Obesity treatment Szczecin

Obesity is a chronic disease of the system that regulates appetite. It has the code E66 in ICD-10, and the Polish Society for the Treatment of Obesity (PTLO) published dedicated clinical guidelines in 2024. At Nasz Gabinet Szczecin, we manage obesity like any chronic disease: diagnose it using measurements, set a goal for the coming months, prescribe medicine and continue seeing the patient over the following years.

Hormones send the fullness signal to the brain: the intestine releases GLP-1 after a meal, and fat tissue continually releases leptin. In a person with obesity, this signal reaches the brain in a weakened form, so fullness fades sooner. When the patient starts eating less, the body treats this as a threat: it slows metabolism and intensifies hunger, while daily energy expenditure falls by several hundred kilocalories. This is why attempts to lose weight usually end in a return to the starting weight or even a higher one.

Excess fat tissue damages blood vessels, the liver and joints for years before the first symptom appears. According to PTLO, obesity increases the risk of more than 200 diseases; among patients from Szczecin, we most often find hypertension, prediabetes and type 2 diabetes, fatty liver disease, obstructive sleep apnoea and knee pain from excess load. Losing 5 to 10 percent of body weight improves these complications, so that is our goal for the first six months, rather than a promise of returning to the weight of youth.

We diagnose obesity using two measurements: BMI and waist circumference. BMI is weight in kilograms divided by height in metres squared. A woman who is 165 cm tall and weighs 88 kg has a BMI of 32.3, meaning class I obesity. PTLO thresholds for adults are: overweight from 25, class I obesity from 30, class II from 35 and class III from 40. At a height of 165 cm, class I obesity starts at around 82 kg and class II at around 95 kg.

BMI alone does not show how much of this weight is fat or where it has accumulated, so we also measure waist circumference. Under International Diabetes Federation criteria, abdominal obesity is diagnosed from 80 cm in women and 94 cm in men. Visceral fat around the liver and pancreas releases inflammatory substances and raises the risk of diabetes and heart attack more than subcutaneous fat does. A man with a BMI of 28 and a waist of 108 cm needs treatment even though the BMI table still places him in the overweight category.

Which BMI and test results are reasons to book a first appointment?

We book appointments for anyone with a BMI of 30 or more. At a BMI of 27 to 29.9, we see patients who already have prediabetes, type 2 diabetes, hypertension, lipid disorders, fatty liver disease, sleep apnoea or overloaded joints. We also see people with a normal BMI whose waist circumference exceeds the normal range and whose blood tests show insulin resistance, meaning a poor response to their own insulin. Obesity medicine is not a separate medical specialty in Poland; an obesity medicine doctor holds a PTLO certificate. At our practice, obesity treatment is provided by doctors with experience in internal medicine.

The first medical appointment at the practice on ul. Bohaterów Getta Warszawskiego costs PLN 250; an online appointment costs the same. The doctor asks how the patient's weight has changed, which diets they have tried, which medicines they take regularly and which illnesses run in their close family. The doctor then weighs the patient, measures height, waist circumference and blood pressure, reviews the results brought in and requests any missing tests. A patient with a complete set of tests leaves the first appointment with an e-prescription for the lowest dose and an appointment with the dietitian.

PTLO recommends planning obesity treatment over years, because a course lasting a few weeks does not make results last. The first twelve months look like this:

Follow-ups take place every 4 weeks because this is the schedule for increasing semaglutide and tirzepatide doses.

The goal for the first six months is to lose 5 to 10 percent of body weight, or 7 to 15 percent in a patient with type 2 diabetes. We decide on treatment beyond the first year together with the patient, based on progress, follow-up tests and how the patient manages eating without support from the medicine.

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

• We do not dispense medicines at the practice. Patients receive an e-prescription code and have it dispensed at a pharmacy of their choice.
• We do not see underage patients. Children and adolescents are treated in paediatric clinics.
• We do not perform surgery. We provide and document non-surgical treatment, and refer eligible patients to a surgical centre.

Blood tests answer two questions: which organs obesity has already damaged and whether any result is a contraindication to the medicine. The panel includes fasting glucose and glycated haemoglobin, a lipid profile, liver enzymes ALT and AST, creatinine with calculated eGFR, TSH, uric acid and a full blood count. Three results matter most: glycated haemoglobin reflects blood glucose over the last 3 months, eGFR describes kidney function and TSH thyroid function. For women with irregular periods, we add hormone tests for polycystic ovary syndrome. We repeat the whole panel after 3 months of treatment.

We accept recent results from primary care or routine occupational health examinations without reservation, so the patient does not pay for them again. Missing tests can be done at any laboratory in Szczecin; a photograph of the result or a laboratory printout is enough.

When the thyroid, cortisol or a medicine is responsible for weight gain

Raised TSH suggests hypothyroidism, which slows metabolism; we confirm it by measuring FT4 and treat the thyroid condition first, then assess how much weight is due to obesity itself. Less often, the cause is excess cortisol in Cushing's syndrome, which causes a rounded face, broad purplish stretch marks and hypertension in a young person. Among secondary causes, however, we most often find medicines: some antidepressants, antipsychotics and antiepileptic drugs, insulin, older diabetes medicines from the sulfonylurea group and steroids. We do not stop a medicine prescribed by a psychiatrist or neurologist; our doctor writes to that specialist to ask whether an alternative with less effect on weight can be chosen.

Obesity is the most common cause of obstructive sleep apnoea. Fat accumulating around the throat and neck narrows the airways, which collapse for a dozen or so seconds during sleep; breathing stops and the patient briefly wakes. The patient does not remember this but wakes tired in the morning. We suspect apnoea when a patient snores loudly with pauses in breathing, wakes with a dry mouth or headache, falls asleep during the day and has hypertension that does not respond to treatment.

It is usually the patient's partner who tells us about the breathing pauses, rather than the patient.

Severity is described by the AHI, the number of apnoeas and hypopnoeas per hour of sleep: 5 to 15 is mild, 15 to 30 moderate and over 30 severe. Only a sleep study, either respiratory polygraphy or full polysomnography, confirms the diagnosis; a family doctor or specialist provides a referral for suspected apnoea, code G47.3. A CPAP device remains the standard treatment for severe disease: during sleep, it delivers air at continuous pressure to keep the airways open.

How much sleep apnoea decreased in patients treated with tirzepatide

In the two SURMOUNT-OSA trials, published in 2024, adults with obesity and moderate or severe sleep apnoea received tirzepatide for 52 weeks. At baseline, patients had around 50 apnoeas and hypopnoeas per hour of sleep. Among those not using a device, AHI fell by an average of 25.3 per hour versus 5.3 with placebo; among device users it fell by 29.3 versus 5.5. Systolic blood pressure also fell, and patients rated their sleep quality more highly.

The European Medicines Agency assessed these results in December 2024. It did not grant tirzepatide a separate indication for sleep apnoea, but agreed to add the trial results to the summary of product characteristics, the official medicine information; the medicine was licensed for this indication in the United States in the same month. In Poland, doctors therefore prescribe tirzepatide for obesity, and the number of night-time breathing pauses falls as weight decreases. Patients using CPAP continue to use it. Only a respiratory specialist, after a follow-up sleep study, decides on changing settings or stopping the device; patients must never make that decision themselves simply because they have lost weight.

A GLP-1 analogue mimics the hormone released by the intestine after a meal. Subcutaneous semaglutide and tirzepatide maintain a steady concentration throughout the week, so one injection a week is enough. They slow gastric emptying, making a meal satisfying for longer, and strengthen the fullness signal in the brain, so patients serve themselves smaller portions without going hungry. Tirzepatide also stimulates the receptor of a second intestinal hormone, GIP, and reduces weight more than semaglutide alone. PTLO lists five medicines licensed for obesity in Poland: semaglutide, tirzepatide and liraglutide as injections, and naltrexone with bupropion and orlistat as tablets.

Patients qualify for drug treatment at a BMI of 30 or more, or 27 or more with an obesity-related illness, provided an earlier attempt with diet and exercise did not work. Treatment always starts at the lowest dose because the stomach needs several weeks to adjust to slower emptying; skipping this stage causes nausea and patients give up. We introduce successive doses every 4 weeks for semaglutide and tirzepatide, and weekly for liraglutide.

How much weight participants lost in STEP 1, SURMOUNT-1 and SCALE

In STEP 1, participants taking semaglutide 2.4 mg lost an average of 14.9 percent of body weight after 68 weeks, versus 2.4 percent with placebo. In SURMOUNT-1, tirzepatide 15 mg reduced weight by 20.9 percent after 72 weeks, versus 3.1 percent with placebo. In SCALE, liraglutide 3 mg reduced weight by 8.4 kg after 56 weeks, versus 2.8 kg with placebo. For a participant weighing 100 kg, this meant around 15 kg less on semaglutide and around 21 kg less on tirzepatide. These are averages; some participants lost substantially less.

What happens to weight when a patient stops taking the medicine

Weight loss slows around week 60 because the body then uses roughly as much energy as the patient consumes. The medicine still works, but maintains the achieved weight instead of reducing it. If a patient has lost less than 5 percent after 3 months on the target dose, PTLO recommends changing the medicine; at our practice, this most often means switching semaglutide to tirzepatide. STEP 1 participants followed after stopping semaglutide regained two thirds of their lost weight within a year, and blood pressure and glucose returned to previous levels. We therefore withdraw the medicine gradually, once weight is stable and a nutritional plan is ready for the period without medicine.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are licensed for obesity. Ozempic and Rybelsus are licensed only for type 2 diabetes, although they contain the same substance as Wegovy.

Why semaglutide has three names but only one is used for obesity

The indication depends on the patient group and dose studied by the manufacturer. Wegovy has doses up to 2.4 mg and an obesity licence; STEP 1 studied this product. Ozempic has doses up to 2 mg, while Rybelsus is a tablet; both treat type 2 diabetes. Liraglutide is similarly divided between two products: 3 mg in Saxenda for obesity and a lower dose in Victoza for diabetes. Tirzepatide is an exception, because Mounjaro is licensed for both diseases. For a patient without diabetes, we prescribe a product licensed for obesity, because the other products have not been studied in patients without diabetes and the doctor has no basis for using them.

How much a month of treatment costs at a Szczecin pharmacy

None of these medicines is reimbursed for obesity, so patients pay the full pharmacy price. According to prices from September 2026, a month of Wegovy costs about PLN 550 to 890, Mounjaro PLN 800 to 1900, Saxenda PLN 500 to 1250, Mysimba PLN 370 to 600 and Xenical PLN 160 to 350. For injections, the lower end corresponds to the lowest doses in the first weeks, and the upper end to the full dose. However, the same pack can cost twice as much in one pharmacy as in another, so checking several before having an e-prescription dispensed is worthwhile.

When we suggest tablets instead of injections

Mysimba combines naltrexone and bupropion and acts on the reward system, so it particularly helps people who eat to reward or calm themselves. Patients taking it in COR-I lost 6.1 percent of body weight after 56 weeks, versus 1.3 percent with placebo. We do not prescribe it for people with epilepsy, those taking opioids or those with uncontrolled hypertension. Xenical, containing orlistat, blocks absorption of around one third of dietary fat and produces 2 to 3 kg more weight loss than placebo over a year, at the cost of oily diarrhoea after fatty meals. We suggest tablets when a GLP-1 analogue is contraindicated or poorly tolerated.

Gastrointestinal symptoms are the most common side effects: nausea, vomiting, diarrhoea and constipation. More than one in ten patients report them, most often in the week after a dose increase; they ease over time as the stomach adapts to slower emptying. In STEP 1, 4.5 percent of participants stopped treatment because of them. Smaller portions, avoiding fatty food on injection day and drinking water between meals help; if symptoms persist, we keep the lower dose for longer.

Five symptoms require a call to the practice the same day. The first is severe upper abdominal pain radiating to the back with vomiting, because this can be the start of pancreatitis. The second is pain under the right ribs with fever or yellowing of the skin: gallstones were found in 1.6 percent of patients taking semaglutide and occur more often with rapid weight loss. The third is sudden deterioration of vision in one eye, which may be ischaemic optic nerve damage; in 2025, the European Medicines Agency added this to semaglutide's leaflet as a very rare side effect. The fourth is vomiting or diarrhoea lasting a full day despite drinking fluids, because dehydration strains the kidneys. The fifth is shaking hands, cold sweats and faintness in a patient taking insulin or a sulfonylurea: signs of hypoglycaemia.

Who we do not prescribe a GLP-1 analogue for

We do not prescribe these medicines during pregnancy or breastfeeding; a woman planning pregnancy stops semaglutide at least 2 months beforehand. We do not prescribe them after pancreatitis. We also do not use them in NYHA class IV heart failure or severe kidney or liver failure, because the manufacturer has not provided safety data for these groups. Few patients over 75 have been studied, so we use the medicine cautiously in this age group; liraglutide is not recommended at all at this age. A patient taking contraceptive pills who starts tirzepatide additionally uses condoms for 4 weeks after starting and after each dose increase, because slower gastric emptying reduces pill absorption.

Where counterfeit semaglutide comes from and what has been found in it

Pens sold through classified advertisements and vials labelled as research peptides undergo no quality control. Poland's Chief Pharmaceutical Inspectorate withdrew a counterfeit batch of a semaglutide medicine in October 2023. That same month in Austria, several patients were hospitalised with severe hypoglycaemia because counterfeit pens contained insulin instead of semaglutide. Obesity medicines are bought at a pharmacy with an e-prescription, and doses are increased under medical supervision.

A GLP-1 analogue lowers appetite but does not determine whether the patient loses fat or muscle. In the STEP 1 body composition analysis, roughly two fifths of the loss was lean mass, much of it muscle; with insufficient protein and no training, this proportion rises. After stopping the medicine, it is mainly fat that returns, because muscles do not rebuild themselves. In line with PTLO recommendations, the dietitian agrees a daily deficit of 500 to 750 kcal with the patient and spreads protein across three or four meals, because a large amount will not fit into a single meal while on the medicine. The order of eating affects how quickly patients feel full: protein first, such as lean meat, fish, dairy or pulses, then vegetables, and carbohydrates and fat last.

We recommend training to preserve muscle and help the body manage glucose; calories burnt during exercise are secondary here. PTLO recommends 150 to 300 minutes of moderate activity weekly, plus two resistance training sessions. A patient with knee pain does not run, because running loads the knees with each step; swimming, a stationary bike and Nordic walking are the options. Above 120 kg, we start with 10 minutes a day and add a few minutes each week.

What the eating behaviour specialist does when a patient eats out of anger or boredom

The medicine quietens physical hunger, but the habit of eating under stress remains. The specialist teaches patients to tell the two apart and agrees what to do before opening the fridge: leave the kitchen, call someone or drink a glass of water. When patients describe binge eating with a sense of losing control, the specialist checks for an eating disorder that requires psychotherapy. This work is most useful after stopping the medicine, when appetite returns to its previous level.

A gram of pure alcohol provides 7 kcal. A half-litre can of beer contains about 220 kcal, a 50 ml measure of vodka about 110 kcal and a 150 ml glass of wine about 120 kcal. Four beers over the weekend add up to about 880 kcal, roughly a day and a half of the calorie deficit. The liver breaks down alcohol first and pauses fat burning for several hours, while alcohol itself increases the desire for salty, fatty food.

There are four additional reasons related to the medicine. The stomach empties more slowly, so alcohol absorption is delayed and patients find it harder to judge how much they have already drunk. Alcohol worsens the nausea that can occur after an injection. In someone taking insulin, alcohol raises the risk of hypoglycaemia, which is already greater after starting the medicine. Regular drinking itself increases pancreatitis risk, and pancreatitis is also a rare complication of this drug group. We therefore ask for complete abstinence during the weeks of dose escalation, and afterwards no more than one beer, one measure of vodka or one glass of wine on any one occasion.

Some patients say they no longer feel like drinking while on the medicine. In a study published in JAMA Psychiatry in 2025, 48 people with alcohol dependence were randomly assigned to semaglutide or placebo for 9 weeks; treated participants experienced alcohol craving less often and drank fewer servings on drinking days. This was a small, early study, so we do not use semaglutide as an addiction medicine. We refer patients whose drinking is becoming uncontrolled for alcohol addiction treatment in Szczecin, and those using other substances for addiction therapy. We provide both pathways at the same practice, alongside obesity treatment.

We hold the first appointment at Nasz Gabinet Szczecin, ul. Bohaterów Getta Warszawskiego 16/2. Patients come in person so the doctor can weigh them on scales with adequate capacity, measure waist circumference and blood pressure, examine the abdomen and make a plan for a year or more. Those unable to travel have the first appointment online and send test results and their own weight and blood pressure measurements beforehand; the doctor then decides whether an in-person examination is needed to assess eligibility.

Follow-ups every 4 weeks take place by video, and the e-prescription code arrives by text message immediately afterwards. Patients report weight and blood pressure measured at home and describe side effects; the doctor sets the next dose. We ask patients to come to the practice every 3 months after blood tests, and additionally whenever warning symptoms occur: vision changes, severe abdominal pain or dehydration. Dietitian and eating behaviour appointments can take place at the practice or online, according to the patient's preference.

NFZ-funded metabolic disease clinics treat obesity with a referral from a family doctor. There are three such clinics in the whole West Pomeranian province: two in Szczecin and one in Koszalin. According to waiting-list data from 31 August 2026, the expected appointment is 334 days away at one Szczecin clinic and 659 at the other; in Koszalin it is 136 days away. A patient referred today therefore waits from eleven months to almost two years in Szczecin, with their family doctor managing care in the meantime.

Reimbursement does not include the medicine. The NFZ does not subsidise GLP-1 analogues used for obesity, so patients pay the full pharmacy price regardless of who writes the prescription. Semaglutide is reimbursed only for type 2 diabetes in patients meeting the criteria in the Minister of Health's reimbursement notice. Blood tests, however, can be done free of charge and without a waiting list if ordered by a family doctor; we provide the list of required tests.

At our practice, patients pay for appointments: PLN 250 for the first medical appointment and the same for an online appointment, with dietitian and eating behaviour consultations charged separately; their prices are provided when booking. In return, patients receive an appointment without a referral or waiting list, follow-ups every 4 weeks and an e-prescription after each appointment.

We consider surgery at a BMI of 40 or more, or 35 or more with type 2 diabetes, hypertension or sleep apnoea, when diet and medicines have not produced a lasting effect. Surgical provision in the region is limited: the Association of Polish Surgeons' list includes one bariatric centre in West Pomerania, in Szczecin, out of 67 in Poland; Opole and Świętokrzyskie provinces have the same number. The operation itself is reimbursed like any other procedure. The KOS-BAR comprehensive care pilot, which included preparation and a year of postoperative care, ended on 30 June 2026, and no new programme has launched.

To assess eligibility, the surgical centre requires a documented attempt at non-surgical treatment; our doctor provides and documents this. For 3 to 6 months before surgery, the patient takes a GLP-1 analogue and follows a diet, because losing 5 to 10 percent of body weight reduces liver volume and the risk of complications during surgery. We perform tests, describe the course of treatment and pass the records to the centre.

After surgery, the stomach holds much less food: a few dozen millilitres after gastric bypass and about a cup after sleeve gastrectomy. Iron and vitamin absorption falls, so the dietitian develops a new eating pattern and supplementation plan with the patient, while the doctor monitors the full blood count, iron and vitamins B12 and D. The eating behaviour specialist works on emotional eating, which is the most common reason for weight regain several years after surgery.

Patients travel to our Szczecin practice from Police, Goleniów, Stargard, Gryfino, Nowogard, Pyrzyce and Świnoujście, as well as people working on the German side of the border. A patient from outside the city brings a complete set of results to the first appointment so that only one trip is needed before treatment starts. Follow-ups take place online, and blood tests after 3 months are done at a laboratory in the patient's own town.

If a metabolic disease clinic with a shorter waiting list is closer to the patient, we tell them at the first appointment. The choice is theirs: some start treatment with us and transfer to an NFZ clinic once an appointment becomes available, taking their results and established dose with them; others stay because they prefer a doctor, dietitian and eating behaviour specialist in one place, with follow-ups without a wait.

In West Pomeranian province, 392 thousand adults have obesity, according to Ministry of Health data from 2022 compiled by Poland's Supreme Audit Office. This is comparable to Szczecin's population.

The Supreme Audit Office's review covering 2020 to 2022 showed that the public healthcare system has no dedicated treatment programme for adults with obesity, and the clinics inspected spent a fraction of one percent of their NFZ funding on preventing overweight and obesity. Bariatric surgery remains the only obesity treatment procedure funded from public resources.

An adult Szczecin resident wanting drug treatment for obesity today must therefore wait for an appointment at one of the city's two metabolic disease clinics or pay privately; the medicine costs the same at the pharmacy in either case.