Obesity treatment Radom

The International Classification of Diseases lists obesity under code E66, and the Polish Society for the Treatment of Obesity describes it in its 2024 guidelines as a chronic disease that requires long-term care. After repeated attempts to lose weight, some people regain the weight they lost. After a loss of body fat, some people use less energy and have lower levels of leptin, the hormone through which fat tissue tells the brain about energy stores, while levels of ghrelin, the hunger hormone, rise. As a result, hunger may increase after weight loss. The strength of these responses varies from person to person.

What factors lead to obesity?

Obesity rarely has a single cause. In twin studies, genes accounted for 40 to 70 percent of the differences in body weight between people, which is why the disease runs in families. An inherited tendency comes to the surface when high-calorie food is easy to buy and most of the day is taken up by sitting at work and driving. Short sleep, chronic stress, pregnancy and menopause also promote weight gain. Some people gain weight on medicines such as steroid tablets, some antidepressants, antipsychotics and antiepileptic drugs, and insulin. Untreated hypothyroidism can also increase body weight, but it usually does not explain obesity as a whole. After stopping smoking most people gain weight, and emotional eating supplies more energy than the body needs. Breathlessness also matters, because it limits physical activity, and less activity makes weight control harder.

Obesity usually develops gradually over many years, when the energy from meals consistently exceeds what the body uses. The surplus goes into fat tissue. First the existing fat cells grow in volume, and once the cells are very large, the body produces new ones. Besides leptin, fat tissue releases substances that sustain chronic inflammation, and these substances reduce tissue sensitivity to insulin.

Which diseases accompany obesity?

Obesity is linked to type 2 diabetes, high blood pressure and fatty liver disease, and in people with asthma to poorer disease control. In chronic obstructive pulmonary disease (COPD), the course of the disease depends not only on excess weight but also on nutritional status and muscle loss.

How does the treatment plan change?

The treatment plan includes long-term follow-up and changes as the disease progresses. The doctor makes the diagnosis and decides whether medication is indicated; not everyone receives it at the initial consultation. If the doctor starts a medicine, they assess how well it is tolerated and how effective it is, and after a few months decide whether to continue it or change the treatment. The programme includes two online consultations with a psychologist, after months 1 and 3, lasting 40-50 minutes each. From the start we explain that there will be weeks without weight loss.

The initial consultation starts with weight and waist circumference, which the patient measures at home, and with a discussion of weight history. We calculate BMI by dividing weight in kilograms by height in metres squared. A woman who is 165 cm tall and weighs 92 kg has a BMI of 33.8. The World Health Organization thresholds, also adopted by the Polish Society for the Treatment of Obesity, are the same for women and men: overweight from 25, class I obesity from 30, class II from 35 and class III from 40. However, this index does not distinguish muscle from fat or tell us where fat is stored.

We therefore also check waist circumference, measured halfway between the lowest rib and the iliac crest after a normal breath out. The International Diabetes Federation defines abdominal obesity from 80 cm in women and 94 cm in men; these thresholds apply to European populations regardless of BMI. Fat around abdominal organs reduces tissues' sensitivity to insulin, prompting the pancreas to release more, and promotes inflammation more strongly than fat on the thighs. The third part of the consultation is weight history. We ask about weight at school, when it began to rise, every treatment tried and how much of the lost weight stayed off. We also ask about breathing: how many flights of stairs cause breathlessness, whether the patient coughs in the morning, whether they smoke or used to, and since when.

When does BMI justify considering medication?

A BMI of 30 or more meets the body weight criterion for many obesity medicines. The doctor also assesses indications, contraindications and previous treatment, so the number alone does not decide whether a prescription is issued. With a BMI of 27 to 29.9, the doctor assesses weight-related conditions and the indications of the specific product described in its summary of product characteristics, the official description of the medicine. These documents give examples such as prediabetes, type 2 diabetes, high blood pressure, lipid disorders, obstructive sleep apnoea and cardiovascular disease. The examples should not be treated as a closed list. For a person with asthma and a BMI of 28, the doctor therefore assesses their overall health, and asthma alone neither qualifies nor disqualifies them for medication. Blood tests help detect coexisting conditions that the doctor takes into account in this assessment.

Orlistat (Xenical) has a different threshold: a BMI of 30 or more, or above 28 with risk factors. We do not offer medication to adults with a BMI below 27; in that case the plan covers nutrition and physical activity matched to fitness. Age does not rule out treatment, but it affects the choice of medicine. Liraglutide (Saxenda) is not recommended from the age of 75, Mysimba is not recommended over 75 and is used with caution over 65. Data for semaglutide and tirzepatide in people aged 85 and over are limited.

For patients from Radom we run an online obesity treatment programme. It lasts 6 months and costs PLN 1,799. The patient buys the medicine at a pharmacy with an e-prescription and pays for it separately. Before starting, the patient has blood tests done and measures weight, waist circumference and blood pressure at home following instructions. The doctor reviews the medical history and the results and then decides whether the patient can be treated in the programme. The price includes two 30-minute doctor consultations, two 40-50-minute online consultations with a psychologist and five medical reviews of app data without a call. The patient books the video consultations in the Nasz Gabinet app. The dates of later consultations are counted from the day of the initial consultation.

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

The dose of injectable medicines is increased gradually. Semaglutide (Wegovy) is started at the lowest dose and, if well tolerated, increased every 4 weeks to the maintenance dose of 2.4 mg. The summary of product characteristics allows a further increase to 7.2 mg in some adults with a BMI of 30 or more. The dose does not go up automatically: the patient reports weight and blood pressure measured at home and describes how they are tolerating the medicine, and the doctor decides on the dose and issues the next prescription. Between consultations the patient records their weight in the app every week and their body measurements once a month, and after the injection takes a photo of the pen, which the medical team looks at. Resistance exercise, using bands, dumbbells or body weight, helps preserve muscle while weight is falling fastest. The doctor decides when to start it and how intense it should be after assessing fitness, and in a person with unexplained breathlessness only after the breathlessness has been investigated. The timing of follow-up blood tests depends on baseline results and current medicines.

When effectiveness is assessed depends on the medicine. With liraglutide (Saxenda), treatment is stopped if weight has not fallen by at least 5 percent after 12 weeks on the 3 mg dose. With Mysimba, the threshold is 5 percent after 16 weeks, after which the doctor regularly reviews the benefits and safety of treatment. With orlistat (Xenical), the 5 percent threshold applies after 12 weeks. With semaglutide and tirzepatide, the doctor assesses the effect according to the product information and the patient's condition. If treatment is not working, the doctor may switch the medicine or change the whole plan. We set the length of treatment individually, with no stopping date fixed in advance.

According to the Polish Society for the Treatment of Obesity (PTLO), obesity is treated for a year or longer. After the programme the patient can therefore extend treatment with a continuation package: 3 months for PLN 350, with a monthly review by the doctor and an e-prescription, but without video consultations.

What does the obesity treatment programme not include?

• We do not diagnose asthma or COPD and do not change inhaled treatment. A pulmonologist makes the diagnosis based on the medical history, examination and spirometry; we deal with body weight, which affects the course of these diseases.
• The obesity treatment programme does not include treatment for nicotine addiction. Within the programme we address the weight that most people gain after stopping smoking, and we take stop-smoking medicines into account when choosing an obesity medicine.
• We do not recommend intense exercise to a patient with unexplained breathlessness. The doctor decides on the type and intensity of activity after the breathlessness has been investigated and exercise safety assessed.

The basic set of tests usually includes a full blood count, fasting glucose or glycated haemoglobin, a lipid profile, liver function tests, creatinine with an assessment of kidney function, and thyroid-stimulating hormone (TSH). The doctor matches the range of tests to the patient's conditions and treatment, and whether an older result needs repeating depends on its clinical relevance. A family doctor can order NFZ-funded tests if they are needed for the care they provide. We accept results in any form, including a photo taken with a phone. Glucose and the lipid profile help assess weight-related conditions, which matters with a BMI of 27 to 30. Liver function tests alone neither diagnose nor rule out fatty liver disease, and creatinine shows how well the kidneys are working. A normal TSH usually rules out primary hypothyroidism as a cause of weight gain, which patients ask about most often. If there are other symptoms, the doctor may extend the investigations.

Which tests do we add for a patient with breathlessness?

For a person who gets out of breath with little effort, the doctor chooses tests based on symptoms, the physical examination and possible causes, including anaemia and heart or lung disease. These may include, for example, a full blood count with a differential or iron with ferritin. The eosinophil count, which rises in allergic conditions among others, does not confirm asthma on its own, and a normal result does not rule it out. Spirometry with a bronchodilator test, which measures breathing before and after a medicine that widens the airways, is ordered by a family doctor or a pulmonologist, and we send them a letter describing the symptoms. For long-term smokers, we add a question about chronic obstructive pulmonary disease. When assessing spirometry in a person with obesity, the specialist takes into account the effect of body weight and the quality of the test, while the diagnostic criteria for asthma and COPD remain the same as for other patients.

Breathlessness on exertion is a common symptom in people with obesity. It can have several coexisting causes, so we ask how it developed and what tests have already been done, including patients who do not mention breathlessness themselves. This part describes breathlessness that has lasted for weeks or months. Sudden or rapidly worsening breathlessness requires immediate medical help.

What causes breathlessness in someone with healthy lungs?

Fat around the abdomen and chest pushes the diaphragm upwards, reduces the amount of air left in the lungs after a normal breath out and increases the work the breathing muscles do with every breath. A study of 373 people with normal airway patency measured how lung volumes change with BMI. In this group, at a BMI of 30 the amount of air remaining in the lungs after a normal breath out was 75 percent, and the amount that could still be breathed out was 47 percent, of the values seen in people with a BMI of 20. The largest changes occurred already with overweight and class I obesity. Other lung volumes remained within the normal range on average, which is why spirometry can be normal in a person with marked breathlessness. The results describe a relationship in the study group and do not predict the result for every person with a given BMI. In a meta-analysis of seven studies involving more than 333,000 adults, overweight and obesity were associated with more frequent development of asthma in both sexes, and the association was stronger with obesity.

How is the cause of breathlessness determined?

Investigations are guided by the medical history and examination. Spirometry with a bronchodilator test helps detect airflow problems, but a single normal result does not rule out asthma or every cause of breathlessness. The doctor may recommend repeating spirometry, home peak expiratory flow (PEF) measurements or other tests. The table below organises the questions we ask during the appointment. It helps the conversation with the doctor and is not a tool for self-diagnosis.

A Canadian study assessed 496 adults whose asthma had previously been diagnosed by a doctor. After serial diagnostic assessment, with medicines withdrawn under medical supervision, asthma was not confirmed in 31.8 percent of people with obesity and 28.7 percent of people without obesity. Of those in whom asthma was ruled out, 65.5 percent needed no medicines or appointments for breathlessness during the following six months of observation. Obesity did not increase the risk of misdiagnosis, as the proportions in both groups were similar. A doctor can therefore review an asthma diagnosis made in the past without tests, but patients should not stop their inhalers on their own.

What does weight loss change for a person with asthma?

One randomised trial, from Finland, included 38 people with asthma and a BMI of 30 to 42. The weight-loss group followed a supervised very low-calorie diet, faster than the pace we suggest to our patients. After a programme that included an eight-week diet, weight in this group was 14.5 percent lower, compared with 0.3 percent in the control group. After one year, the first group weighed 11.3 percent less than at baseline and the second 2.2 percent more. Forced expiratory volume in one second (FEV1), the amount of air breathed out in the first second and the basic measure of airway patency, changed more favourably in the weight-loss group than in the control group. The difference in change between the groups was 7.2 percentage points of the predicted value at the end of the programme and 7.6 points after one year, and 8.6 points for vital capacity at the end of the programme. A separate analysis looked at data from 3,073 adults with moderate asthma from four trials of disease-controlling medicines. In this post hoc analysis, the higher the BMI, the weaker the response to an inhaled corticosteroid, while the response to montelukast remained similar. The finding comes from re-analysing data collected for another purpose and is not a reason to switch an inhaled medicine.

Data on surgical treatment come from observational studies. A review of 33 studies involving 3,731 people with asthma after bariatric surgery reported that 47 percent stopped their asthma medicines, remission of asthma was recorded in 58 percent, and FEV1 and vital capacity increased by 8 to 9 percentage points. Remission in such studies does not mean a lasting cure, and the results are not guidance for stopping medicines. In observational studies, people taking GLP-1 analogues had fewer asthma exacerbations, but other factors may have influenced this result. The effectiveness of these medicines in treating asthma needs to be confirmed in randomised trials. Patients do not change their inhaler doses themselves, and any change is decided by the doctor treating their asthma after reassessing disease control.

How much weight is gained after quitting smoking, and what do we do about it?

A review of 62 studies found that people who stopped smoking without medication weighed on average 1.1 kg more after one month, 2.9 kg more after three months, 4.2 kg more after six months and 4.7 kg more after one year. Individual results varied widely: after one year, 16 percent weighed less than on the day they quit, 37 percent had gained less than 5 kg, 34 percent between 5 and 10 kg and 13 percent more than 10 kg. In a study of more than three thousand people followed for an average of a quarter of a century, those who had stopped smoking in the previous four years gained a median of 2.7 kg over that period if they did not have diabetes and 3.6 kg if they did. Despite the weight gain, they had fewer cardiovascular events than people who continued to smoke. In people without diabetes the finding was statistically stronger, while in people with diabetes the estimates were less precise. The benefits of not smoking outweigh the effects of weight gain.

We plan weight management alongside support for staying smoke-free. For some people, the first goal is to limit weight gain. We explain this at the initial consultation so that the patient does not see a stable weight as a failure. Dietitian support with meal planning can be sought separately; it is not included in the programme. The doctor matches the pace of weight loss and any medication to the patient's health, with no mandatory waiting period after stopping smoking.

GLP-1, glucagon-like peptide 1, is a hormone released by the gut after a meal. It reduces appetite, slows stomach emptying and, when blood glucose is raised, stimulates the pancreas to release insulin; blood enzymes break it down within a minute or two. The molecules used in treatment are broken down much more slowly, so they act for longer. Patients describe two changes: feeling full after a smaller portion and thinking about food less often between meals. Liraglutide and semaglutide act on the GLP-1 receptor. Tirzepatide acts on the receptors for two gut hormones: GLP-1 and GIP, glucose-dependent insulinotropic polypeptide. Semaglutide and tirzepatide are injected under the skin once a week, into the abdomen, thigh or upper arm, and liraglutide daily. The dose is increased gradually, depending on tolerance: for semaglutide and tirzepatide usually every 4 weeks, and for liraglutide usually no more often than once a week.

What do study results mean for someone weighing 92 kg?

Study results are given as a percentage of body weight, while patients think in kilograms, so we convert them during the appointment. In the STEP 1 trial, weight fell by an average of 14.9 percent after 68 weeks on semaglutide and by 2.4 percent on placebo. In the SURMOUNT-1 trial, tirzepatide at 15 mg reduced weight by an average of 20.9 percent after 72 weeks, compared with 3.1 percent on placebo. For a person weighing 92 kg, these averages correspond to 13.7 kg and 19.2 kg. This is a conversion of average results from two different trials and does not predict an individual result. The trials differed in population and duration, so they cannot be used to compare the medicines directly, and participants in both trials also changed their diet and activity. In the SCALE trial, liraglutide reduced weight by 8.4 kg after 56 weeks, compared with 2.8 kg on placebo, in a group with a different starting weight from the example of 92 kg. The averages hide very different results among individual participants, which is why the doctor assesses effectiveness at the time points that apply to each medicine.

How do we plan further treatment and possible discontinuation?

In the extension of the STEP 1 trial, some participants stopped semaglutide and the lifestyle programme at the same time. After one year, this subgroup regained on average about two-thirds of the weight they had lost, and metabolic measures such as blood glucose and blood pressure moved back towards pre-treatment values. Gradual dose reduction has not been proven to work as a universal method of preventing weight regain. The doctor decides individually whether to continue the medicine, reduce the dose or stop it, based on the course of treatment, tolerance and coexisting conditions. Follow-up continues after the medicine is stopped, and if weight starts rising again, the doctor reassesses the treatment.

On this page we discuss five medicines used in obesity treatment: Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. The list does not cover every medicine on the market, and registration does not mean that every pack is available in Polish pharmacies. Wegovy has also been registered as tablets. Patients often come in with other medicine names. Ozempic and Rybelsus contain semaglutide, and Victoza contains liraglutide, the same substances as Wegovy and Saxenda, but they were registered for type 2 diabetes. The indication of a medicine is set by its summary of product characteristics, even when the active substance is the same.

Why do we not prescribe a diabetes medicine for obesity?

What matters is the indication and the trials in which the medicine was studied. Wegovy was studied in the STEP programme in people with obesity; its maintenance dose is usually 2.4 mg, and the product information allows 7.2 mg in some adults. Ozempic is registered for type 2 diabetes, and Rybelsus is semaglutide in tablet form, also for people with diabetes. Saxenda, containing liraglutide at 3 mg, is used to treat obesity, and Victoza, at up to 1.8 mg, to treat diabetes. Mounjaro, containing tirzepatide, is indicated for both conditions. At Nasz Gabinet, for obesity without diabetes we prescribe medicines registered for obesity treatment. Reimbursement of diabetes medicines is a separate matter that depends on the indications in the reimbursement list. The doctor chooses the medicine based on contraindications, tolerance, preferred route of administration and coexisting conditions, and in type 2 diabetes agrees the treatment with a diabetologist.

Approximate medicine costs

According to the reimbursement list of July 2026, none of the five medicines discussed is reimbursed for obesity, so patients pay the full price. The monthly cost depends on the medicine, dose, pack size and pharmacy. For injectable medicines, the price may change with the dose, and a pack with four weekly doses does not always last a full calendar month. Prices of the same medicine vary between pharmacies, so it is best to check the current price of the chosen medicine and dose before the first purchase. Medicines should only be bought from a licensed pharmacy.

What do naltrexone with bupropion and orlistat offer?

Oral medicines are usually less effective than injectables, but some patients respond better to them. Mysimba contains two substances, naltrexone and bupropion, which act on brain centres involved in appetite and pleasure. In the COR-I trial, weight fell by 6.1 percent after 56 weeks, compared with 1.3 percent on placebo. The product information requires treatment to be stopped if weight loss has not reached 5 percent after 16 weeks, after which the doctor regularly reviews the benefits, cardiovascular safety and whether the effect is maintained. The medicine is not used, among other situations, in uncontrolled high blood pressure, epilepsy, bipolar disorder, after bulimia or anorexia, in people taking opioids or monoamine oxidase inhibitors, or during abrupt withdrawal from alcohol. The anaesthetic team must be told about the medicine before a planned procedure, because naltrexone interacts with opioid medicines. We ask separately about stop-smoking medicines, because bupropion is an ingredient of one of them and must not be taken in two products at the same time. Mysimba does not replace the diagnosis and therapy of binge eating disorder.

Xenical is a capsule containing orlistat, which blocks the absorption of roughly one-third of the fat in a meal. After one year, orlistat gave on average about 3 kg more weight loss than placebo, which does not guarantee the same result for every patient. It requires limiting fat in the diet, otherwise oily stools occur. Orlistat is used with a BMI of 30 or more, or above 28 with risk factors, and treatment is stopped if weight has not fallen by at least 5 percent after 12 weeks. The contraindications listed for both medicines are not the complete list from the product information.

The summary of product characteristics for semaglutide lists hypersensitivity to the active substance or any of the excipients as a contraindication. It separately describes warnings and situations in which the medicine is not recommended. Semaglutide is not used during pregnancy or breastfeeding; the rules for tirzepatide are different and the doctor discusses them separately. In severe gastroparesis, a markedly slowed emptying of the stomach, the medicine is not recommended, and in milder disorders the doctor takes extra care. In kidney disease, the doctor assesses the degree of impairment, because the product information does not refer only to end-stage kidney failure. After previous pancreatitis, the doctor considers treatment with particular caution. The US labelling also lists a personal or family history of medullary thyroid cancer and multiple endocrine neoplasia type 2. The European product information does not contain this contraindication, but at our practice we do not offer the medicine to these patients. In people with diabetes taking insulin or sulfonylureas, the doctor adjusts the doses of these medicines when blood glucose readings call for it, in consultation with a diabetologist. We also ask about long-term steroid tablets, which some people with severe asthma take. Steroids themselves increase body weight and make it harder to judge whether the obesity medicine is working, but patients should not stop them on their own.

Side effects involving the digestive tract and gallbladder

In the first weeks, the most common complaints involve the stomach and intestines. In a pooled analysis of the STEP 1 to 3 trials, nausea was reported by 43.9 percent of people taking semaglutide compared with 16.1 percent on placebo, diarrhoea by 29.7 percent, vomiting by 24.5 percent and constipation by 24.2 percent of participants. The median duration of an episode of nausea was 8 days. In the STEP 1 trial alone, these complaints led 4.5 percent of patients taking the medicine and 0.8 percent of those taking placebo to stop treatment. Symptoms often worsen temporarily after a dose increase, and if tolerance is poor, the doctor may keep the current dose for longer. Smaller portions, eating more slowly and cutting down on fatty foods while getting used to the medicine all help. Gallstones were recorded in 1.6 percent of treated people in the trials and gallbladder inflammation in 0.6 percent; rapid weight loss promotes stone formation. Acute pancreatitis affected about 0.2 percent of treated people.

When should you contact a doctor, and when do you need urgent help?

Immediate medical help is needed for sudden or rapidly worsening breathlessness, difficulty speaking in full sentences, blue lips, impaired consciousness, and breathlessness with chest pain. With these symptoms, do not wait for the practice to open or for a scheduled check-up. Severe abdominal pain, especially pain spreading to the back, needs urgent assessment in hospital; stop the medicine and do not wait to contact us. Sudden worsening or loss of vision needs urgent help, including in people without diabetes, and a very rare ischaemic damage to the optic nerve (NAION) has been described with semaglutide. Urgent assessment is also needed if you cannot keep fluids down or have signs of dehydration, such as passing very little urine, dizziness or confusion; do not wait for a full day to pass. Contact a doctor the same day if the whites of your eyes or your skin turn yellow. People with asthma who use their reliever inhaler more often during treatment should contact the doctor who treats their asthma and should not change inhaler doses themselves. We answer the phone every day from 8am to 8pm; outside these hours, the night and holiday healthcare service is available.

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

Counterfeit semaglutide pens have already been found in Europe, including at wholesalers. Buying from a licensed pharmacy reduces the risk, because when dispensing the medicine the pharmacist scans the two-dimensional code on the pack in the European medicines verification system. This check does not give complete certainty, so before use make sure the pack is intact, and report any doubts about how the pen looks to the pharmacist. Do not buy the medicine from classified ads, auction sites or friends, even if the price is half as much. An e-prescription can be dispensed at any pharmacy in Poland using the four-digit prescription code and the patient's PESEL number.

The medicine reduces appetite, and the dietitian helps plan meals around the patient's appetite, needs and daily routine. The dietitian starts with a dietary history and working hours, including shift work if the patient works shifts. The approximate energy deficit is 500 to 750 kcal a day. Protein is usually calculated at 1 to 1.5 g per kilogram of ideal body weight, the weight appropriate for the patient's height, and spread across all meals. Ideal body weight is used for calculations and does not mean a target weight. In kidney or heart disease and in physical work, the dietitian adjusts these values. With rapid weight loss, muscle is lost along with fat, and in a person with obesity the breathing muscles work harder than in a lean person, so losing them can reduce fitness. The dietitian adds fibre from vegetables, groats and whole grains, which lowers the risk of constipation when the gut slows down, and usually at least one and a half litres of fluid a day, unless the doctor has advised otherwise.

We plan physical activity separately. Its purpose is to maintain muscle and fitness, because the calories burned during exercise are fewer than people think. The more muscle is preserved, the higher the resting metabolic rate, including after the medicine is stopped. After assessing fitness, we suggest resistance exercise twice a week at home, with bands and body weight, and a daily walk in between. For a patient who gets breathless after one flight of stairs, we suggest walking on flat ground at a pace that allows speaking in full sentences. Being able to talk comfortably while walking helps set the intensity, but it does not replace investigation of unexplained breathlessness or an assessment of exercise safety. We increase the load gradually, and the first goal is fifteen minutes of activity a day.

What do we do when a patient eats in response to tension?

Some patients reach for food when tense, after a difficult day or an argument. A GLP-1 analogue suppresses hunger but does not remove a response learned over years. Such patients can be disappointed in the first weeks: the medicine works, but the urge to reach for food remains. The psychodietitian teaches them to recognise the moment just before reaching for food and arrange the day so they do not come home ravenous. People who recently quit smoking and replaced cigarettes with food are a separate group: we work mainly on the impulse to snack. For binge eating disorder, repeated episodes of eating very large portions with a sense of lost control, we also suggest a psychiatric consultation.

One gram of alcohol provides 7 kcal, closer to fat at 9 kcal than to sugar at 4 kcal. Half a litre of beer contains about 250 kcal and 50 ml of vodka about 110 kcal, depending on the product. Three beers in one evening therefore provide about 750 kcal, a whole day's deficit at the upper limit, and at a 500 kcal deficit as much as a day and a half. Alcohol adds extra energy and can make it harder to keep to the planned energy balance. It also raises blood pressure, weakens control over eating and disrupts sleep in the second half of the night, especially when used as a way to fall asleep.

During treatment with a GLP-1 analogue, alcohol may worsen nausea and reduce tolerance of the medicine. In people taking insulin or sulfonylureas, drinking alcohol increases the risk of hypoglycaemia. In people who have recently stopped smoking, drinking can make it harder to stay smoke-free. We do not require everyone to abstain, but a safe amount of alcohol depends on the medicine, the patient's health and the risk of addiction, so we ask for an honest answer about how much and how often the patient drinks. With Mysimba, abrupt withdrawal from alcohol is a contraindication, and a person who is physically dependent on alcohol should not plan a sudden break from drinking on their own.

Sometimes a conversation about weight turns to drinking. A daily evening beer does not by itself establish a diagnosis of addiction, but it is a reason for a closer conversation. We will assess the drinking pattern and agree a safe plan of support. At the same address we provide alcohol addiction treatment in Radom and addiction therapy. Mysimba contains naltrexone, but it is not used to treat alcohol addiction; that indication uses a different naltrexone product at a different dose.

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. At the initial consultation the doctor reviews the results, asks about weight history and chronic conditions and reads blood pressure measurements recorded at home, while the patient measures their own waist following instructions. Home blood pressure measurements require a cuff that fits the arm, because a cuff that is too narrow overestimates the reading in a person with obesity. Dark, velvety patches of skin in the armpits and groin can accompany disorders of carbohydrate metabolism, so it helps to tell the doctor about them.

If there is breathlessness, the doctor assesses the medical history and the results and then decides whether the patient can be treated in the programme. Investigations for breathlessness, such as spirometry, can be ordered under the NFZ by a family doctor.

At a check-up, the doctor assesses tolerance and effectiveness of treatment and whether further tests or changes to treatment are needed. The patient has blood taken at a laboratory close to home and sends the result before the agreed appointment. The doctor issues an e-prescription after each medical review. Sudden symptoms require the help described in the treatment safety section, without waiting for a consultation.

Obesity can be diagnosed and treated under the NFZ in primary care and in specialist clinics, and the scope of care and waiting times depend on the facility. A family doctor can diagnose obesity, order the blood tests needed for the care they provide and issue a referral to a specialist clinic, and for breathlessness also refer the patient for breathing tests. Our obesity treatment programme is private.

The NFZ funds imaging and other services if they are indicated and the patient has the appropriate referral. Reimbursement of inhaled asthma medicines depends on the specific product and indication, and patients pay a co-payment according to the reimbursement list. The NFZ funds bariatric surgery after qualification at a bariatric centre. Free help with stopping smoking is provided by tobacco addiction clinics, which do not require a referral, and by a national telephone helpline for smokers; the cost of the call depends on the number used and the operator. Patients pay PLN 1,799 for the six-month programme at Nasz Gabinet and separately for the medicine bought at the pharmacy. Dietitian and psychodietitian consultations are not included in the programme. According to the reimbursement list of July 2026, none of the five medicines discussed is reimbursed for obesity. The budget may influence the choice of medicine, so we ask about it at the initial consultation.

The 2022 recommendations of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) and the American Society for Metabolic and Bariatric Surgery (ASMBS) lowered the thresholds for surgical treatment. The Polish consensus of 2025 recommends considering surgery with a BMI of 35 or more regardless of obesity-related conditions. For a BMI of 30 to 34.9, it describes selected situations in which surgery can be considered, including type 2 diabetes that remains poorly controlled despite treatment. Clinical recommendations are not the same as the conditions for NFZ funding, and the decision on surgery is made by the bariatric centre after assessing the patient.

The timing of a bariatric consultation depends on the indications and an individual assessment; not every patient has to take a medicine without success for a year first. We suggest a consultation when a patient meets the thresholds described above and is considering surgery together with the doctor. A referral is valid throughout Poland, so a hospital can be chosen outside the patient's own region. Preparation for surgery is decided by the centre's team. It usually includes getting diabetes and blood pressure under control, correcting deficiencies and a psychological consultation, and for some people also losing weight before the operation. We specifically ask patients to stop smoking, because wounds heal worse in smokers and breathing complications after anaesthesia are more common. After surgery, long-term follow-up and usually lifelong vitamin and mineral supplementation are needed, and blood tests are done more often in the first year, then usually once a year.

After a few years, some patients start gaining weight again. The doctor then reassesses treatment and may consider medication.

We run the programme online, so it is also available to residents of southern Mazovia, including Skaryszew, Jedlnia-Letnisko, Pionki, Zwoleń, Szydłowiec, Iłża, Kozienice, Białobrzegi, Przysucha and Grójec. The patient connects with the doctor and the psychologist by video and has blood taken at a laboratory close to home.

Tests ordered by the doctor, such as spirometry, can be done at a facility closest to the patient's home.

The NFZ waiting times guide lists a metabolic disease clinic in Radom. In its statistics for August 2026, it reported 55 people waiting and an average waiting time of 54 days. These figures describe a past period and do not show the first available appointment, so before booking check which patients the clinic accepts and the current queue. A referral is needed for the clinic, for example from a family doctor. In the Mazovia region, the guide lists 24 metabolic disease clinics, 14 of them in Warsaw, and some of them are clinics for children. Clinics in this category do not cover all public obesity care, as treatment is also provided in primary care and in other specialist clinics.

Under the NFZ, a family doctor can refer a patient with breathlessness for spirometry and order blood tests if they are needed for the care provided. The results are useful both at an NFZ clinic and in our online programme. A medicine bought on a full-price prescription costs the same whether the prescription was issued at a private appointment or under the NFZ; the price depends on the medicine and the pharmacy.