Obesity treatment Warsaw

Obesity is a chronic disease with its own code, E66, in the ICD-10 classification, and the Polish Society for the Treatment of Obesity (PTLO) describes it in the same way in its 2024 guidelines. It does not go away on its own, and a three-month diet does not cure it, just as three months of tablets do not cure hypertension. Obesity is treated and managed over years.

How does obesity develop?

Obesity develops when, over years, the body gets more energy from food and drinks than it uses and stores the surplus in fat cells. Fat cells first increase in size, and with further weight gain the body produces new fat cells. We speak of a disease when there is so much fat tissue that it harms health. Fat tissue also releases hormones and pro-inflammatory substances into the blood, which over time reduce the sensitivity of cells to insulin and lead to insulin resistance.

We inherit a large part of the risk of obesity: according to twin studies, genes explain 40 to 70 percent of the differences in body weight. An inherited tendency leads to weight gain especially when desk work and commuting take up most of the day and high-calorie food is easy to get. Shift work, too little sleep, chronic stress, pregnancy, menopause and quitting smoking also promote weight gain. In some patients, another disease or a medicine increases body weight, so we rule out these causes before starting treatment.

Whatever started the weight gain, the disease is maintained by disturbed regulation of hunger and fullness. After a meal, the intestines release the hormone GLP-1 and fat tissue releases leptin; both signal fullness to the brain. In a person with obesity, this signal is weaker and arrives later, so hunger returns sooner. After weight loss, there is a risk of regaining weight. Treatment therefore also includes long-term support to maintain the results. Medicines that activate the GLP-1 receptor help increase feelings of fullness.

What diseases does obesity lead to?

Obesity leads to more than 200 diseases and complications. In our patients, we most often see type 2 diabetes and prediabetes, hypertension, fatty liver disease, sleep apnoea, osteoarthritis of the knees and hips and, in women, polycystic ovary syndrome. Treating obesity slows the development of these diseases, and weight loss and improved test results show whether treatment is working.

We start by calculating body mass index (BMI). It is calculated by dividing weight in kilograms by the square of height in metres. According to the 2024 PTLO guidelines, in adults a BMI of 25.0 to 29.9 means overweight, 30.0 to 34.9 class I obesity, 35.0 to 39.9 class II obesity, and 40 or more class III obesity. Someone who is 170 cm tall and weighs 87 kg has a BMI of 30.1, meaning class I obesity; at 102 kg, their BMI is 35.3, meaning class II obesity.

BMI does not distinguish fat from muscle or show where fat accumulates. Visceral fat, which builds up around the organs in the abdomen, is the most harmful, so waist circumference is our second measurement. Under International Diabetes Federation criteria, abdominal obesity is diagnosed at a waist circumference of 80 cm in women and 94 cm in men, including people whose BMI still indicates only overweight. When abdominal obesity is accompanied by raised blood pressure, raised fasting glucose and high triglycerides, this is known as metabolic syndrome.

What does an obesity specialist do and when should you book an appointment?

An obesity medicine doctor holds a certificate from the Polish Society for the Treatment of Obesity; there is no separate medical specialty in obesity medicine in Poland, so internists, endocrinologists and family doctors also treat obesity. An appointment is worthwhile at a BMI of 30 or more, or from 27 if the patient has prediabetes, hypertension, lipid disorders, fatty liver disease, sleep apnoea or joint pain caused by excess load. It is also worth seeking advice if you have regained weight after repeated attempts at dieting. PTLO also allows pharmacotherapy in adolescents from the age of 12 who weigh more than 60 kg, but Nasz Gabinet Warsaw treats adults only.

In the Nasz Gabinet programme, obesity treatment is led by a doctor who diagnoses the condition, assesses whether medication is appropriate and selects the medicine. The programme also includes two online consultations with a psychologist, after months 1 and 3, lasting 40-50 minutes each. The Polish Society for the Treatment of Obesity (PTLO) identifies four pillars of treatment: nutritional treatment, physical activity, psychological support and medication, with bariatric surgery as an additional option for class III obesity. We tailor the plan to the patient and include support to maintain the results.

The first goal is to lose 5 to 10 percent of body weight within 3 to 6 months, or 7 to 15 percent in people with type 2 diabetes. A woman weighing 95 kg should therefore lose around 5 to 10 kg in the first stage. Even this reduction lowers blood pressure and glucose, improves the lipid profile and reduces the number of breathing pauses at night.

We provide treatment in an online programme that lasts 6 months and costs PLN 1,799. The price does not include the medicine, because the patient buys it at a pharmacy with an e-prescription. 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, and the dates are counted from the initial consultation.

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

Once a week the patient enters a weight measurement in the app. Body measurements are entered once a month. The patient also photographs the pen after each injection, and our medical team looks at the photo. The doctor looks through this information before every check-up. PTLO advises against short courses of medication lasting less than 6 months, and obesity treatment should last a year or longer. That is why after the programme the patient can buy a continuation package for 3 months for PLN 350. Every month the doctor reviews the patient's results and issues an e-prescription. The continuation package does not include video consultations.

What is not included in obesity treatment at our clinic?

• We do not sell medicines. The patient receives an e-prescription from us and buys the medicine at a pharmacy of their choice.
• We do not treat children or adolescents. Our treatment is for adult patients only.
• We do not perform bariatric surgery. We provide non-surgical treatment, and prepare patients with an indication for surgery and refer them to a surgical centre.

The initial consultation is primarily about taking a medical history. We ask when the patient began gaining weight and what was happening in their life at the time, which diets and medicines they have tried, which illnesses their parents and siblings have, which medicines they take regularly, what they usually eat during the day, whether they eat at night or have episodes of binge eating, and how much alcohol they drink each week. The patient measures weight, height, waist circumference and blood pressure at home beforehand, and the doctor discusses these measurements during the conversation. The initial 30-minute consultation is one of two doctor consultations included in the programme. The other takes place after month 6 and also lasts 30 minutes. There are also two online psychologist consultations and five monthly medical reviews of app data without a call.

We also need the following blood tests:

• fasting glucose and glycated haemoglobin, HbA1c,
• a lipid profile,
• TSH,
• liver enzymes ALT and AST,
• creatinine,
• uric acid.

The patient has these done at any laboratory before the initial consultation. The results help assess liver and kidney function and identify abnormalities in glucose metabolism. This determines which complications we treat alongside obesity and which medicine we choose.

How we check whether another illness or a medicine is causing weight gain

Before prescribing an obesity medicine, we rule out secondary obesity, meaning obesity caused by another illness or a medicine. We check thyroid function, rule out polycystic ovary syndrome in women and, when characteristic symptoms are present, Cushing's syndrome. We also review the patient's medicines, because glucocorticoids, some antidepressants and antipsychotics, certain antiepileptic medicines and insulin can cause weight gain. When another illness or medicine is responsible, we first discuss changes to treatment with the patient's treating doctor, and only then choose drug treatment for obesity.

We consider obesity medication for adults with a BMI of 30 or above, or a BMI of 27 to 29.9 with at least one weight-related condition. The doctor considers the results of diet and physical activity so far and the indications for the particular medicine. For Xenical, the threshold for overweight patients with risk factors is a BMI of 28. An unsuccessful diet alone does not replace the eligibility criteria for medication.

Medicines used to treat obesity in Poland include orlistat, naltrexone with bupropion, liraglutide, semaglutide and tirzepatide. GLP-1 and GIP are gut hormones released after a meal that help regulate blood sugar. GLP-1 also affects appetite and slows stomach emptying. Liraglutide and semaglutide activate the GLP-1 receptor, while tirzepatide activates two receptors: GIP and GLP-1. These medicines help reduce hunger and food intake. Liraglutide is injected under the skin daily, while injectable semaglutide and tirzepatide are given once a week. The doctor increases the dose gradually, depending on the medicine, treatment response and tolerability.

What results did the STEP 1 and SURMOUNT-1 trials show?

In the STEP 1 trial, semaglutide at a dose of 2.4 mg over 68 weeks reduced body weight by an average of 14.9 percent, compared with 2.4 percent with placebo; one in two participants lost 15 percent or more. In SURMOUNT-1, the highest dose of tirzepatide reduced weight by an average of 20.9 percent after 72 weeks, compared with 3.1 percent in the placebo group. Participants in both trials were also following a diet and exercising, so these results reflect medicine combined with diet and exercise. In STEP 1, weight stopped falling around week 60 and stabilised; this is a normal treatment stage, and the medicine continues to work.

When do we change or stop medication?

After 3 months at a therapeutic dose, we assess weight change, taking the assessment rules for the particular medicine into account. If weight loss is below 5 percent, we investigate the reasons, how the medicine is being used and any difficulties following the recommendations. The doctor then assesses whether treatment should change. For Mysimba, the assessment 16 weeks after starting treatment determines whether it can continue: the medicine must be stopped if weight loss is below 5 percent.

In the STEP 1 extension, participants regained an average of about two-thirds of their previous weight loss one year after stopping semaglutide and the lifestyle intervention provided in the trial. We decide individually when to end treatment and agree on a follow-up plan. We do not prescribe products authorised solely for type 2 diabetes to treat obesity.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are licensed for obesity treatment, while Ozempic and Rybelsus are licensed only for type 2 diabetes. A patient who comes to Nasz Gabinet asking about weight-loss injections usually knows one brand name and does not realise that its active substance is also available in another product with a different indication. We therefore explain the brand names at the initial consultation so that the patient knows what we are discussing.

Which brand names contain semaglutide, liraglutide and tirzepatide?

Three substances appear under six brand names:

• Semaglutide is available as Wegovy (obesity treatment), Ozempic (injections up to 2 mg for type 2 diabetes) and Rybelsus (tablets for type 2 diabetes). The maintenance dose of injectable Wegovy is 2.4 mg weekly. In adults with an initial BMI of 30 or above, a doctor may increase it to 7.2 mg if needed after at least 4 weeks at 2.4 mg. Ozempic reimbursement applies to diabetes when the reimbursement criteria are met.
• Liraglutide is Saxenda (3 mg, obesity) and Victoza (a lower dose, diabetes).
• Tirzepatide has one name, Mounjaro, and one product licensed for both conditions.

When a patient asks about Ozempic for weight loss, they are asking about semaglutide. For obesity we prescribe the version licensed for obesity: Wegovy. Wegovy tablets have also been authorised in the European Union. Authorisation does not mean every formulation and dose is available in Polish pharmacies; availability should be checked before having a prescription dispensed.

Daily or weekly injections, and how much weight can be lost?

Saxenda is injected daily, with the dose gradually increased to 3 mg as directed by the doctor. Injectable Wegovy and Mounjaro are given once a week. Tirzepatide starts at 2.5 mg weekly and increases to 5 mg after 4 weeks. Further increases of 2.5 mg are possible if needed after at least 4 weeks on the current dose. Maintenance doses are 5, 10 or 15 mg. The doctor selects the dose based on treatment response and tolerability.

Results depend on the medicine, dose and study population. In SCALE, liraglutide produced 5.6 kg more weight loss than placebo after 56 weeks. In STEP 1, semaglutide 2.4 mg led to 14.9 percent weight loss after 68 weeks, compared with 2.4 percent on placebo. In SURMOUNT-1, tirzepatide 15 mg led to 20.9 percent after 72 weeks, compared with 3.1 percent. These were separate trials in which medication was combined with diet and physical activity, rather than a direct comparison of the medicines.

Pharmacy costs of Wegovy, Mounjaro and Saxenda

The amounts below are estimates. They cover 4 weeks of treatment for Wegovy and Mounjaro and 30 days for Saxenda. The Wegovy price range covers doses up to 2.4 mg only and does not show the cost of using 7.2 mg.

The price depends on the pharmacy, dose and pack size. Check the current cost and availability of the particular product before having a prescription dispensed.

How do Mysimba and Xenical work and what results do they offer?

Mysimba, the combination of naltrexone and bupropion, suppresses hunger and reduces the pleasure of eating, so it suits people who eat in response to stress; in COR-I, patients lost 6.1 percent after 56 weeks, compared with 1.3 percent on placebo. Epilepsy, opioid use and uncontrolled hypertension rule it out. Xenical contains orlistat in 120 mg hard capsules. It prevents the absorption of about one third of the fat in a meal in the intestine, produces 2 to 3 kg more weight loss than placebo over a year and causes oily stools after fatty foods.

How do we choose an obesity medicine?

The doctor selects a medicine based on health, the planned weight loss, previous treatment response and tolerability, and the patient's budget. The number of kilograms to lose does not determine the choice on its own. A history of pancreatitis calls for caution and an individual assessment of treatment options. We do not prescribe Ozempic or Rybelsus to treat obesity.

GLP-1 medicines most commonly cause gastrointestinal symptoms: nausea, vomiting, diarrhoea and constipation in at least one in ten patients, particularly in the first weeks and after a dose increase. In STEP 1, 4.5 percent of participants stopped treatment for this reason. Acute pancreatitis and gallstones occur less often; gallstones were reported in 1.6 percent of people treated with semaglutide. If severe abdominal pain radiates to the back, the patient stops the medicine and sees a doctor the same day.

Pregnancy, chronic conditions and other medicines during obesity treatment

Liraglutide, semaglutide and tirzepatide should not be used during pregnancy. Before a planned pregnancy, semaglutide should be stopped at least 2 months beforehand and tirzepatide at least one month beforehand. Semaglutide and liraglutide should not be used while breastfeeding. A doctor may consider tirzepatide after an individual assessment of benefits and risks; breastfeeding data are limited.

Semaglutide and liraglutide 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 caution is needed in severe impairment because experience is limited. A history of pancreatitis requires caution when considering semaglutide or tirzepatide and does not in itself rule out treatment. If a doctor confirms acute pancreatitis during treatment, the medicine being taken when it occurred should not be restarted.

Liraglutide is not recommended for people aged 75 or older. There are limited data on the use of semaglutide and tirzepatide in people aged 85 or older.

Patients taking tirzepatide and the contraceptive pill are advised to add a barrier method as a precaution. It should be used for 4 weeks after starting treatment and after each dose increase. An alternative is to switch to non-oral contraception after consulting a doctor.

For patients taking insulin or a sulfonylurea, the doctor assesses whether the doses need to be reduced, because combining them with a GLP-1 medicine increases the risk of hypoglycaemia. All current medicines are reviewed to avoid duplicating treatment; semaglutide should not be combined with other GLP-1 receptor agonists. Patients with diabetic retinopathy need eye checks. Sudden deterioration in vision during treatment requires urgent assessment by an ophthalmologist.

Planned general anaesthesia. The patient tells the anaesthetist that they take the medicine, because delayed gastric emptying increases the risk of aspiration.

Why GLP-1 medicines must come from a pharmacy on prescription

Poland's Chief Pharmaceutical Inspectorate warned about counterfeit semaglutide pens sold outside pharmacies and, in 2025, together with the Chief Sanitary Inspectorate, about semaglutide offered online as a research peptide without a prescription or any guarantee of dose or purity. We do not use products from unverified sources in treatment. Before further treatment, the doctor assesses the patient's health and the products used so far.

Nutritional treatment is based on a daily deficit of 500 to 750 kcal relative to energy needs. An overly restrictive diet can cause nutritional deficiencies and muscle loss and make results harder to maintain. Patients usually eat less while taking medication, so the dietitian ensures an adequate intake of protein and other nutrients. Appropriate nutrition and activity help limit muscle loss during weight reduction. We adapt exercise to joint health and fitness. PTLO recommends 150 to 300 minutes a week, but for a patient with painful knees we may suggest swimming or an exercise bike to start with.

When food is used to relieve emotions

Some patients eat because of fatigue, stress or loneliness rather than hunger. Evening binge eating followed by guilt and a promise to do better tomorrow resembles other compulsive behaviours and does not go away simply because a medicine reduces appetite. The programme includes two online consultations with a psychologist, after months 1 and 3, lasting 40-50 minutes each. Dietitian and psychodietitian consultations are not included. Work on eating behaviour can help patients notice situations in which they reach for food and practise other ways of managing tension. Support with emotional eating can be discussed with the specialists who provide addiction therapy in Warsaw. The format and availability of consultations are confirmed when booking.

Alcohol provides 7 kcal per gram and can make it harder to maintain a calorie deficit. We therefore include alcoholic drinks when assessing eating habits. At the initial consultation, we count calories from alcohol as well as food: two beers a day provide about 500 kcal, equivalent to the lower end of the planned dietary deficit.

During treatment with GLP-1 medicines, alcohol worsens nausea and dehydration and increases the risk of hypoglycaemia in people with diabetes. Many patients say they feel less like drinking after starting treatment. A randomised trial published in 2025 involving 48 people with alcohol use disorder showed that low doses of semaglutide reduced alcohol craving and the amount consumed on days when participants drank. This is a preliminary finding from a small group, and semaglutide is not licensed for treating alcohol dependence. When a patient has a drinking problem alongside obesity, we treat both conditions in parallel, as part of alcohol addiction treatment in Warsaw.

We treat patients from Warsaw in the same way as everyone else, entirely online. Before the initial consultation, the patient has blood tests done at a laboratory of their choice. At home the patient measures weight, waist circumference and blood pressure. The same scales should be used for subsequent weight measurements. After reviewing the history and results, the doctor decides whether to admit the patient to the programme.

The patient connects with the doctor and the psychologist by video in the Nasz Gabinet app and has the e-prescription dispensed at any pharmacy. The five monthly medical reviews use app data without a call. Dietitian and psychodietitian consultations are not included in the programme. The programme includes two consultations with a psychologist, both online. If medication is unsuitable, for example because of a planned pregnancy, the doctor assesses the appropriate next steps individually.

Any doctor, including a GP, can diagnose and treat obesity. According to the Mazovian branch of Poland's National Health Fund (NFZ), the number of patients treated for obesity in Mazovia rose from 13,500 in 2022 to 17,500 in 2023 and 22,300 in 2024. These figures refer to patients receiving treatment, not everyone living with obesity in the region.

Patients pay the full price for Wegovy, Mounjaro, Saxenda, Mysimba and Xenical. Semaglutide in Ozempic may be reimbursed for type 2 diabetes when the reimbursement criteria are met. At Nasz Gabinet, patients pay for the treatment programme, PLN 1,799 for 6 months, and buy the medicine separately at a pharmacy. The cost of the medicine depends on the product, dose and pack size. We discuss it at the initial consultation so the patient can budget for long-term treatment.

Bariatric surgery may be funded by NFZ under the general rules. The KOS-BAR pilot, used by more than 2,200 Mazovian residents from 2022 to 2024, ended on 30 June 2026. The surgical centre provides information about eligibility and the care arrangements currently available.

For class III obesity, bariatric surgery, most often sleeve gastrectomy or gastric bypass, is the most effective treatment. In their 2022 statement, international bariatric surgery societies allow surgery from a BMI of 35 regardless of accompanying conditions, and from a BMI of 30 in people with type 2 diabetes for whom non-surgical treatment has failed; Medical indications must be distinguished from NFZ funding rules. Class II obesity alone does not automatically qualify a patient for publicly funded surgery. In 2024, 6.7 thousand NFZ-funded bariatric operations were performed in Poland.

We assess whether a bariatric consultation is indicated and help patients prepare for surgery. The bariatric surgery centre makes the final eligibility decision. Before the procedure, patients should reduce their weight by a few percent, manage emotional eating, bring diabetes under control and normalise blood pressure, because this lowers the risk of perioperative complications; we often use a GLP-1 medicine to reduce weight before surgery. We then refer the patient to a bariatric surgery centre. After the procedure, we continue to monitor weight, oversee vitamin supplementation and provide psychological support, because without these measures some patients return to their previous weight after several years.

Alongside residents of the capital, we treat patients from all over Mazovia, most often from Pruszków, Piaseczno, Legionowo, Otwock, Wołomin, Grodzisk Mazowiecki, Marki, Ząbki, Łomianki, Konstancin-Jeziorna, Józefów, Mińsk Mazowiecki, Nowy Dwór Mazowiecki, Żyrardów and Sochaczew.

People living in these towns are treated in the same online programme as patients from the capital. They have blood tests at a local laboratory and have the e-prescription dispensed at a pharmacy near home. The five monthly medical reviews use app data without a call. Dietitian and psychodietitian consultations are not included in the programme. The programme includes two consultations with a psychologist, both online.

Among adult patients from Warsaw whose measurements were recorded in primary care between January and July 2025, 58.7 percent had overweight or obesity. In Łosice county, the proportion in this group was 72.4 percent. These data refer to patients who were measured, not all residents. In 2022, the number of adults with obesity in Mazovia was estimated at around 1.225 million.

At the Nasz Gabinet clinic in Mokotów we treat addictions, and we treat obesity in the online programme. A patient whose obesity coexists with alcohol addiction or compulsive eating can receive help with both problems from the same team.