Obesity treatment in Słupsk

Obesity is classified as E66 in the International Classification of Diseases. In its 2024 recommendations, PTLO recognises it as a chronic disease: one that does not resolve on its own and returns when treatment stops. Women working two shifts who lost 11 kg over six months on a diet found online usually weigh as much a year later as they did before the diet. This is due to the physiology of hunger and satiety. After losing body fat, the body responds in two ways: it burns less energy than its weight would suggest and increases secretion of ghrelin, the hormone that triggers hunger. The hypothalamus also stops responding to leptin, the hormone that signals fat reserves. Once the diet ends, the patient eats more than before and feels hungrier after the same portion.

There are also causes nobody has asked her about. These include medication, thyroid disease, emotional eating and, in some patients, a circadian rhythm disrupted by shift work and short sleep. Many of our patients from Słupsk have a disrupted circadian rhythm because working in industry and retail here often means working shifts. Fat tissue itself also releases hormones: it raises insulin levels, produces oestrogens and substances that maintain chronic inflammation. This explains the links between obesity and type 2 diabetes, hypertension, fatty liver disease and sleep apnoea.

We approach treatment as we would for any chronic disease. The doctor makes a diagnosis, selects medication, checks its effect every month, changes it if necessary and plans treatment over years. The dietitian designs meals around the patient's actual daily schedule, while the specialist in the psychology of eating addresses emotional eating.

Our diagnosis is based on two measurements and a medical history. The first measurement is BMI: weight divided by height in metres squared. For someone 165 cm tall and weighing 92 kg, it is 34. The World Health Organization thresholds adopted by PTLO are the same for both sexes: overweight starts at 25, class I obesity at 30, class II at 35 and class III at 40. This measure is unreliable in people with substantial muscle mass and says nothing about where fat is stored.

The second is waist circumference, measured with a tape measure during a relaxed exhalation, halfway between the lowest rib and the iliac crest. The International Diabetes Federation sets the threshold for abdominal obesity at 80 cm in women and 94 cm in men, regardless of BMI. Where fat accumulates affects the risk of complications: fat around the abdominal organs releases inflammatory substances and raises insulin levels more strongly than fat on the thighs. A driver with a BMI of 29 and a 108 cm waist is therefore at greater risk of diabetes than a colleague with the same BMI and a 94 cm waist. Finally, we take a weight history: how much the patient weighed at age 20, when weight gain began and after which event, how often they lost weight and how many kilograms returned, their work schedule and how much they sleep on workdays and days off.

At what BMI can we prescribe medication?

At 30 or above, BMI alone is sufficient. Between 27 and 30, prescribing is only an option once complications have developed: prediabetes or type 2 diabetes, hypertension, lipid disorders or obstructive sleep apnoea. Medication is therefore justified in a shift worker with a BMI of 28, a 106 cm waist and glycated haemoglobin of 6.0 percent. With a BMI between 25 and 27, we focus on diet, activity and improving sleep, and only consider pharmacotherapy where insulin resistance with abdominal obesity is documented. Age alone does not rule out treatment, but it changes the choice of medicine: we do not use liraglutide above the age of 75 and introduce other medicines more cautiously because research in this age group is limited.

Treatment is provided by internal medicine specialists certified by PTLO. The first medical consultation costs PLN 250, lasts about an hour and takes place at the clinic or online. The doctor takes a weight history, reviews current medicines, weighs the patient, measures their waist and blood pressure, checks test results and requests any missing tests. They also ask specifically about working hours and sleep, because these determine meal times and when the patient will inject their medicine. Patients with a complete set of tests who meet the criteria receive an electronic prescription for the starting dose and a dietitian appointment. Before they leave, we teach them how to use the injection pen.

Reaching the target dose takes three months. During this period, we meet by video every 4 weeks: patients report their weight and blood pressure measured at home and explain how well they tolerate the medicine. The doctor then decides on the dose and sends the next electronic prescription code. Resistance training starts in the first week, because weight falls fastest early on, when it is easiest to lose muscle instead of fat. We repeat blood tests in month four. In month six, after three months on the full dose, we assess whether the medicine has worked: PTLO considers it effective if weight has fallen by at least 5 percent. Anyone who has not reached this threshold receives a medicine from another group. During the second half of the year, the dose stays the same, reviews take place every 4 to 8 weeks and patients attend the clinic once a quarter for a waist measurement and examination. After twelve months, we decide together whether to continue the medicine or start reducing the dose.

What we do not do when treating obesity at Nasz Gabinet Słupsk

• We do not make treatment conditional on giving up shift work. Patients earn their living through shift work, so we adapt treatment to their schedule rather than issue recommendations they cannot follow.
• We do not treat insomnia with sleeping tablets or renew prescriptions for them. For chronic insomnia, we refer patients to a psychiatrist or sleep disorders clinic; where sleep apnoea is suspected, we refer them for a sleep study.
• We do not assess fasting glucose from blood taken immediately after a night shift. We ask patients to repeat the test after a day when they have slept through the night, to avoid diagnosing diabetes from a result that may look different a week later.

The list of tests before the first prescription contains eight items, each intended to confirm or change the treatment decision. Glycated haemoglobin and fasting glucose establish whether the patient already has prediabetes or diabetes, which determines both the BMI threshold and the choice of medicine. Creatinine with calculated eGFR assesses kidney function; a result below 30 ml/min rules out liraglutide. TSH rules out an underactive thyroid, which causes weight gain, fatigue and feeling cold: symptoms easily confused with obesity. The lipid profile includes triglycerides and cholesterol. ALT and AST aminotransferases indicate whether fat is accumulating in the liver, uric acid indicates the risk of gout and a full blood count may be the first sign of anaemia, which we investigate separately. We ask patients to repeat tests more than six months old. We accept more recent results regardless of who ordered them; patients can have missing tests at any laboratory in Słupsk and send us a photograph before their appointment.

We also review all medication, preferably with the packaging or photographs of it, including supplements. Several medicine groups promote weight gain: glucocorticoids, insulin, sulfonylureas and some anti-seizure medicines, antidepressants and antipsychotics. Patients must not stop any of these on their own. If one interferes with obesity treatment, we write to the prescribing doctor to ask about an alternative from the same group with less effect on weight. We pay separate attention to medicines for blood pressure and diabetes because their doses usually need to be reduced after weight loss.

Additional assessments for patients who work nights

For patients on permanent nights or rotating shifts, we diagnose diabetes and prediabetes using glycated haemoglobin rather than a single glucose reading, because individual readings depend on the time of day and when the patient last slept. We also ask for a week's blood pressure readings, marking those taken after a night shift. If snoring includes pauses in breathing, morning headaches and falling asleep during the day, we refer for a sleep study before beginning weight loss treatment. We take daytime sleepiness more seriously in professional drivers and machine operators than in other patients because it determines their fitness for work.

Patients ask why they are gaining weight despite watching their diet. For some, their working hours are the reason. The body follows a circadian rhythm set by light: melatonin levels rise in the evening, cortisol rises towards morning and glucose tolerance is markedly higher in the morning than in the middle of the night. The same meal raises blood glucose more at night than at midday. Shift work forces people to eat at night and sleep during the day, against this rhythm. Once it is disrupted, insulin levels rise, the lipid profile worsens and appetite for high-calorie food increases.

A meta-analysis of 26 studies involving 311,334 participants found that shift work was associated with a 25 percent higher risk of overweight and a 17 percent higher risk of obesity. A second meta-analysis of 28 studies found an odds ratio of 1.23 for night-shift work, meaning that obesity was more common among night workers than day workers. Permanent night work showed worse results than rotating shifts, and the strongest association was with abdominal obesity. A separate analysis found an approximately 10 percent higher risk of type 2 diabetes among shift workers. All these studies are observational: they show associations and do not prove that working hours alone cause weight gain. Some of the difference comes from eating habits, less physical activity and smoking. However, successive meta-analyses show the same pattern.

How much does an hour of sleep matter when losing weight?

In a meta-analysis of more than 600,000 adults, short sleepers had a 55 percent higher risk of obesity, and each hour less sleep was associated with a BMI 0.35 points higher. In an intervention study, ten adults with overweight followed the same calorie deficit twice, once with 8.5 and once with 5.5 hours of sleep. With less sleep, the proportion of weight lost as fat was 55 percent lower, loss of fat-free mass was 60 percent greater and participants were hungrier. In a second study conducted at home in 80 people sleeping less than 6.5 hours, simply extending sleep by 1.2 hours reduced daily energy intake by 270 kcal without any dietary advice. That is roughly one cheese roll a day.

How we adapt treatment to working hours

We start with sleep at a fixed time: the patient sleeps during the same hours each day regardless of their shift and adds a nap after a night shift. Next, we change meal times. We suggest eating the main meal before leaving for work and having a light protein snack at night, because night-time meals raise blood glucose more and more often lead to another helping towards morning. We stop caffeine several hours before planned sleep; otherwise, the patient goes to bed tired but cannot fall asleep. Finally, we address light: bright in the first half of the shift, dim on the way home and windows covered in the bedroom.

Injection times can be adapted to changing schedules. Semaglutide and tirzepatide are injected once a week at any time of day, so we choose one fixed day, usually a day off. Liraglutide requires a daily injection at approximately the same time, making it less suitable for schedules that change every week. Orlistat is taken with meals containing fat, including night-time meals. When switching from day to night shifts, we do not move the weekly dose or make up for missed injections with a double dose.

We do not promise that shift work will stop getting in the way. Some patients lose weight more slowly on nights than people working fixed hours. We explain this at the first appointment so that, after three months, slower progress is not seen as a personal failure. The risk of obesity also increases with years of shift work. We set a more cautious target for someone who has worked shifts for twenty years than for someone who has done so for a year.

GLP-1 is a hormone released by the intestine after a meal. It suppresses appetite, slows stomach emptying and stimulates insulin secretion, but breaks down within minutes. Medicines in this group mimic the hormone without breaking down as quickly, so they work for many hours or days. Patients feel full with a smaller portion and stop thinking repeatedly about food between meals. Patients most often describe the second effect if they constantly thought about their next meal before treatment. Tirzepatide also stimulates the receptor for another intestinal hormone, GIP, and reduces body weight more than semaglutide in clinical trials. Semaglutide and tirzepatide are injected under the skin of the abdomen, thigh or upper arm once a week; liraglutide is injected daily. We increase the dose every 4 weeks to give the digestive tract time to adjust.

Clinical trial results translated into kilograms

Registration trials report results as a percentage of body weight, so we convert these into kilograms during appointments. A woman weighing 95 kg usually loses 14 kg after a year of semaglutide treatment and roughly 20 kg with tirzepatide. The first figure comes from STEP 1, where body weight fell by 14.9 percent after 68 weeks, compared with 2.4 percent in the placebo group. The second comes from SURMOUNT-1, where tirzepatide at 15 mg reduced weight by 20.9 percent after 72 weeks, compared with 3.1 percent on placebo. Liraglutide had the smallest effect: in SCALE, body weight fell by 8.4 kg after 56 weeks, compared with 2.8 kg on placebo. However, individual results varied widely: some people lost twice the average, others almost nothing, and this cannot be predicted beforehand. That is why, after 3 months on the full dose, we check whether body weight has fallen by at least 5 percent. If not, we change the medicine instead of waiting another quarter.

Why stopping medication needs a separate plan

When STEP 1 ended, participants stopped the medicine and follow-up care ended. Within a year, they regained two-thirds of the weight lost, and blood glucose and blood pressure returned to pretreatment levels. We therefore treat withdrawal as a separate stage of treatment rather than its end. We gradually reduce the dose once weight has been stable for several months, eating habits are established and resistance training has a regular place in the week. Reviews continue for six months after the final injection. Anyone who gains 5 percent of their body weight after stopping resumes medication. We do not regard this as failure, because relapse is part of a chronic disease.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are authorised in Poland for treating obesity. However, patients arrive with lists found online that also include Ozempic, Rybelsus and Victoza. These three contain semaglutide or liraglutide, the active ingredients in Wegovy and Saxenda, but their indication covers type 2 diabetes only. What may be prescribed for obesity is determined by the summary of product characteristics, not the active ingredient alone.

What explains the difference between Wegovy and Ozempic?

Both contain semaglutide, but Ozempic has doses up to 2 mg and is authorised for diabetes, while Wegovy has doses up to 2.4 mg and is authorised for obesity on the basis of the STEP trial programme. Rybelsus is oral semaglutide, also restricted to diabetes. The same applies to liraglutide: Saxenda at 3 mg treats obesity, while Victoza at up to 1.8 mg treats diabetes. Mounjaro, or tirzepatide, is the only product authorised for both diseases. A person without diabetes who takes Ozempic receives it outside its authorised indication and at a dose never studied for obesity treatment. If the prescription was reimbursed, NFZ may require the doctor to repay the cost. Our patients without diabetes therefore receive Wegovy or Mounjaro; those with type 2 diabetes receive a medicine agreed with their diabetes specialist.

What patients pay at the pharmacy and why prices vary

Patients pay the full cost of their medicine because none of the five products is reimbursed for this indication. In September 2026, a month of treatment costs: Mounjaro PLN 800-1900, Saxenda PLN 500-1250, Wegovy PLN 550-890, Mysimba PLN 370-600 and orlistat PLN 160-350. The first figure in each range is for the starting dose and the second for the target dose, so patients planning their treatment budget should expect the upper end after a few months. The Saxenda range is so wide because cheaper liraglutide equivalents are available alongside the original product. Prices for the same dose differ between pharmacies by several dozen złoty, so we ask patients to compare them before their first purchase and then use one pharmacy consistently.

Who may benefit more from oral medicines?

Two medicines are taken orally. Although less effective than injections, they suit some patients better. Mysimba contains naltrexone and bupropion, which act on the brain's reward system: food becomes less effective at improving mood, so the patient eats in response to emotions less often. In COR-I, weight fell by 6.1 percent after 56 weeks compared with 1.3 percent on placebo; its product characteristics require stopping it if weight has not fallen by 5 percent after 16 weeks. We do not use Mysimba in uncontrolled hypertension, epilepsy, bipolar disorder, a history of bulimia or anorexia, during opioid treatment or during alcohol withdrawal. We offer it to people who eat in response to emotions and those who do not want to inject their medicine. Orlistat, sold as Xenical, blocks absorption of roughly one-third of the fat in a meal. In studies, weight loss after a year was around 3 kg greater than with placebo. It requires a reduction in dietary fat because otherwise it causes oily stools. We offer orlistat to patients with mild overweight and those for whom other medicines are contraindicated.

The semaglutide product characteristics list one absolute contraindication: hypersensitivity to the active substance. However, there are other situations in which we do not use these medicines. We do not give them during pregnancy or breastfeeding. We also avoid them in gastroparesis, or stomach paralysis, and severe kidney failure, and take particular care after previous pancreatitis. For patients with diabetes treated with insulin or sulfonylureas, we reduce these doses together with their diabetes specialist because otherwise the risk of hypoglycaemia increases. We pay particular attention to doses in night workers, as symptoms of hypoglycaemia can easily be mistaken for fatigue after a shift.

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

Digestive symptoms affect most patients during this treatment. In STEP 1, nausea occurred in 43.9 percent of people taking semaglutide compared with 16.1 percent in the placebo group; in half of those affected, nausea resolved within 8 days. Diarrhoea was reported in 29.7 percent of participants, vomiting in 24.5 percent and constipation in 24.2 percent; 4.3 percent stopped treatment because of digestive symptoms. The days immediately after a dose increase are the hardest, so we increase it every 4 weeks and keep the previous dose for another month if tolerance is poor. Smaller portions, slower eating and avoiding fatty food while adjusting can help. We also monitor the gallbladder, because gallstones occurred in 1.6 percent of treated patients and gallbladder inflammation in 0.6 percent. Rapid weight loss promotes stone formation regardless of the medicine. Acute pancreatitis occurs in around 0.2 percent of treated patients. Upper abdominal pain radiating to the back with vomiting requires urgent hospital assessment.

When to call us immediately

We want to hear about certain symptoms immediately rather than at the next scheduled appointment. Please call if vomiting lasts longer than a day and the patient cannot drink anything. The same applies to abdominal pain radiating to the back. The third warning sign is yellowing of the skin or whites of the eyes; the fourth is weight loss of more than 2 kg in a week despite eating normally. We also ask patients with diabetes to contact us if their visual acuity deteriorates rapidly, because rapid blood glucose correction temporarily worsens retinopathy. We answer calls every day from 8am to 8pm; outside these hours, night and holiday healthcare services are on duty.

How to recognise a genuine injection pen

Counterfeit semaglutide pens have appeared in Europe, including Poland, reaching people who bought the medicine outside pharmacies. Pharmacy packaging carries a batch number and a two-dimensional code, which the pharmacist checks in the European medicines verification system when dispensing the medicine. Please do not buy obesity medicines from classified advertisements, auction websites or private individuals, even if the price is tempting. Patients receive their prescription from us as a code by text message and can fill it at any pharmacy.

The medicine reduces appetite, but it does not determine what patients eat or at what time. The dietitian therefore starts with a dietary history and the daily schedule: meals are planned differently for someone working from seven to three than for someone whose waking time changes every week. We set an energy deficit of 500 to 750 kcal below requirements and protein intake at 1 to 1.5 g per kilogram of ideal body weight, spread across all meals, because rapid weight loss involves losing muscle as well as fat. We add fibre from vegetables, groats and whole grains to prevent constipation when stomach emptying is slowed. We also ask patients to drink at least one and a half litres of fluids daily. With night work, the main change is meal timing: the largest meal before the shift, a portion of protein and vegetables at night instead of a sweet vending-machine snack, and a light breakfast on arriving home so sleep does not start on a full stomach.

Alongside the meal plan, we recommend resistance exercise twice a week and walking every day. A gym membership is unnecessary: resistance bands and body weight are enough at home, and with shift work, two short sessions are easier to maintain than one long one. Exercise is intended to preserve muscle; it burns relatively few calories. Muscle mass determines metabolic rate after treatment ends.

When we involve a specialist in the psychology of eating

Some patients eat because of tension rather than hunger: after a difficult shift or an argument. A GLP-1 analogue reduces physical hunger but does not change tension-driven eating, so the first weeks of treatment bring less benefit than these patients expected. The specialist in the psychology of eating teaches them to recognise the moment before they reach for food and plan meals so they do not arrive home on an empty stomach. Together, they also look for other ways to relieve tension. For binge-eating disorder and night eating syndrome, which PTLO lists among eating disorders requiring diagnosis, we work over a longer period and suggest a psychiatric consultation alongside treatment. During the first year, we work as a team, so the doctor, dietitian and specialist in the psychology of eating see the same measurements and notes.

A gram of pure alcohol provides 7 kcal, only slightly less than a gram of fat. The body does not store these calories for later: it burns them first. While the liver breaks down alcohol, fat from a meal is not burned. Half a litre of beer contains around 250 kcal and a shot of vodka around 110, so three beers after a shift wipe out the entire daily deficit. Alcohol also raises blood pressure and weakens control over eating. Drinking after a night shift to fall asleep more easily shortens the time to sleep, but fragments the second half of sleep and suppresses the dreaming phase, making sleep less restorative.

When stomach emptying is slowed, alcohol is absorbed unevenly, making it harder for patients to judge how much they have drunk and worsening nausea after an injection. In people taking insulin or sulfonylureas, the risk of hypoglycaemia rises, usually at night when nobody is measuring blood sugar. We do not require complete abstinence, but we ask patients to be honest about how much and how often they drink, because both the pace of weight loss and safety depend on it.

In some patients, discussing weight reveals that drinking needs more urgent attention. Over time, an evening beer after a shift becomes a condition for falling asleep. Weight loss then takes second place, and we suggest starting with addiction treatment. At the same clinic, we provide alcohol addiction treatment in Słupsk and addiction therapy. Naltrexone, an ingredient in one obesity medicine, is also used to treat alcohol dependence.

Treatment can start remotely, and with changing working hours this is usually easiest, because an appointment can fit between shifts. During a video call, the doctor takes a medical history, reviews test results and weight and blood pressure readings recorded at home, and issues a prescription on that basis. We invite patients to the clinic when an in-person examination is needed. The doctor examines the thyroid and checks the skin in the armpits and groin for acanthosis nigricans. We measure waist circumference and blood pressure in both arms using a cuff suited to the arm's size, because a cuff that is too narrow gives an artificially high reading in a person with obesity.

A video call is sufficient during dose escalation, when we discuss medicine tolerance and review measurements recorded at home. We meet in person once a quarter and whenever a new symptom requires examination. Patients have blood taken at a laboratory near home and send the results before their appointment. They receive their electronic prescription as a code by text message regardless of the consultation format. We also offer appointments before eight in the morning and after six in the evening, so patients do not have to choose between sleep and speaking to a doctor after a night shift.

No medicine authorised for treating obesity is reimbursed, so the monthly medicine cost remains the patient's responsibility. A family doctor can diagnose the disease, order basic tests and refer to a specialist clinic. However, a primary care appointment lasting a dozen or so minutes is insufficient to manage this treatment, and the country has few metabolic disease clinics, with waits of several months. The Pomeranian regional government does not run an obesity prevention programme for adults.

NFZ does fund sleep apnoea diagnosis and treatment with a device that maintains pressure in the airways, following referral to a sleep disorders clinic. Waiting times are measured in months, so we issue a referral as soon as the history indicates a need rather than postponing it until weight loss is complete. Patients can also have blood tests ordered by their family doctor and a referred abdominal ultrasound free of charge, and undergo bariatric surgery if they meet the criteria. They pay for appointments with us, pharmacy medication, and dietitian and specialist in the psychology of eating consultations. Our price list gives the fees for these consultations.

The eligibility threshold for bariatric surgery was lowered by guidelines published in 2022 by surgical societies, including the Association of Polish Surgeons. Surgery is considered from a BMI of 35 without comorbidities and from a BMI of 30 in people with type 2 diabetes, regardless of their diabetes treatment. PTLO estimates that around half a million Poles meet the criteria, while several thousand operations are performed each year.

We refer for a surgical consultation in two situations: when a patient meets the criteria but more than a year of properly managed conservative treatment has not produced lasting results, and when class III obesity coexists with diabetes or severe sleep apnoea. Patients may choose a hospital outside their own region. Before surgery, we reduce weight, bring diabetes and hypertension under control, correct iron and vitamin D deficiencies and refer for a psychological consultation. After surgery, patients take vitamins and trace elements for life and repeat blood tests every six months. We also explain the loss of bone mass that accompanies rapid weight loss after surgery and that some medicines are absorbed differently afterwards.

Before referring a shift worker, we ask whether they can take sick leave during recovery and whether, after returning to work, they will be able to eat five small meals over the day, because this affects how well they tolerate surgery. Surgery does not end obesity treatment: it changes how it is delivered. Some patients return to medication after a few years because they regain weight.

Patients travel to our clinic at Piłsudskiego 2 from across central Pomerania, including Ustka, Kobylnica, Sławno, Kępice, Główczyce, Lębork, Bytów, Miastko and Darłowo. We arrange treatment to minimise travel: the first appointment and quarterly measurements take place at the clinic, monthly reviews by video, and blood tests at a local laboratory.

Patients from Bytów and Słupsk counties have to travel to another town for a sleep study, and waits are measured in months. We therefore issue referrals at the first appointment rather than after several months of observation, and treat obesity while patients wait for the study.

Słupsk has no NFZ-funded metabolic disease clinic. Of the four such clinics in the Pomeranian region, the nearest is in Chojnice. According to the NFZ treatment waiting-time guide, in August 2026 it had 165 people waiting, with an average wait of 56 days. In Gdańsk and Gdynia, the July figures were 698 and 742 people respectively, with average waits of 126 and 229 days. An appointment requires a family doctor's referral, and patients return to the same clinic for reviews every few weeks, so each one involves a journey from Słupsk.

With a referral, patients can attend any bariatric surgery centre. On the Association of Polish Surgeons' list, one of the six centres in the Pomeranian region is in Słupsk. Patients who do not want to travel to Chojnice or the Tricity for reviews can receive treatment with us without a referral, and we schedule follow-ups around their night shifts. Pharmacy medication costs the same through either route.