Obesity treatment Szczecin

Obesity is a chronic disease with many causes, classified under ICD-10 code E66. The Polish Society for the Treatment of Obesity (PTLO) published recommendations on its diagnosis and treatment in 2024. After weight loss, changes in appetite and energy expenditure may make it harder to maintain the result. This does not mean that the lost weight must return after every diet. At the Nasz Gabinet clinic in Szczecin, we plan treatment over the long term, including the period of maintaining a lower body weight.

How does obesity develop?

Obesity builds up gradually: over months and years, food and drinks provide more calories than the body burns, and the excess energy is stored in fat tissue. Fat cells first increase in volume, and if the surplus continues, their number also grows. According to PTLO, obesity is an excess of fat tissue that worsens health. Fat tissue produces leptin, which together with GLP-1, released by the intestine after meals, is involved in regulating appetite. Enlarged fat tissue also releases pro-inflammatory substances that reduce the sensitivity of tissues to insulin.

The tendency to gain weight is largely inherited. Twin studies indicate that genes account for 40 to 70 percent of the differences in body weight between people, and children of parents with obesity are at higher risk of the disease. Living conditions also lead to obesity: easily available high-calorie food, many hours of sitting at work and while travelling, shift work, short sleep and chronic stress. Weight can also be gained in connection with pregnancy, menopause and quitting smoking. In some patients, another disease or a medicine contributes to weight gain, so before treatment we check for these causes in test results and on the list of medicines.

What diseases does obesity lead to?

Common complications of obesity include hypertension, type 2 diabetes, fatty liver disease, obstructive sleep apnoea and joint strain. Losing 5 to 10% of body weight may improve health and is often an initial treatment goal. The doctor decides on the treatment methods, the need for medication and the treatment goal together with the patient.

We begin by calculating body mass index (BMI): weight in kilograms divided by height in metres squared. A woman who is 165 cm tall and weighs 88 kg has a BMI of about 32.3, corresponding to class I obesity. In adults, overweight starts at BMI 25, class I obesity at 30, class II at 35 and class III at 40. At 165 cm, the thresholds for classes I and II are approximately 82 and 95 kg.

BMI does not show fat distribution or body composition, so we also measure the waist and assess health. IDF thresholds for abdominal obesity in people of European ancestry are 80 cm for women and 94 cm for men. Excess visceral fat increases metabolic risk. A man with BMI 28 and a waist of 108 cm may need treatment, but waist circumference alone does not establish eligibility for a particular medicine.

When should you seek a consultation, and when can medication be considered?

You can seek advice for overweight, an increased waist circumference or rapid weight gain. Eligibility for medication is assessed separately. For the incretin medicines discussed here and Mysimba, the usual thresholds are BMI at least 30, or at least 27 with an appropriate associated condition, such as hypertension, abnormal blood lipids, sleep apnoea or a glucose regulation disorder. Xenical has an overweight threshold of 28 with risk factors. Insulin resistance, a reduced response to insulin, does not automatically justify these medicines in someone with a normal BMI.

In Poland, an obesity physician is a doctor who treats obesity; this is not a separate medical specialty. PTLO runs a certification programme for doctors.

We treat obesity in patients from Szczecin online, in a 6-month programme for PLN 1,799. The price does not include the medicine, which the patient buys at a pharmacy with an e-prescription. Before the programme starts, the patient has blood tests done and measures weight, waist circumference and blood pressure at home. The doctor assesses the medical history and the results and then decides whether the patient can be treated in the programme. The programme includes two 30-minute doctor consultations, two 40-50-minute online consultations with a psychologist and five medical reviews of app data without a call. The patient books the video consultations in the Nasz Gabinet app. The schedule is counted from the initial consultation.

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

Between consultations the patient enters their weight in the app every week and their body measurements once a month. After the injection, the patient uses the app to take a photo of the pen, which the medical team checks. The doctor already has this information before the check-up. PTLO recommends treatment lasting a year or longer, which is why after the programme we offer a continuation package for 3 months for PLN 350. In the package the doctor reviews the results every month and issues an e-prescription, and there are no video consultations.

An initial goal may be 5 to 10% weight loss; with type 2 diabetes, a goal of 7 to 15% can be considered. These are not mandatory results within six months. We regularly assess effectiveness and tolerability without requiring a trial period off medication.

What don't we do in the obesity treatment programme?

• We do not dispense medicines. Patients have prescriptions dispensed at a licensed pharmacy.
• This programme is for adults. Children and adolescents need paediatric care.
• We do not perform surgery. We provide nonsurgical treatment and share records with a surgical centre when an assessment for an operation is needed.

Tests help identify conditions associated with obesity and guide treatment. The doctor may request fasting glucose, glycated haemoglobin (HbA1c), a lipid profile, ALT and AST, creatinine with eGFR, TSH, uric acid and a full blood count. The selection is individual. HbA1c reflects average blood glucose over roughly 2 to 3 months, eGFR estimates kidney filtration and TSH provides an initial assessment of thyroid function. ALT and AST alone do not diagnose fatty liver or establish its cause. Irregular periods may warrant investigation for conditions including polycystic ovary syndrome.

It helps to have results from primary care or occupational health checks ready. The doctor assesses how current they are and whether they need repeating. Additional tests can be performed at a chosen laboratory; a legible electronic report or printout is useful. Not everyone needs the entire panel repeated every three months.

When weight gain is related to the thyroid, cortisol or a medicine

Raised TSH may suggest hypothyroidism; further assessment includes tests such as free T4. We treat diagnosed thyroid disease while assessing other contributors to excess weight. A rounded face, wide purple stretch marks and hypertension may warrant testing for Cushing's syndrome, but do not establish the diagnosis on their own.

Some antidepressants, antipsychotics, antiepileptics, insulin, sulphonylureas and glucocorticoids can contribute to weight gain. Do not stop them yourself. Any change is decided by the treating doctor in consultation with other clinicians involved.

Obesity is one of the main risk factors for obstructive sleep apnoea. Narrowing and collapse of the upper airway during sleep cause pauses or reductions in breathing and brief awakenings that the patient may not remember. Not everyone who snores has sleep apnoea, and it also occurs without obesity. We ask about pauses witnessed by a partner, daytime sleepiness, morning headaches, a dry mouth and blood pressure that is difficult to control.

AHI is the number of apnoeas and hypopnoeas per hour of sleep. Values from 5 to below 15 indicate mild disease, 15 to below 30 moderate disease, and 30 or more severe disease. Diagnosis requires clinical assessment and a sleep study, such as respiratory polygraphy or polysomnography. A home test may calculate events per recording time, so a doctor must interpret the results. Referral requirements depend on the centre; for example, one hospital in Szczecin describes assessment through a clinic and a referral to its respiratory clinic with code G47.3.

Treatment includes CPAP, which supplies air under positive pressure to help keep the airway open. It is particularly important in severe disease.

How did tirzepatide affect sleep apnoea in the SURMOUNT-OSA trials?

In two trials published in 2024, adults with obesity and moderate or severe sleep apnoea received the maximum tolerated tirzepatide dose of 10 or 15 mg weekly or placebo for 52 weeks, alongside diet and activity advice. Baseline AHI was around 50. In participants not using PAP, AHI fell by an average of 25.3 events per hour versus 5.3 with placebo; among PAP users, the reductions were 29.3 versus 5.5. Systolic blood pressure and reported sleep problems also improved. These are group averages, not a prediction for every patient.

In December 2024, EMA agreed to include the results in Mounjaro's product information without granting a separate sleep apnoea indication; the US granted such an indication. In Poland, tirzepatide can be used after assessment for obesity treatment. Improvement does not automatically mean CPAP can be stopped. The clinician managing sleep apnoea decides on settings or discontinuation after reassessment, including an appropriate sleep study.

GLP-1 and GIP are intestinal hormones involved in processes including insulin release after meals. GLP-1 also affects appetite and gastric emptying. Semaglutide and liraglutide activate the GLP-1 receptor, while tirzepatide acts on both GIP and GLP-1 receptors. These medicines may increase fullness and help people eat smaller portions. The prolonged action of semaglutide and tirzepatide allows weekly injections; liraglutide is injected daily.

Medication complements dietary treatment and activity after eligibility is assessed. We consider previous attempts, but do not impose the same waiting period before medication for everyone. Gradual dose escalation reduces the risk of gastrointestinal symptoms; the schedule depends on the product and tolerability.

How much weight did participants lose in STEP 1, SURMOUNT-1 and SCALE?

In STEP 1, semaglutide 2.4 mg produced average weight loss of 14.9% after 68 weeks versus 2.4% with placebo. In SURMOUNT-1, tirzepatide 15 mg produced 20.9% versus 3.1% after 72 weeks. In SCALE, liraglutide 3 mg produced 8.4 kg versus 2.8 kg after 56 weeks. Participants did not have type 2 diabetes and received lifestyle support. These were separate trials. To illustrate the percentages, 15% of 100 kg is 15 kg and 21% is 21 kg; this is not a promise of those results.

The direct SURMOUNT-5 comparison found average losses of 20.2% with tirzepatide 10 or 15 mg and 13.7% with semaglutide 1.7 or 2.4 mg after 72 weeks, at maximum tolerated doses in people with obesity without diabetes. It did not compare semaglutide 7.2 mg and does not determine the best medicine for every person.

What happens to weight when medication is stopped?

Weight loss may slow over time, and the point of stabilisation varies. Medication can still help maintain the result. Effectiveness is assessed according to the particular product; a smaller response calls for a review of the whole plan, not an automatic switch.

In the STEP 1 follow-up subgroup, around two thirds of the lost weight returned within a year after semaglutide and lifestyle support ended, and cardiometabolic measures moved towards baseline. The study did not test whether tapering prevents regain. Any decision to stop is planned individually, with continued monitoring and dietary support.

Medicines discussed here that are authorised for obesity treatment include Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. This is not a complete list of all therapies or formulations. Choice depends on indications, other conditions, current medicines and tolerability.

How do the indications for Wegovy, Ozempic and Rybelsus differ?

Wegovy is indicated for weight management, whereas Ozempic and Rybelsus are indicated for type 2 diabetes, although all contain semaglutide. Saxenda contains liraglutide at doses up to 3 mg; Victoza is a liraglutide product for diabetes. Mounjaro has indications for both type 2 diabetes and weight management. Use outside an authorised indication requires an individual medical decision; this is neither a blanket prohibition nor permission to interchange products freely.

Injectable Wegovy starts at 0.25 mg weekly and is usually increased over 16 weeks to 2.4 mg. The product information also allows 7.2 mg after at least 4 weeks at 2.4 mg, if needed, in adults whose initial BMI was at least 30. EU documentation also includes oral Wegovy; authorisation does not establish availability of a particular formulation in Polish pharmacies.

Tirzepatide starts at 2.5 mg weekly, increasing to 5 mg after 4 weeks. Further 2.5 mg increases are made after at least 4 weeks only if needed; maintenance doses are 5, 10 or 15 mg. Liraglutide starts at 0.6 mg daily and increases in 0.6 mg steps at intervals of at least a week to 3 mg, depending on tolerability. The doctor determines the dose.

What determines the cost of obesity medicines?

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are paid for in full when used for obesity. Cost depends on the dose, number of packs and pharmacy. Check both starting and maintenance costs, distinguishing a pack price from the cost of 4 weeks or 30 days. Wegovy 7.2 mg needs a separate estimate. Pharmacies provide current prices and availability.

When can an oral medicine be considered?

Mysimba combines naltrexone and bupropion. In COR-I, a daily dose of 32 mg/360 mg with diet and activity produced an average 6.1% loss after 56 weeks versus 1.3% with placebo. Emotional eating alone does not determine suitability. Contraindications include uncontrolled hypertension, seizures, a history of bipolar disorder, anorexia or bulimia, opioid use, acute alcohol or benzodiazepine withdrawal, and other products containing bupropion or naltrexone. The doctor also checks interactions.

Xenical contains orlistat in 120 mg hard capsules. It inhibits lipases and reduces absorption of some dietary fat; average additional weight loss compared with placebo is a few kilograms over a year. Fatty stools and bowel urgency can occur. A contraindication to a GLP-1 medicine does not automatically establish suitability for oral treatment.

Saxenda is stopped if weight loss is below 5% after 12 weeks at 3 mg; Mysimba after 16 weeks from starting, and Xenical after 12 weeks of treatment, if 5% has not been achieved. Mysimba also requires annual review of continued benefit, cardiovascular risk and maintenance of at least 5% weight loss after a year. These are not universal stopping rules for all medicines.

Nausea, vomiting, diarrhoea and constipation are common with incretin medicines, especially at the start and after dose increases. They often ease, but persistent symptoms need assessment. In STEP 1, 4.5% of participants stopped semaglutide 2.4 mg because of gastrointestinal symptoms. Smaller portions, limiting fatty foods and adequate fluids can help; the doctor may delay a dose increase.

Severe, persistent upper abdominal pain, especially radiating to the back, requires urgent care for possible pancreatitis, even without vomiting. Do not take the next dose until medically assessed; the medicine is not restarted if pancreatitis is confirmed. Right upper abdominal pain with fever or jaundice may indicate a biliary complication. Gallstones occurred in 1.6% of semaglutide-treated participants in trials; this is not the frequency of that combination of warning symptoms.

Sudden deterioration or loss of vision requires urgent eye assessment. In 2025, EMA recognised NAION, a type of injury to the optic nerve caused by reduced blood supply, as a very rare semaglutide adverse effect. Do not wait a full day if vomiting prevents drinking, urine output falls or weakness increases. Tremor, cold sweats or faintness with insulin or sulphonylureas may indicate hypoglycaemia: follow the agreed action plan. Loss of consciousness or inability to swallow safely requires immediate medical help; give nothing by mouth to someone in this state. A call to the practice does not replace urgent care.

When is a medicine contraindicated, and when is caution needed?

We do not use semaglutide, liraglutide or tirzepatide during pregnancy. Before a planned pregnancy, semaglutide is stopped at least 2 months and tirzepatide at least one month beforehand. Wegovy and Saxenda should not be used while breastfeeding; a doctor may consider tirzepatide individually.

Wegovy and Saxenda are not recommended in severe kidney or liver impairment or NYHA class IV heart failure. Tirzepatide does not require a dose adjustment for kidney or liver impairment, but severe impairment calls for caution; the same blanket NYHA IV restriction must not be applied to it. Previous pancreatitis requires caution and individual assessment rather than automatic exclusion. Saxenda is not recommended from age 75; experience with Wegovy and Mounjaro is limited from age 85.

The EU Mounjaro product information does not require dose adjustment of oral contraceptives. An additional barrier method for 4 weeks after starting tirzepatide and after each dose increase may be a precautionary recommendation, rather than a requirement in the EU product information. The doctor discusses contraception and what to do with vomiting or diarrhoea. Contraindication, use not recommended and caution are distinct categories; each product needs its own assessment.

Where do counterfeit semaglutide products come from, and what has been found in them?

Buying through an advertisement or a vial labelled for research does not assure composition or quality. In October 2023, Poland's Chief Pharmaceutical Inspectorate warned about counterfeit Ozempic pens and issued a decision concerning specified falsified packs. Severe hypoglycaemia following counterfeit products containing insulin was reported in Austria at that time. Buy medicine from a licensed pharmacy and change doses only as directed.

Weight loss can include lean mass, which is not the same as skeletal muscle. An analysis of 140 STEP 1 participants found reductions in both fat and lean mass, while lean mass made up a greater proportion of total weight afterwards. Participants also received lifestyle support; the study does not show that two fifths of weight lost with medication alone, without dietary changes, is muscle.

Appropriate nutrition and exercise help limit muscle loss. A daily deficit of 500-750 kcal may form part of an individual plan. Protein needs depend on factors including age and kidney function. With a smaller appetite, distributing protein sources across 3-4 meals can help: fish, lean meat, dairy or pulses. Starting a meal with a protein source may be useful, but is not a mandatory eating order.

A general goal is 150-300 minutes of moderate activity weekly and strength exercises on at least 2 days. Activity is adapted to fitness and medical conditions. With knee pain, swimming, a stationary bicycle or walking may be considered; the cause of pain needs assessment. Someone who is inactive can begin with short bouts and increase them gradually. Weight above 120 kg alone does not determine a single exercise schedule.

How can a psychodietitian help with eating out of anger or boredom?

Medication may help control appetite, but does not replace work on emotional eating. Support from a psychodietitian (a dietitian trained in the psychology of eating) helps identify triggers and alternative responses to distress. Episodes involving loss of control need assessment for an eating disorder and appropriate psychological or psychiatric care. The programme includes two online consultations with a psychologist. Dietitian and psychodietitian consultations are not included; any further support depends on the assessment.

Alcohol supplies about 7 kcal per gram. Half a litre of beer contains about 220 kcal, 50 ml of vodka about 110 kcal and 150 ml of wine about 120 kcal; strength and composition affect these values. Four such beers provide around 880 kcal, which can substantially reduce a planned energy deficit. Alcohol metabolism temporarily reduces fat oxidation, and drinking may encourage extra snacking.

Alcohol can worsen gastrointestinal symptoms and increase hypoglycaemia risk with insulin or sulphonylureas. Heavy alcohol use is also a risk factor for pancreatitis. We recommend abstinence during dose escalation as a precaution; later advice depends on health and the medicine. No single serving is appropriate for everyone. With Mysimba, alcohol should be minimised or avoided; acute withdrawal is a contraindication. Someone with physical dependence needs a medical withdrawal plan.

In a 2025 trial, 48 people with alcohol use disorder received semaglutide or placebo for 9 weeks. Some, but not all, measures of drinking and craving improved. Semaglutide is not authorised to treat alcohol dependence. People losing control of drinking can seek alcohol dependence treatment in Szczecin, or addiction therapy for other substances. We coordinate that care with obesity treatment.

We run the programme online only, so consultations with the doctor and the psychologist take place by video in the Nasz Gabinet app. Before a video appointment, provide test results, a medication list and home weight and blood pressure measurements. On this basis the doctor decides on eligibility for the programme.

At the five monthly reviews, the doctor assesses app data without a call; the doctor sets the ongoing dose and may issue a prescription where indicated. Dietitian and psychodietitian consultations are not included in the programme.

For sudden vision loss, severe abdominal pain or significant dehydration, seek urgent help at the nearest appropriate facility rather than waiting for a scheduled consultation.

Assessment and basic investigations can start with a primary care doctor, who can refer to a suitable specialist clinic when indicated. Local options include a metabolic diseases and obesity treatment clinic in Szczecin and a metabolic diseases clinic in Koszalin. Confirm the treatment scope and age groups before booking; one of the metabolic clinics in Szczecin is a children's clinic.

Waiting times depend on the facility and medical urgency category. Check current information with NFZ and reception. Reported average waits and predicted waiting times are different measures, and neither guarantees an individual's appointment. Other care need not wait for a metabolic clinic visit.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical remain fully self-funded for obesity even with an NFZ prescription. Ozempic may be reimbursed for type 2 diabetes if criteria are met; this does not cover every semaglutide formulation. Primary care doctors independently assess indications for NFZ-funded tests. A list from a private consultation does not guarantee coverage of every test.

Our online programme is a paid service and costs PLN 1,799 for 6 months. The scope of additional support is given in the current price list or by reception. The pharmacy sets the medicine price.

Traditional surgery thresholds are BMI at least 40, or at least 35 with complications. Newer recommendations include BMI at least 35 without complications and, in selected cases, 30-34.9. The bariatric centre determines eligibility and funding conditions. The Polish Surgeons' Society directory includes one hospital in Szczecin; a team at another Szczecin hospital also describes surgical obesity treatment. These are examples, not a complete directory.

The KOS-BAR pilot ended on 30 June 2026. Bariatric operations can be funded by NFZ under general arrangements after assessment at a contracted facility. The selected centre confirms preparation and postoperative care.

We share records of previous nonsurgical treatment. Not everyone must first use a GLP-1 medicine for 3-6 months or lose a fixed percentage. The team chooses dietary preparation and any medication. Weight loss may make surgery easier and reduce liver volume, but does not guarantee freedom from complications.

The procedure, such as gastric bypass or sleeve gastrectomy, affects meal size and nutrient absorption. Long-term follow-up, suitable nutrition and supplementation are needed. The doctor selects tests, including blood count, iron status and vitamins B12 and D where appropriate. Regain can have dietary, psychological, metabolic or postoperative anatomical causes and requires assessment rather than attribution to a single cause.

The online programme is also available to people from Police, Goleniów, Stargard, Gryfino, Nowogard, Pyrzyce and Świnoujście, and to those working across the German border. Providing test results and a medication list in advance is useful. The doctor and psychologist consultations take place by video, and tests can be performed close to home. The five monthly medical reviews use app data without a call.

Patients can compare the scope and availability of NFZ care in the region. When changing providers, we share records; the new doctor assesses the ongoing plan and dosing. Reception confirms the availability and format of dietary and psychodietetic support.

According to NIK's estimate for 2022, around 392,000 adults in West Pomerania had obesity. The estimate used information obtained from the Ministry of Health; it is not a measurement of the number affected in 2026.

The audit covering 2020-2022 identified insufficient prevention and a lack of consistent arrangements for adult obesity care. This does not mean surgery is the only publicly funded treatment. NFZ funds primary care, appropriate specialist consultations, investigations and eligible operations, although access to comprehensive care is uneven.

An adult in Szczecin can start an assessment in primary care, check the remit of a suitable specialist clinic or choose a private consultation. The medicines discussed here are fully self-funded for obesity whether prescribed privately or within NFZ care.