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. We treat and manage obesity over years, so we plan treatment for several years from the outset.

The disease starts in the system that regulates 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 every successful diet, the body returns to its previous weight, causing the yo-yo effect that many patients know from experience. GLP-1 analogues strengthen this weakened fullness signal.

Obesity leads to more than 200 diseases and complications. At the practice, 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.

Diagnosis starts with body mass index, or BMI: weight in kilograms divided 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 is an obesity medicine doctor, and when should you book a first 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. Another reason is having tried several diets and regained the weight afterwards. PTLO also allows pharmacotherapy in adolescents from the age of 12 who weigh more than 60 kg, but Nasz Gabinet Warsaw treats adults only.

At Nasz Gabinet Warsaw, obesity treatment is led by a doctor who makes the diagnosis, assesses eligibility for drug treatment and treats complications, while a dietitian and an eating behaviour specialist work with the patient alongside the doctor. This distinguishes an obesity treatment clinic from a dietetic practice where nobody can prescribe medicine or medically assess test results. PTLO identifies four pillars of treatment: nutritional therapy, physical activity, psychological support and pharmacotherapy, with bariatric surgery as an additional option in class III obesity. A medicine alone reduces hunger but does not teach a different way of eating, while weight quickly returns after diet alone.

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 plan treatment for at least 12 months because, according to PTLO, drug treatment lasting less than 6 months does not have a lasting effect, and some patients need long-term treatment. This year has five stages:

1. The first appointment. Medical history, measurement of weight, waist circumference and blood pressure, blood test requests and diagnosis of obesity class.
2. Assessment and planning. The doctor reviews the results, rules out secondary obesity, chooses a medicine and sets a goal for the first 3 to 6 months; the dietitian prepares a meal plan, and the eating behaviour specialist starts work on emotional eating.
3. Follow-ups every 4 weeks. We weigh the patient, measure waist circumference, ask about side effects, set the next dose and issue an e-prescription.
4. Assessment after 3 months on the therapeutic dose. Weight loss of less than 5 percent means changing the medicine and tightening the diet.
5. Weight maintenance. After the goal is reached, appointments become less frequent, but treatment continues, because maintaining the new weight is a separate treatment stage.

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

• 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 first appointment 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. We measure weight, height, waist circumference and blood pressure. The first medical appointment at our Warowna practice costs PLN 250, and an online appointment costs the same.

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 can have these done at any laboratory and bring the results, or have the tests after the first appointment. The results show whether obesity has already damaged the liver or kidneys and whether glucose metabolism is normal. 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 assess eligibility for drug treatment of obesity using the 2024 PTLO criteria: adults with a BMI of 30 or more, adults with a BMI of 27 to 29.9 and at least one weight-related illness, and people in whom 3 to 6 months of diet and exercise have not produced a 5 percent weight loss. Below these thresholds we do not prescribe the medicine, even at the patient's request.

Five substances are licensed for obesity treatment in Poland: orlistat, the combination of naltrexone and bupropion, and three GLP-1 medicines: liraglutide, semaglutide and tirzepatide, which also acts on the GIP receptor. GLP-1 analogues, commonly called weight-loss injections, mimic the intestinal hormone that signals fullness to the brain after eating and slows gastric emptying. Patients feel full after a smaller portion and think about food less often between meals. Patients inject the medicine themselves, using a fine needle under the skin of the abdomen or thigh: liraglutide daily, and semaglutide and tirzepatide once weekly. We increase the dose gradually, every week for liraglutide and every 4 weeks for the other two, to allow the stomach to adjust.

How semaglutide and tirzepatide performed in STEP 1 and SURMOUNT-1

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 we switch to a stronger medicine and when we stop it

After 3 months on the therapeutic dose, we check whether weight has fallen by at least 5 percent. If not, PTLO recommends switching to a stronger medicine and a stricter diet. One year after stopping semaglutide, participants in the STEP 1 extension had regained two thirds of the weight they had lost. We therefore withdraw the medicine gradually and only once the patient has established lasting habits; some patients receive it long term. We do not prescribe products licensed exclusively 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 Warsaw 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 first appointment 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 Wegovy (an injection up to 2.4 mg, licensed for obesity), Ozempic (an injection up to 2 mg, licensed only for type 2 diabetes and reimbursed only for people with diabetes) and Rybelsus (tablets, also for diabetes only).
• 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.

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

Patients inject Saxenda daily and increase the dose every week until they reach 3 mg; Wegovy and Mounjaro are injected once weekly, with the dose increased every 4 weeks. The difference in efficacy is substantial: liraglutide's advantage over placebo in SCALE after 56 weeks was 5.6 kg; semaglutide's in STEP 1 after 68 weeks was 12.5 percentage points (14.9 versus 2.4 percent); and tirzepatide's in SURMOUNT-1 after 72 weeks was 17.8 points (20.9 versus 3.1 percent). Tirzepatide stimulates the GIP receptor as well as GLP-1, which is why it produces the greatest weight reduction of all licensed medicines.

How much a month of Wegovy, Mounjaro or Saxenda costs at the pharmacy

Prices in 2026 do not follow the order suggested by efficacy:

Saxenda requires a daily injection with about half the effect of Wegovy, and its price varies more between pharmacies than the other products. We therefore prescribe liraglutide only exceptionally, for example when a patient has tolerated weekly injections poorly.

How Mysimba and Xenical tablets work and how much weight patients can lose on them

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, or orlistat, 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. Both medicines are considered only when a patient cannot take GLP-1 analogues.

What determines the choice between semaglutide and tirzepatide, and who receives tablets?

When a patient needs to lose 20 kg or more or has type 2 diabetes, the options are semaglutide and tirzepatide. The choice depends on price, accompanying conditions and how well the patient tolerates nausea, because tirzepatide causes it more often at higher doses. A person who cannot take GLP-1 analogues, for example after pancreatitis, receives naltrexone with bupropion or orlistat. We do not prescribe Ozempic or Rybelsus for obesity, regardless of the name the patient uses when asking about them.

GLP-1 analogues 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.

How pregnancy, contraception, kidney disease or insulin affect GLP-1 analogue treatment

There are five situations in which a GLP-1 analogue is contraindicated or requires extra caution:

• Pregnancy and breastfeeding. We do not use GLP-1 analogues during these periods. A woman stops semaglutide at least 2 months before a planned pregnancy because the medicine remains in the body for a long time.
• Contraceptive pills with tirzepatide. The medicine slows the absorption of oral medicines, so the patient also uses a barrier method for 4 weeks after starting treatment and after every dose increase.
• Severe kidney or liver failure, class IV heart failure, previous pancreatitis. We do not recommend GLP-1 analogues in these conditions. They have been little studied in people over 75; the manufacturer does not recommend liraglutide at this age.
• Type 2 diabetes treated with insulin or sulfonylureas. We reduce the doses of these medicines because combining them with GLP-1 increases the risk of hypoglycaemia; patients with diabetic retinopathy are referred for ophthalmology follow-ups, and sudden worsening of vision requires an urgent ophthalmology assessment.
• 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 treat a patient taking a product from such a source until they switch to a prescription medicine dispensed at a pharmacy.

Nutritional treatment is based on a daily deficit of 500 to 750 kcal below energy requirements. We do not recommend starvation diets: the body loses muscle instead of fat, and after a few weeks this ends in binge eating. During GLP-1 analogue treatment, patients eat less, so the dietitian makes sure each smaller portion contains protein. Without it, muscle is lost along with fat, and a patient with less muscle returns to their previous weight more quickly after treatment ends. We tailor exercise to joint health and fitness. PTLO recommends 150 to 300 minutes a week, but for someone with painful knees we suggest swimming or a stationary bike to begin 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. We therefore include eating behaviour support in the treatment plan: patients learn to notice the situations in which they reach for food and practise other ways of managing tension. Therapists at Nasz Gabinet Warsaw provide this support as part of addiction therapy in Warsaw, at the practice or online.

Alcohol contains 7 kcal per gram, only slightly less than fat, and the body burns it first. Calories from food eaten at the same time are therefore stored as fat, mainly in the abdomen. This creates an alcohol belly that persists despite a good diet. At the first appointment, we count calories from alcohol just as we count those from food: two beers a day provide about 500 kcal, which is the entire planned dietary deficit.

During treatment with GLP-1 analogues, 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 during the day. 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 at the same practice, as part of alcohol addiction treatment in Warsaw.

We hold the first appointment at Nasz Gabinet Warsaw at ul. Warowna 1/U4 in Mokotów, with follow-ups every 4 weeks online. At the practice, the doctor measures waist circumference, blood pressure and weight using the same scales that will be used at every subsequent in-person check, which is why it is better to have the first appointment at the practice. At an online follow-up, the doctor discusses tolerance of the medicine and results, sets the dose and issues an e-prescription to be dispensed at any pharmacy. The patient does not lose a working day travelling across the city, and online treatment covers the same care as in-person treatment.

We require an in-person visit, regardless of the patient's preference, at a BMI of 40 or more, for heart or kidney disease requiring physical examination, and when a secondary cause of obesity is suspected. A patient living outside Warsaw can start treatment online if they have blood tests at a laboratory near home and measure their own weight and waist circumference. Consultations with the dietitian and eating behaviour specialist are available both at the practice and online. Someone temporarily unable to take medicines, for example because of a planned pregnancy, receives the same nutritional plan and psychological care, without pharmacotherapy.

Any doctor, including a family doctor, can diagnose and treat obesity, as recommended in the PTLO guidelines. In Mazovia, the number of patients treated for obesity rises each year: according to the Mazovian branch of the NFZ, from 13.5 thousand in 2022 to 17.5 thousand in 2023 and 22.3 thousand in 2024. In a province where more than a million adults have obesity, this is still a small proportion of those affected. A primary care appointment lasts a dozen or so minutes and rarely ends with a treatment plan, while the dozen or so NFZ-funded metabolic disease clinics in Warsaw require a referral.

No medicine licensed for obesity treatment is reimbursed. Semaglutide in a product for people with type 2 diabetes is reimbursed only for diabetes and only if reimbursement criteria are met; the NFZ can require a doctor to repay reimbursement wrongly claimed for a discounted prescription issued for obesity. Private patients pay for consultations and follow-ups according to the Nasz Gabinet Warsaw price list (the first medical appointment costs PLN 250), and for the medicine at the pharmacy: in 2026, a month of GLP-1 analogue treatment costs about PLN 550 to 2000, depending on the substance and dose, with target doses the most expensive. We discuss these costs at the first appointment because treatment a patient cannot afford for a whole year breaks off after three months and the weight returns. Bariatric surgery is a publicly funded NFZ benefit under general rules, while the KOS-BAR comprehensive care pilot, used by more than 2.2 thousand Mazovian residents between 2022 and 2024, ended on 30 June 2026 and awaits introduction as a permanent benefit.

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; Polish criteria refer to class II and III obesity. In 2024, 6.7 thousand NFZ-funded bariatric operations were performed in Poland.

We assess patients for surgery and prepare them for it. 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 analogue 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. Patients from outside the city, like Warsaw residents travelling across it, want their follow-up every 4 weeks to take less than a whole day.

Patients from outside Warsaw have the blood test panel at a laboratory in their own town, measure their own weight and waist circumference, and attend the first appointment online with the results or travel once to our Mokotów practice. Subsequent follow-ups and consultations with the dietitian and eating behaviour specialist take place remotely, and patients have their e-prescription dispensed at a pharmacy near home. We ask patients to come to the practice only when the doctor needs to examine them in person: in class III obesity, heart or kidney disease, and when a secondary cause of obesity is suspected.

According to measurements in primary care clinics from January to July 2025, 58.7 percent of adult Warsaw residents have overweight or obesity. The rest of the province fares worse: in Łosice County the proportion reaches 72.4 percent, the highest in Poland, while over 1.2 million adults in Mazovia have obesity itself (1 225 thousand), according to Ministry of Health figures quoted by Poland's Supreme Audit Office. Warsaw directs its municipal weight-related programmes at schoolchildren and funds hypertension prevention for people aged 18 and 19; it has no programme for adult residents with obesity, who must turn to primary care or private treatment.

Nasz Gabinet Warsaw treats obesity in Mokotów, in the same practice where it has treated addictions for years. Patients whose obesity coexists with alcohol dependence or compulsive eating receive treatment for both problems from one team, without being sent between clinics.