Obesity treatment in Słupsk

In the International Classification of Diseases, obesity has the code E66, and the Polish Society for the Treatment of Obesity (PTLO) describes it in its 2024 recommendations as a chronic disease that requires long-term care. After treatment ends, the risk of regaining weight is high. This follows from the physiology of hunger and satiety. When body fat decreases, levels of leptin, the hormone that informs the brain about fat stores, fall, secretion of ghrelin, the hormone that triggers hunger, rises, and the body may use less energy. After a diet ends, appetite is often greater than before it, so maintaining a lower body weight requires a continued plan. What happens after weight loss nevertheless differs between patients.

Where does obesity come from?

Obesity results from a combination of an inherited tendency and living conditions. According to twin studies, genes account for 40 to 70 percent of the differences in body weight between people, and the disease is more common in the families of people with obesity. The tendency to gain weight shows itself when high-calorie food is available at any hour and people mostly sit at work and on the way there. In some patients shift work and short sleep are added to this, and they disrupt the daily rhythm and increase appetite. Work in industry and retail often means shift work, so we ask every patient about their schedule and sleep. Chronic stress, emotional eating, pregnancy, menopause and stopping smoking also promote weight gain. Some medicines and diseases can also increase body weight, so before treatment we review the patient's medicines and test results. An underactive thyroid can raise body weight, but it usually does not explain obesity as a whole.

Obesity builds up when, over months and years, food provides more energy than the body uses for the work of its organs and for movement. The surplus is stored in fat tissue: fat cells first increase in volume, and if weight gain continues, the body forms new cells. The enlarged fat tissue produces hormones, including oestrogens, as well as substances that sustain chronic inflammation.

Which diseases are linked to obesity?

Obesity increases the risk of type 2 diabetes, high blood pressure, fatty liver disease and sleep apnoea. Insulin resistance links obesity to diabetes: substances from fat tissue weaken the action of insulin, so the pancreas produces more of it.

Does everyone with obesity receive medication?

A diagnosis of obesity does not automatically mean medication or monthly appointments for years. The doctor makes the diagnosis, assesses related conditions and agrees a plan with the patient: changes to eating, physical activity, sleep and, where indicated, drug treatment. The programme also includes two online consultations with a psychologist, after months 1 and 3, lasting 40-50 minutes each.

Diagnosis is based on measurements and a medical history. We start by measuring weight and height and calculating BMI, which is body weight divided by the square of height in metres; at 165 cm and 92 kg, BMI is about 34. The World Health Organization thresholds adopted by PTLO are the same for both sexes: overweight from 25, class I obesity from 30, class II from 35 and class III from 40. BMI is misleading in people with a lot of muscle and does not show where in the body fat is stored.

That is why we also measure waist circumference with a tape measure during a relaxed exhalation, midway between the lowest rib and the top of the hip bone. For European populations, the International Diabetes Federation set the threshold for abdominal obesity at 80 cm for women and 94 cm for men. Fat stored around the abdominal organs is more strongly linked to insulin resistance and complications of obesity than fat on the thighs. At the same BMI of 29, a driver with a 108 cm waist has a higher risk of diabetes than a colleague with a 94 cm waist, and a full risk assessment also takes blood tests, blood pressure and the medical history into account. Finally, we take a weight history: what the patient weighed at 20, when and after what event they started gaining weight, how many times they lost weight and how many kilograms came back, what their work schedule looks like, and how much they sleep on working days and on days off.

What BMI allows drug treatment to be considered?

Obesity medicines can be considered at a BMI of 30 or more, or at a BMI of 27 or more if the patient has a weight-related condition such as prediabetes or type 2 diabetes, high blood pressure, lipid disorders or obstructive sleep apnoea. For Xenical, the threshold is a BMI of 30 or more, or above 28 with risk factors. Meeting the threshold is part of the assessment and does not guarantee a prescription, because the doctor also considers contraindications, current medicines and the patient's preferences. For a shift worker with a BMI of 28, a 106 cm waist and glycated haemoglobin of 6.0%, drug treatment can therefore be considered. At a BMI of 25 to 27 without such conditions, treatment is based on diet, exercise and better sleep; insulin resistance on its own is not an indication for these medicines. Age does not rule out treatment, but it affects the choice of medicine. Saxenda is not recommended from the age of 75, Mysimba is not recommended over 75 and requires caution over 65, and data for Wegovy and Mounjaro in people aged 85 and over are limited.

We treat obesity in patients from Słupsk in an online programme. It lasts 6 months, costs PLN 1,799 and 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 pays for the medicine separately at the pharmacy where the e-prescription is dispensed. The doctor first assesses the medical history and test results and then tells the patient whether they can be treated in the programme. A prescription is issued if the patient meets the indications and has no contraindications. The patient books each consultation themselves in the Nasz Gabinet app, and later dates are counted from the initial consultation.

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

Throughout the programme the patient weighs themselves every week and enters the result in the app, and takes their body measurements every month. After the injection, the patient takes a photo of the pen for our medical team. Before every check-up the doctor looks through the recorded results. Because PTLO recommends treatment lasting a year or longer, after the programme the patient can buy a continuation package: 3 months for PLN 350. In the package the doctor reviews the results every month and issues an e-prescription, without video consultations.

The dose is increased gradually according to the schedule for each medicine, the response to treatment and tolerability, and tirzepatide does not have to reach the maximum dose. At check-ups, the patient reports weight and blood pressure measured at home and describes how they tolerate the medicine, and the doctor decides on the dose and the next prescription. When effectiveness is assessed also depends on the medicine. Saxenda is stopped if at least 5% of initial body weight has not been lost after 12 weeks on 3 mg, Xenical if 5% of body weight has not been lost after 12 weeks, and Mysimba if there is no such loss after 16 weeks. If the effect is weak, the doctor looks for the reason and plans next steps, without automatically switching to another class of medicine. Resistance training can start in the first weeks, because it helps preserve muscle during weight loss. Follow-up tests are planned according to the patient's health. Stopping the medicine is not a mandatory step once the programme ends.

What is the scope of care in the programme?

• We do not make treatment conditional on giving up shift work. We adapt the treatment plan to the patient's schedule so that the recommendations can be followed.
• We do not treat insomnia with sleeping tablets or renew prescriptions for them. For chronic insomnia we refer patients to a psychiatrist or a sleep disorders clinic, and if sleep apnoea is suspected, for a sleep study.
• We interpret a fasting glucose result from blood taken after a night shift in light of sleep and the time of the last meal. We confirm an abnormal result with a repeat test under planned conditions and do not disregard a result suggesting significant hyperglycaemia.

The doctor chooses the tests based on the medical history and the patient's conditions. They most often include glycated haemoglobin (HbA1c) and fasting glucose, creatinine with estimated glomerular filtration rate (eGFR), TSH, a lipid profile, the liver enzymes ALT and AST, uric acid and a full blood count. HbA1c and glucose help identify prediabetes or diabetes, which affects the BMI threshold and the choice of medicine. eGFR shows kidney function: in severe kidney failure, liraglutide is not recommended, and other medicines have their own rules. TSH helps assess thyroid function, and the doctor interprets the result together with symptoms, because an underactive thyroid causes weight gain, tiredness and feeling cold. ALT and AST are part of a liver assessment, but on their own they neither diagnose nor rule out fatty liver. The lipid profile covers cholesterol and triglycerides, uric acid helps assess the risk of gout, and a blood count may reveal anaemia, whose cause we investigate separately. We usually ask for results older than six months to be repeated, and patients can have missing tests done at any laboratory in Słupsk or near home and send the results before the initial consultation.

Besides tests, we review the patient's medicines, ideally with the packaging or photos of it, including supplements. Several groups of medicines promote weight gain: glucocorticoids, insulin, sulfonylureas, and some antiepileptic, antidepressant and antipsychotic medicines. The patient should not stop any of them on their own. If one of them makes obesity treatment harder, we write to the doctor who prescribed it and ask about an alternative from the same group with a milder effect on weight. We look separately at medicines for blood pressure and diabetes, because their doses may need adjusting as the patient loses weight; the doctor decides based on blood pressure and blood glucose measurements.

What do we add to the tests for patients who work nights?

For people on permanent nights or rotating shifts, the doctor adapts the tests and blood collection conditions to the work schedule. HbA1c does not require fasting and does not depend on the time of day, but it does not replace all other diagnostic tests for everyone and has its own limitations, for example in anaemia. We confirm an abnormal glucose result and do not attribute a result suggesting significant hyperglycaemia to the night shift. We also ask for blood pressure readings from a whole week, marking those taken after a night shift. If the patient snores with pauses in breathing, has morning headaches and falls asleep during the day, we refer them for a sleep study and treat obesity in parallel with the diagnostic process. In professional drivers and machine operators, daytime sleepiness needs more urgent assessment, because it affects safety and fitness to work.

Patients ask why they gain weight even though they watch their diet, and for some of them the work schedule is the cause. The body works to a daily rhythm set by light: melatonin rises in the evening and cortisol towards morning, and glucose tolerance is clearly higher in the morning than in the middle of the night. The same meal eaten at night raises blood glucose more than at midday. Shift work forces people to eat at night and sleep during the day, against this rhythm. After such disruption, insulin levels rise, the lipid profile worsens and appetite for high-calorie food increases.

A meta-analysis of 26 studies with 311,334 participants found that shift work is associated with a 25% higher risk of overweight (relative risk, RR 1.25) and a 17% higher risk of obesity (RR 1.17). A second meta-analysis of 28 studies found an odds ratio (OR) for obesity of 1.23 for night work; the association was stronger for abdominal obesity and permanent night work. In a separate analysis, the risk of type 2 diabetes in shift workers was about 10% higher. These are observational studies, so they show that the factors occur together and do not prove that the schedule itself caused obesity in a particular person; part of the difference comes from diet, lower physical activity and smoking.

How does sleep duration affect weight loss?

In a meta-analysis of more than 600,000 adults, short sleep was associated with more frequent obesity (OR 1.55), and each hour less of sleep was associated with a BMI 0.35 points higher. In an intervention study, ten adults with overweight followed the same calorie deficit during two 14-day periods, once with 8.5 and once with 5.5 hours set aside for sleep. With shorter sleep, the share of fat in the weight lost was 55% lower, the loss of fat-free mass, which includes more than muscle, was 60% higher, and participants felt hungrier. In a second study, carried out at home, 80 adults with overweight who slept less than 6.5 hours extended their sleep by an average of 1.2 hours and ate on average about 270 kcal less per day, without dietary advice. Both studies were short and involved selected groups, so they do not guarantee the same effect in every patient.

How do we adapt treatment to the work schedule?

We start with sleep and rest times that are as regular as the schedule allows. A nap after a night shift can help, but it does not replace enough sleep. Next, we set meal times. We suggest eating the main meal before going to work and having a light snack containing protein at night, because a meal eaten at night raises blood glucose more and more often leads to extra eating in the early morning. The time of the last coffee and exposure to bright light are agreed individually, depending on shift and sleep times. Darkening the bedroom windows helps.

The timing of medicines can be adapted to a changing schedule. Semaglutide and tirzepatide are injected once a week at any time of day, so the patient chooses one fixed day of the week. Liraglutide is given daily, preferably at a similar time that fits the patient's routine. Orlistat is taken with meals that contain fat, including night-time meals. A missed dose should not be made up with a double injection, and the rules for changing the injection day and what to do after a missed dose depend on the product, so we discuss them when treatment starts.

Shift work can make obesity treatment harder, but its effect differs between patients. We set the goal and pace of treatment based on health, sleep, the work schedule and the first months of therapy, not on the number of years of shift work alone.

GLP-1 and GIP are gut hormones released after a meal that help regulate appetite and insulin secretion. Natural GLP-1 breaks down within a few minutes. Liraglutide and semaglutide act on the GLP-1 receptor but break down more slowly, so they work for many hours or days. Tirzepatide acts on both GIP and GLP-1 receptors. These medicines can reduce hunger, make it easier to feel full after a smaller portion and slow stomach emptying; some patients also notice that they think about food less often between meals. Semaglutide and tirzepatide are injected under the skin of the abdomen, thigh or upper arm once a week, and liraglutide daily. Each medicine has its own dose-escalation schedule. Liraglutide is increased at intervals of at least one week, semaglutide every 4 weeks, and tirzepatide in 2.5 mg steps at intervals of at least 4 weeks, only when needed.

Clinical trial results translated into kilograms

Results of registration trials are given as a percentage of body weight. In the STEP 1 trial, semaglutide 2.4 mg reduced body weight by an average of 14.9% after 68 weeks, compared with 2.4% with placebo. In the SURMOUNT-1 trial, tirzepatide 15 mg reduced it by an average of 20.9% after 72 weeks, compared with 3.1% with placebo. In both trials, treatment was combined with lifestyle changes. Applying these averages to a person weighing 95 kg gives about 14 kg and 20 kg respectively. This is not a forecast for an individual patient or the result of a direct comparison of the two medicines, because the trials differed in duration and participants. In the SCALE trial, liraglutide 3 mg reduced body weight by an average of 8.4 kg after 56 weeks, compared with 2.8 kg with placebo; this result in kilograms cannot be applied to a person with a different starting weight. Results varied widely between participants: some lost twice the average, others little, and this cannot be predicted in advance. Effectiveness is assessed according to the rules for each medicine, without one common time point for all of them.

Why does stopping the medicine need a separate plan?

In the STEP 1 extension, a subgroup of participants stopped semaglutide and the lifestyle programme at the same time. Within a year, they regained on average about two thirds of the weight they had lost, and some measures, including blood glucose and blood pressure, moved back towards pre-treatment values. The study did not test whether gradually reducing the dose prevents weight regain. Stopping the medicine is therefore a separate decision that the doctor discusses with the patient when weight has been stable for several months, eating habits are established and training has a fixed place in the week. We then agree a follow-up plan for after the medicine is stopped. Regaining 5% of body weight after stopping the medicine requires a new medical assessment; the patient does not restart treatment on their own. Relapse is part of the course of a chronic disease.

Medicines with an indication for obesity include Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. Patients, however, often arrive with a list of names found online that also includes Ozempic, Rybelsus and Victoza. These three contain semaglutide or liraglutide, the same substances as Wegovy and Saxenda, but they are authorised for type 2 diabetes. When choosing a medicine, three things need to be distinguished: the indication in the summary of product characteristics, a doctor's decision to prescribe outside the authorised indication, and reimbursement rules.

What explains the difference between Wegovy and Ozempic?

Both contain semaglutide. Ozempic comes in doses of up to 2 mg and is indicated for type 2 diabetes. Wegovy is indicated for obesity, based on the STEP trial programme. The standard maintenance dose of Wegovy injections is 2.4 mg, and in adults with a starting BMI of 30 or more, the product information allows an increase to 7.2 mg after at least 4 weeks on 2.4 mg if needed. The EU authorisation also covers an oral form of Wegovy for adults, which does not mean that these packs are available in Polish pharmacies. Rybelsus is oral semaglutide authorised for diabetes. Liraglutide 3 mg is Saxenda, authorised for obesity, while liraglutide up to 1.8 mg is Victoza, authorised for diabetes. Mounjaro, or tirzepatide, is indicated for both conditions. Ozempic prescribed to a person without diabetes solely for obesity is off-label use; the lack of an indication does not mean that semaglutide has not been studied in obesity. Reimbursement of Ozempic covers specific situations in type 2 diabetes, and if a reimbursed prescription is issued outside them, the NFZ may demand repayment of the reimbursement. For patients without diabetes we suggest a medicine indicated for obesity, and for patients with type 2 diabetes we agree the choice with their diabetologist.

What do patients pay for at the pharmacy and why do prices vary?

Patients pay the full price for obesity medicines at the pharmacy, because according to a review of the reimbursement list from July 2026, none of the five medicines discussed is reimbursed for this indication. The monthly cost depends on the medicine, dose, pack size and pharmacy. Treatment does not have to reach the highest dose: tirzepatide can be maintained at 5, 10 or 15 mg, and the price of starting doses does not reflect the cost of the whole treatment. Liraglutide is also available as alternatives to the original product, whose availability and price need to be checked for the product chosen. Prices for the same dose vary between pharmacies, so it pays to compare them before buying.

Who may benefit more from oral medicines?

Mysimba and Xenical are taken by mouth, as is the oral form of Wegovy authorised in the EU. An oral medicine may be a better choice for patients who do not want to inject or cannot use injectable medicines. Mysimba combines two substances, naltrexone and bupropion, which act on areas of the brain involved in appetite and reward. In the COR-I trial, body weight fell by an average of 6.1% after 56 weeks, compared with 1.3% with placebo. Treatment is stopped if at least 5% of initial body weight has not been lost after 16 weeks. Mysimba is not used in uncontrolled high blood pressure, epilepsy, bipolar disorder, current or past bulimia or anorexia, during opioid treatment, or during abrupt withdrawal from alcohol. Xenical is hard capsules containing 120 mg of orlistat. It reduces the absorption of roughly one third of the fat in a meal, and in studies body weight fell after a year by about 3 kg more than with placebo. It requires limiting fat in the diet, otherwise it causes oily stools. Xenical is used in adults with a BMI of 30 or more, or above 28 with risk factors, and treatment is stopped if at least 5% of body weight has not been lost after 12 weeks.

Semaglutide, liraglutide and tirzepatide are contraindicated in people who are hypersensitive to the active substance or any of the excipients. These medicines are not used in pregnancy. Wegovy and Saxenda should not be used while breastfeeding, and the current product information for Mounjaro allows treatment during this period to be considered individually. In severe kidney or liver impairment, Wegovy and Saxenda are not recommended; Mounjaro does not require a dose change for this reason, but data in severe disease are limited and caution is needed. In severe gastroparesis, a disorder of stomach emptying, Wegovy is not recommended and Mounjaro requires caution. After previous pancreatitis, we take particular care. In people with diabetes treated with insulin or sulfonylureas, the doctor assesses whether the doses of these medicines need to be reduced, based on blood glucose measurements and the risk of hypoglycaemia. In night workers, we pay particular attention to symptoms of hypoglycaemia, because they are easily mistaken for tiredness after a shift.

Which symptoms are most common and how long do they last?

Digestive symptoms are the most common. In the pooled documentation for Wegovy, nausea occurred in 43.9% of treated people, diarrhoea in 29.7%, vomiting in 24.5% and constipation in 24.2%; 4.3% stopped treatment because of digestive symptoms. Other medicines have their own data on how often side effects occur. The median duration of an episode of nausea was about 8 days, which does not mean that symptoms will resolve within that time in everyone. Symptoms usually get worse after a dose increase; if tolerability is poor, the doctor may extend the time on the current dose. Smaller portions, eating more slowly and limiting fatty food help. In semaglutide studies, gallstones were found in 1.6% of treated people and gallbladder inflammation in 0.6%, and rapid weight loss promotes gallstone formation regardless of the medicine. Acute pancreatitis occurs in about 0.2% of treated people.

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

Severe, persistent abdominal pain, including pain spreading to the back, needs urgent medical help without waiting to contact the clinic; the medicine must then be stopped, because such pain may mean acute pancreatitis. Urgent help is also needed for vomiting or diarrhoea when the patient cannot keep fluids down, passes very little urine, faints or is confused, and for a sudden deterioration in vision, whether or not the patient has diabetes. A same-day medical assessment is needed for pain under the right ribs with fever and for yellowing of the skin or the whites of the eyes. Please contact the clinic if the patient loses more than 2 kg in a week despite eating normally. In people with diabetes, a rapid fall in blood glucose can temporarily worsen retinopathy. NFZ night and holiday care (nocna i świąteczna opieka zdrowotna) operates from 6pm to 8am on working days and around the clock on days off; it is an NFZ service independent of our clinic.

How can you buy an injection pen safely?

Counterfeit semaglutide pens have appeared in Europe, including Poland, and reached people who bought the medicine outside pharmacies. Please buy prescription medicines only from a pharmacy. Pharmacy packs carry a batch number and a two-dimensional code, which the pharmacist checks in the European medicines verification system when dispensing; the appearance of the pack alone does not allow the patient to confirm that the medicine is genuine. Please do not buy obesity medicines from adverts, auction sites or private individuals. Patients receive our prescriptions as a code by text message and can have them dispensed at any pharmacy.

The medicine reduces appetite, while the eating plan determines what and when the patient eats. The dietitian starts with a dietary history and the daily schedule, because meals are planned differently for someone working from seven to three than for someone whose waking time changes every week. The energy deficit is often 500 to 750 kcal below requirements, but the dietitian adapts it to the patient. Protein intake is also set individually, usually 1 to 1.5 g per kilogram of ideal body weight, taking kidney disease into account. We make sure every meal contains enough protein, because rapid weight loss involves losing muscle as well as fat. Enough fibre from vegetables, groats and whole grains, together with enough fluids, can help reduce constipation; we increase fibre according to how the stomach tolerates it and set fluid intake with heart and kidney disease in mind. With night work, the main change is how meals are distributed: the largest meal before the shift, a portion with protein and vegetables at night instead of a sweet snack from a vending machine, and a light breakfast after getting home so that sleep does not start on a full stomach.

Besides the meal plan, we recommend resistance exercise twice a week and a daily walk, adapted to the patient's fitness. A gym membership is not needed: resistance bands and body weight are enough at home, and with shift work it is easier to keep up two short sessions than one long one. Training helps maintain strength and fitness, improves endurance and makes it easier to maintain weight after weight loss.

When do we involve a psychodietitian?

Some patients reach for food under stress, for example after a difficult duty shift or an argument. The medicine alone may then not be enough, because eating serves as a way of coping with tension. The psychodietitian teaches patients to recognise the moment before they reach for food and to plan meals so that coming home does not start on an empty stomach. Together with the patient, they also look for other ways of relieving tension. A night-time meal required by shift work does not mean night eating syndrome. Binge eating episodes with loss of control require assessment for eating disorders, because dietary advice alone is not enough, and help, including psychotherapy or a psychiatric consultation, is chosen according to the diagnosis.

A gram of pure alcohol provides 7 kcal, only slightly less than a gram of fat. The body breaks down alcohol first, so it burns less fat during that time. Half a litre of beer contains about 250 kcal and a shot of vodka about 110 kcal. Three beers provide about 750 kcal, which can equal an example daily deficit, although each patient's deficit is set individually. Alcohol adds extra energy, can worsen sleep and makes it harder to control eating. Drunk after a night shift to fall asleep more easily, it shortens the time needed to fall asleep but disrupts the second half of the night and suppresses dream sleep, so sleep is less restorative.

The effect of alcohol on blood glucose depends on medicines and meals. In people taking insulin or sulfonylureas, alcohol increases the risk of hypoglycaemia, including at night. During treatment with GLP-1 medicines, alcohol can make nausea worse. We do not require complete abstinence, but we ask patients to tell us honestly how much and how often they drink, because both the treatment plan and safety depend on it.

In some patients, a conversation about weight shows that drinking needs attention more urgently. An evening beer after a shift gradually becomes a condition for falling asleep, and in that case we suggest starting with addiction treatment or running it alongside obesity treatment. At our clinic we also provide alcohol addiction treatment in Słupsk and addiction therapy. Mysimba contains naltrexone, but it is not used to treat alcohol dependence and is contraindicated during abrupt alcohol withdrawal, because bupropion then increases the risk of seizures.

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. Consultations are booked in the app, which makes it easier for people with changing schedules to find a time outside working hours. During the video call, the doctor takes a medical history and reviews test results and weight and blood pressure measurements taken at home. Blood pressure is measured with a cuff sized to the arm, because a cuff that is too narrow gives falsely high readings in people with obesity.

The five monthly medical reviews use app data without a call, including while the dose is being increased. The doctor assesses tolerability, weight and treatment progress and adjusts the dose or medicine if needed. If a new symptom appears, the doctor does not postpone a necessary examination until a planned consultation and decides where and how urgently the patient should be examined. Patients have blood taken at a laboratory near home and send us the result before the consultation. The patient receives the e-prescription as a code by text message.

Medicines authorised for obesity are not reimbursed for this indication, so the patient pays for the medicine. Reimbursement of semaglutide in type 2 diabetes has separate conditions and does not cover the treatment of obesity alone. In primary care, a family doctor can diagnose obesity, order basic tests, treat related conditions and refer the patient to a specialist clinic. The Moje Zdrowie programme in primary care also includes educational advice on topics such as diet, which may be given by a dietitian or another authorised member of the team; this is not full individual dietary therapy at every practice.

The NFZ funds the diagnosis of sleep apnoea with a referral. For adults, the device used to treat sleep apnoea has a reimbursement limit and a patient contribution, so the patient usually pays part of the cost. We issue a referral for sleep diagnostics when the medical history suggests it and do not postpone it until weight loss is complete. Tests ordered within the NFZ according to clinical indications are publicly funded, but a referral from a private appointment does not guarantee that every test will be free. Bariatric operations are performed under the NFZ after assessment at a surgical centre; the KOS-BAR pilot programme ended on 30 June 2026, and surgical treatment of obesity under the NFZ remains available. The patient pays for the obesity treatment programme at Nasz Gabinet and separately for the medicine from the pharmacy. The programme includes two online consultations with a psychologist; dietitian and psychodietitian consultations are not included.

The 2022 recommendations of ASMBS and IFSO, international societies for bariatric and metabolic surgery, lowered the thresholds for surgery. The Polish bariatric consensus of 2025 gives a BMI of 35 or more regardless of obesity-related conditions and allows surgery to be considered at a BMI of 30 to 34.9 in people with type 2 diabetes that remains poorly controlled despite treatment. Meeting the threshold does not mean automatic surgery. The decision is made by the assessing centre after evaluating BMI, health conditions, nutritional status and physical function, and clinical criteria are not the same as the conditions for NFZ funding.

We discuss a referral for a surgical consultation with patients who meet the clinical criteria when current treatment is not effective enough or when obesity is accompanied by a condition that surgery may improve, such as poorly controlled diabetes or severe sleep apnoea. The consultation does not have to wait until all non-surgical treatment options have been exhausted. Patients can also choose a hospital outside their own province. Before surgery, we help reduce body weight, control diabetes and blood pressure and correct deficiencies, for example of iron and vitamin D, and we refer the patient for a psychological consultation. After surgery, the patient takes supplements for life; the bariatric team decides which ones, how often blood tests are needed and how many meals to eat, depending on the type of operation and the stage of care. We also warn patients about the bone loss that accompanies rapid weight loss after surgery and that some medicines are absorbed differently afterwards.

Before referring a shift worker, we discuss how to plan recovery and a safe return to work, including how to distribute meals during a shift after the operation. Surgery does not end obesity treatment but changes how it is managed; some patients return to medication after a few years because of weight regain.

A patient from Ustka, Sławno, Lębork, Bytów, Miastko or another town in central Pomerania goes through the whole programme from home, because consultations with the doctor and the psychologist take place by video. Blood tests are done at a laboratory near home.

We check where and when sleep diagnostics can be carried out when issuing the referral. We issue the referral when the medical history suggests a sleep disorder and treat obesity in parallel with the diagnostic process.

NFZ-funded obesity treatment usually starts with a family doctor, who diagnoses the disease, treats related conditions and refers the patient to a specialist if needed. The NFZ waiting-times directory has no entry for a metabolic diseases clinic in Słupsk, which does not mean that obesity is not treated in primary care or at other clinics. For Pomorskie Province, the directory lists four metabolic diseases clinic entries, but these are not four confirmed clinics for adults. The nearest entry, in Chojnice, covers services for children and adolescents up to 18. One of the Gdańsk entries also concerns children aged 0 to 18: according to data for August 2026, 719 people were waiting there, with an average wait of 127 days. For the other Gdańsk entry and the Gdynia entry, the scope of services and accepted age range need to be confirmed with the facility. For the same period, these entries recorded 336 people and an average wait of 135 days in Gdańsk, and 770 people and an average wait of 187 days in Gdynia. The average waiting time is not the first available appointment. A referral is required for a specialist clinic, and the clinic decides how often follow-ups take place.

The Association of Polish Surgeons' list of bariatric centres includes six centres in Pomorskie Province, one of them in Słupsk. Eligibility and funding conditions for surgery need to be checked with the chosen centre. In our online programme the patient books consultations themselves in the app, so they can be fitted around the work schedule. Obesity medicines are paid for in full regardless of who issued the prescription, and their price varies between pharmacies.