4 weeks after every dose increase because pill absorption is reduced during these periods. For patients taking insulin or a sulfonylurea, we reduce their doses from the first injection to prevent hypoglycaemia. We do not give naltrexone with bupropion in epilepsy, uncontrolled high blood pressure, bipolar disorder, previous bulimia or anorexia, during alcohol or benzodiazepine withdrawal, with opioid treatment or in severe liver or kidney failure; in trials, seizures occurred in 2 of 3239 treated patients and in none receiving placebo.

Which symptoms mean a patient needs to see a doctor that day

Severe upper abdominal pain radiating to the back, with vomiting, can indicate pancreatitis. Pain under the right ribs with fever or yellowing of the skin can indicate gallstones. In semaglutide trials, 1.6 percent of treated patients had gallstones, more often those losing weight rapidly. Anyone whose vision suddenly worsens in one eye should see an ophthalmologist urgently: in 2025 the European Medicines Agency added ischaemic optic nerve damage to semaglutide's product information as a very rare adverse effect. A patient on insulin who feels faint, sweats and has shaking hands should eat something sugary and call us so that we can reduce the doses. Someone receiving psychiatric care who develops insomnia, agitation or thoughts of death during weight loss should report this to their psychiatrist and to us that same day.

How we know a medicine from a pharmacy is authentic, unlike an injection pen bought online

A medicine from a pharmacy has undergone batch testing and carries a number the pharmacy checks in the European verification system before dispensing. Nobody has checked a pen sold through an advertisement. In October 2023, Poland's Chief Pharmaceutical Inspectorate withdrew a counterfeit batch of a semaglutide medicine from the Polish market; that same month in Austria, several people were hospitalised with severe hypoglycaemia after using counterfeit pens containing insulin instead of semaglutide. Vials sold online as research peptides are not medicines, and nobody checks their contents or sterility. Our patients buy medicines only on an e-prescription from a pharmacy, and only the doctor changes the dose.

The dietitian starts with protein because patients eat small portions on medication and, without a plan, lose muscle along with fat. They calculate 1 to 1.5 g of protein per kilogram of ideal body weight, divide it between three or four meals and translate that into food: 85 g of cooked chicken breast provides 28 g of protein, 100 g of semi-fat twaróg cheese 18 g, and 250 ml of plain yoghurt 13 g. They set an energy deficit of 500 to 750 kcal a day, in line with PTLO guidance, and ensure the patient does not eat even less, because starving while taking medication leads to muscle loss and dizziness. For patients on antipsychotics, they also set regular mealtimes, as some of these medicines stimulate appetite in the evening and at night, and monitor sugary drinks that patients with medication-related dry mouth may reach for automatically. Exercise is intended to protect muscle, not burn calories: 150 to 300 minutes of walking, cycling or swimming a week according to WHO recommendations, plus two or three strength sessions with a day off between them; anyone with painful knees starts with swimming and resistance bands.

How stress eating differs from a binge eating episode

The specialist in the psychology of eating addresses eating that medication has not stopped: a packet of biscuits after an argument, sandwiches at midnight after a night shift, or snacking in front of a screen after a day without regular meals. A GLP-1 analogue suppresses physical hunger, but the habit of turning to food when tense remains, and after stopping the medicine it can cause weight regain. The specialist helps patients recognise the moment they begin reaching for food and decide in advance what to do instead of opening the fridge: go outside for ten minutes or have their planned dinner earlier. Stress eating differs from a binge episode in that the person controls how much they eat and stops when they notice what they are doing. When a patient describes being unable to stop, eating quickly and in secret and feeling ashamed afterwards, the specialist refers them to a psychotherapist, because this indicates an eating disorder that changing a meal plan does not treat. Appointments with the dietitian and the specialist in the psychology of eating take place at the practice or online.

A patient who drinks faces three problems during obesity treatment. The first is calories: a gram of alcohol provides 7 kcal, more than a gram of sugar, without creating fullness, so two large beers, around 450 kcal, cancel out almost the entire daily deficit agreed with the dietitian, while a bottle of wine with dinner adds around 600 kcal. The second involves the liver, which burns alcohol first and fat only several hours later, together with reduced control over eating after a few drinks. The third comes from the medicine itself: a GLP-1 analogue slows stomach emptying, delaying alcohol absorption, so the patient may not realise how much they have drunk until they stand up from the table, while nausea gets worse. Hypoglycaemia becomes more likely in someone on insulin and can easily be mistaken for intoxication. During weeks when the dose is increased, we ask patients not to drink at all; afterwards, we ask them to have no more than one serving a day, approximately 250 ml of beer or 100 ml of wine.

Naltrexone, a component of the obesity medicine containing bupropion, is the same substance we use in alcohol addiction treatment, where it reduces the pleasure of drinking. The obesity medicine contains less of it, and its product information recommends keeping alcohol to a minimum because alcohol combined with bupropion increases the risk of seizures and psychiatric disturbances. In people who drink heavily, the medicine is contraindicated during withdrawal. Semaglutide has also been studied in people with alcohol dependence or harmful drinking: in a phase two trial published in JAMA Psychiatry in 2025, 48 people received semaglutide or placebo for 9 weeks, and those on semaglutide experienced less alcohol craving and drank less on drinking days. The group was too small and the duration too short to justify prescribing semaglutide for addiction. For patients who drink daily or cannot stop, we offer alcohol addiction treatment in Poznań at the same practice, and for other substances, addiction therapy; we begin obesity treatment once withdrawal symptoms have resolved and continue it alongside therapy.

The first appointment takes place at our practice at ul. Górki 17A in Poznań because the doctor wants to weigh the patient on scales suitable for a high body weight, measure waist circumference and blood pressure, examine the abdomen and inspect skin folds for the dark patches typical of insulin resistance. Patients who cannot travel book their first appointment online: they send results and their own weight, waist and blood pressure measurements beforehand, and the doctor assesses whether an in-person examination is still needed before the first prescription. Monthly follow-ups are video calls: the patient reports weight and blood pressure readings from recent weeks, explains how they tolerate the medicine, how much they drink and how they sleep, and the doctor sets the dose and sends the e-prescription code by text message. Every 3 months, once new blood results are available, the patient attends the practice for measurements. Anyone reporting a sudden deterioration in mood at a follow-up is offered an in-person appointment that same week; patients who struggle with video calls attend in person or have someone close help them connect.

Under the NFZ, patients do not pay for a GP appointment, basic blood tests, a referred consultation at a metabolic disease clinic or bariatric surgery if they meet the criteria. As of September 2026, nine metabolic disease clinics operate under the NFZ in Wielkopolska: three for adults and one for children in Poznań, plus one each in Konin, Leszno, Jarocin, Koło and Kępno. All require a GP referral. Semaglutide is reimbursed only for type 2 diabetes in patients meeting the criteria on the reimbursement list, while a person without diabetes pays the full pharmacy price regardless of who wrote the prescription. Free dietary advice at a practice providing coordinated care is available only for listed diseases, including diabetes, high blood pressure and hypothyroidism, but not obesity alone. Patients receiving psychiatric care can attend an NFZ mental health clinic without a referral, but that clinic does not treat obesity and the metabolic clinic does not change psychiatric medicines; patients carry information between the two themselves.

Our first medical appointment costs PLN 250, whether in person or online; patients pay for follow-ups and appointments with the dietitian and specialist in the psychology of eating according to the price list, and buy the medicine at full price from a pharmacy. No referral or waiting list is required; throughout the year of treatment the patient speaks to the same doctor, and we write the letter to their treating psychiatrist.

We refer patients for surgery at a BMI of 40 or more, or 35 or more if obesity has caused type 2 diabetes, high blood pressure, sleep apnoea or another illness, and only after documented non-surgical treatment with diet, exercise and medication. International metabolic surgery societies lowered the thresholds in 2022 to 35 without complications and 30 with diabetes, but in Poland eligibility still starts at 40 and 35. PTLO requires a specialist psychological assessment before surgery, and bariatric centres postpone operations in untreated depression, active addiction and uncontrolled binge eating because, after stomach reduction, episodes cause vomiting and stretch the smaller stomach, and weight returns. We therefore prepare patients with these diagnoses for surgery with psychiatric care and psychotherapy as well as weight loss.

Wielkopolska has two bariatric centres on the Association of Polish Surgeons' list, both in Poznań. KOS-BAR, the pilot providing bariatric care with a dietitian and psychologist before and after surgery, never operated in Wielkopolska; it ended on 30 June 2026 and did not become a permanent NFZ service. The NFZ reimburses the operation itself under the general rules. We care for patients until their surgery: we document non-surgical treatment, complete tests and help them lose weight, because a smaller liver makes it easier for the surgeon to reach the stomach. After sleeve gastrectomy, which reduces stomach size, it initially holds only a few dozen millilitres; after an operation bypassing part of the intestine, iron, vitamin B12, vitamin D and calcium, as well as some oral medicines, are absorbed less effectively, so the psychiatrist needs to know about the operation beforehand. Patients take supplements for life after surgery and have blood vitamin and iron levels checked every year; if their weight rises after two or three years, they return to us because medication can also help after surgery.

Patients come to our practice at ul. Górki 17A from Gniezno, Września, Środa Wielkopolska, Śrem, Kościan, Leszno, Konin, Kalisz, Ostrów Wielkopolski, Piła and Szamotuły, as well as municipalities around Poznań: Swarzędz, Luboń, Komorniki, Tarnowo Podgórne, Suchy Las and Kórnik. The first appointment is in Poznań, and everything afterwards follows the same pattern as for local residents: patients have blood tests in their own town, attend follow-ups by video call and come to the practice every 3 months. Patients receiving psychiatric treatment locally give us their doctor's details so that our letter explaining how much weight they gained and on which medication reaches their psychiatrist.

Obesity statistics in Wielkopolska are incomplete. According to Poland's Supreme Audit Office, primary care practices submitted weight data for only 1 to 19 percent of patients, depending on the region, so obesity goes undiagnosed until complications appear. In the same report, Wielkopolska has one of the lowest obesity rates among patients measured and, at the same time, the highest number of deaths directly caused by obesity in 2020, which says more about measurement than residents' health.

Poznań funds several public health programmes, but none for adults with overweight or obesity. Since September 2025, the regional government has instead funded an interdisciplinary obesity treatment programme for children and adolescents: 200 participants will receive a year of care from doctors, dietitians and psychologists with monthly appointments, joining during a hospital stay or through open recruitment. No such programme exists for adults with obesity in the region. Adults can receive that year of care from a doctor, dietitian and specialist in the psychology of eating privately with us, just as children receive it through the programme.