Obesity Treatment Wrocław

Obesity is a chronic disease with its own code E66 in the ICD-10 classification, and in its 2024 guidelines the Polish Society for the Treatment of Obesity (PTLO) describes it as a disease that does not resolve on its own. In practice this means that obesity does not go away after a diet, just as high blood pressure does not go away after a month on tablets. It has to be diagnosed, treated and monitored for years.

The excess body fat comes from disturbed regulation of appetite and satiety. Hormones from the gut and from adipose tissue, among them GLP-1 and leptin, tell the brain that a person has eaten enough. In someone with obesity that message arrives more weakly and later, so hunger returns sooner, and once weight has been lost the body tries to get back to what it weighed before. This is why one diet after another ends in the yo-yo effect. It is precisely this satiety signal that GLP-1 analogues act on.

Untreated obesity leads to more than 200 complications. The most common are type 2 diabetes, insulin resistance, high blood pressure, fatty liver disease, sleep apnoea, osteoarthritis of the knees and hips, and polycystic ovary syndrome in women. Obesity treatment is meant to halt these conditions, and the fall in body weight shows whether it is working.

The first step is the body mass index (BMI), body weight in kilograms divided by height in metres squared. Following the PTLO 2024 guidelines, in adults we use these thresholds:

BMI on its own says nothing about where the fat sits, and it is abdominal fat, around the internal organs, that puts the greatest strain on the heart and the liver. That is why we also measure waist circumference at the first appointment. Following the criteria of the International Diabetes Federation, we diagnose abdominal obesity at a waist circumference of 80 cm or more in women and 94 cm or more in men, even when BMI is still in the overweight range. Abdominal obesity together with raised blood pressure, glucose and triglycerides makes up the metabolic syndrome, which we treat as a whole.

Which doctor treats obesity and at what BMI to book the first appointment

The doctor who treats obesity is an obesity specialist, that is, a doctor certified by the Polish Society for the Treatment of Obesity. Obesity medicine is not a separate specialty, so obesity is also treated by a GP, an internal medicine specialist or an endocrinologist. It is time to see a doctor at a BMI of 30 or more, or from a BMI of 27 if there is at least one complication: prediabetes, high blood pressure, lipid disorders, fatty liver disease, sleep apnoea or joint pain caused by the extra load. Another signal is having been through several diets after which the weight returned to where it was, because that is exactly how untreated obesity behaves. PTLO allows drug treatment for obesity in adolescents from the age of 12 who weigh more than 60 kg, but Nasz Gabinet Wrocław treats obesity in adults only.

An obesity clinic differs from a dietetic practice in that treatment is led by a doctor, who chooses the drugs and treats the complications as well. Obesity treatment at Nasz Gabinet Wrocław rests on the four pillars the PTLO sets out in its 2024 guidelines: nutritional treatment, physical activity, psychological support and drug treatment, with bariatric surgery in selected cases. None of them is enough on its own. A drug reduces hunger, but it will not teach the patient to eat differently. A diet brings the weight down, but without a drug the weight soon returns. The specialist in the psychology of eating deals with eating driven by emotion, which no calorie chart will show.

In the first stage the goal is a fall in body weight of 5 to 10 percent within 3 to 6 months, and of 7 to 15 percent in people with type 2 diabetes. A reduction of that size already lowers blood pressure, improves glucose and lipid results and cuts the number of apnoeas at night. For a patient weighing 110 kg it means 6 to 11 kg less to begin with.

We set the plan out over at least 12 months, because treatment shorter than 6 months does not make the result stick, and some patients need long-term treatment. Follow-up appointments are held every 4 weeks at first: we check body weight, waist circumference, how well the drug is tolerated and the test results, and we raise the dose in steps. Once the target is reached the appointments become less frequent, but they do not stop, because keeping the weight off is a separate stage of obesity treatment.

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

• We do not sell medicines. After the appointment the patient receives an e-prescription (Poland's electronic prescription) and buys the drug at any pharmacy.
• We do not treat children or adolescents. We see adult patients only.
• We do not perform bariatric surgery. We treat without surgery; when a patient is eligible for an operation, we provide a referral and the notes for the surgical centre.

We do not prescribe obesity drugs on the basis of weight alone. The first consultation is the medical history: how long the patient has been gaining weight and in what way, which diets they have already been through, what illnesses run in the family, what medicines they take and how they eat, including whether they eat at night, whether they have episodes of binge eating and how much alcohol they drink. We measure body weight, height, waist circumference and blood pressure. The first medical appointment at our practice at ul. Dworcowa 11b costs PLN 250, and an online appointment costs the same.

We order a basic panel of blood tests: fasting glucose and glycated haemoglobin (HbA1c), a lipid profile, TSH, the liver enzymes ALT and AST, creatinine and uric acid. The results show whether obesity has already damaged the liver or the kidneys and upset blood glucose control, and they determine which complications we treat at the same time.

Which illnesses and medicines we rule out as the cause of weight gain before we choose a drug

Some patients gain weight because of another illness or a medicine. We rule out an underactive thyroid and polycystic ovary syndrome, and where the typical signs are present, Cushing's syndrome, and we check whether the patient is taking medicines that encourage weight gain: glucocorticoids, some antidepressants and antipsychotics, certain epilepsy drugs and insulin. If another illness or a medicine is behind the weight gain, drug treatment for obesity on its own will not be enough, which is why we check this first and only then choose the drug.

We consider drug treatment for obesity in adults with a BMI of 30 or more, in those with a BMI of 27 to 29.9 and at least one complication, and when after 3 to 6 months of diet and exercise the weight has not fallen by 5 percent. Those are the criteria the Polish Society for the Treatment of Obesity set out in 2024, and that is our threshold for treatment.

Five active substances are licensed in Poland for the treatment of obesity: orlistat, naltrexone with bupropion, and three hormone drugs (liraglutide, semaglutide and tirzepatide). The last three are GLP-1 analogues, known colloquially as weight-loss injections. They mimic a gut hormone that signals satiety to the brain after a meal and slows the emptying of the stomach. The patient eats less because they feel full sooner, and between meals they think about food less. The patient injects liraglutide every day, and semaglutide and tirzepatide once a week, with a fine needle under the skin of the abdomen or the thigh. We raise the dose of semaglutide and tirzepatide every 4 weeks, and of liraglutide every week.

How much weight can be lost on GLP-1 drugs

In the STEP 1 trial, after 68 weeks of treatment with semaglutide at a dose of 2.4 mg, patients lost on average 14.9 percent of their body weight against 2.4 percent in the placebo group, and one in two lost 15 percent or more. Tirzepatide at the highest dose in the SURMOUNT-1 trial brought body weight down after 72 weeks by an average of 20.9 percent, against 3.1 percent on placebo. In both trials the drug was combined with diet and exercise.

How many months it takes to know whether an obesity drug is working

We judge how well the drug works after 3 months of treatment at the therapeutic dose. If body weight has not fallen by at least 5 percent in that time, PTLO recommends switching to a stronger drug and more intensive work with a dietitian. In the STEP 1 trial body weight stopped falling after about 60 weeks of treatment and held at the new level. That is the expected course of treatment; the drug is still working, because it is holding body weight down.

How much weight returns after an obesity drug is stopped

A year after semaglutide treatment ended, the participants of the STEP 1 trial who were followed up had regained two thirds of what they had lost. This result confirms that obesity is a chronic disease: the drug works for as long as it is taken, and how much of the lost weight the patient keeps after stopping depends on the habits built during treatment. That is why we decide together with the patient when to end treatment, and we withdraw the drug gradually.

We issue prescriptions for obesity drugs only after the tests and the assessment, and we do not prescribe products licensed solely for type 2 diabetes to treat obesity.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical hold a marketing authorisation in Poland for the treatment of obesity, while Ozempic and Rybelsus are authorised only in type 2 diabetes. Patients know these drugs by their brand names and ask at the appointment which one is best. The answer depends on the active substance, on the indication the drug is authorised for, on the average weight loss seen in the trials and on the cost of a month of treatment. Below we describe the five drugs licensed in Poland for the treatment of obesity, starting with the strongest, together with the names they are sold under in pharmacies.

• Tirzepatide (Mounjaro) acts on two receptors, GLP-1 and GIP, and is today the strongest obesity drug: in the SURMOUNT-1 trial the highest dose produced an average fall in body weight of 20.9 percent after 72 weeks. The patient injects it once a week, and we raise the dose every 4 weeks, from 2.5 to 15 mg. The same product is authorised both in obesity and in type 2 diabetes. In 2026 a month of treatment costs from about PLN 800 at the lowest dose to about PLN 1900 at the highest.
• Semaglutide (Wegovy, Ozempic, Rybelsus) is one substance in three products. Wegovy, an injection once a week at a dose of up to 2.4 mg, is authorised for the treatment of obesity; in the STEP 1 trial it produced an average fall in body weight of 14.9 percent after 68 weeks. Ozempic, an injection at a dose of up to 2 mg, and Rybelsus in tablet form are authorised only in type 2 diabetes, and the National Health Fund (NFZ) reimburses Ozempic only for patients with diabetes. For obesity we prescribe Wegovy, raising the dose every 4 weeks. A month of treatment costs from about PLN 550 to PLN 890 at pharmacy prices from September 2026.
• Liraglutide (Saxenda, Victoza), the oldest of these GLP-1 analogues, is a daily injection; the patient raises the dose every week until reaching 3 mg. Saxenda is authorised in obesity, Victoza at a lower dose only in diabetes. In the SCALE trial patients lost an average of 8.4 kg after 56 weeks against 2.8 kg on placebo, roughly half as much as on semaglutide. A month of treatment at the full dose costs from about PLN 500 to PLN 1250, because the same pack differs widely in price between pharmacies, so the saving against the newer once-weekly drugs is uncertain. We choose it rarely, for example in a patient who tolerated once-weekly injections badly.
• Naltrexone with bupropion (Mysimba) is taken as tablets. The drug dampens appetite and takes some of the pleasure out of eating, so it helps above all people who eat under the influence of emotion; in the COR-I trial patients lost 6.1 percent on it after 56 weeks, against 1.3 percent on placebo. We do not combine it with GLP-1 analogues, and we do not prescribe it to patients taking opioids or to people with epilepsy.
• Orlistat (Xenical) in tablet form blocks the absorption of about one third of the fat in a meal. The effect is small, 2 to 3 kg more than placebo over a year, and after a fatty meal the drug causes oily diarrhoea. We prescribe it to people who cannot take GLP-1 analogues.

Who gets tirzepatide, who gets semaglutide and who gets tablets

At a BMI above 35, or in type 2 diabetes, we usually suggest tirzepatide or semaglutide, because only these bring body weight down by 15 to 20 percent. We choose semaglutide when the lower price matters to the patient, and tirzepatide when the largest possible fall in body weight comes first. Liraglutide, naltrexone with bupropion and orlistat go to people who cannot take once-weekly drugs or who tolerate them badly. Ozempic and Rybelsus are not an option for obesity, even if the patient knows them from advertising or from friends.

The most common side effects of GLP-1 analogues affect the digestive tract. Nausea, vomiting, diarrhoea and constipation occur in at least one patient in ten, mainly in the first weeks and after every increase in dose, and they usually ease with time. In the STEP 1 trial 4.5 percent of people stopped treatment for this reason. Rarer but more serious are acute pancreatitis and gallstones, reported in 1.6 percent of those treated in the semaglutide trials. With severe abdominal pain radiating to the back the drug has to be stopped and the patient has to see a doctor the same day.

In which conditions we do not give GLP-1 analogues and when the doses of other drugs have to change

In line with the summary of product characteristics for semaglutide, we do not use these drugs in pregnancy or while breastfeeding, and a woman planning a pregnancy should stop semaglutide at least 2 months beforehand, because it stays active in the body for a long time. We do not recommend them for people with severe kidney or liver failure, with class IV heart failure or after an episode of pancreatitis. In people over the age of 75 the drug has been little studied, and the manufacturer does not recommend liraglutide at that age. In patients with type 2 diabetes who take insulin or a sulfonylurea, the doctor adjusts the doses of those drugs, because together with a GLP-1 analogue the risk of hypoglycaemia rises. People with diabetic retinopathy have to attend follow-up appointments with an ophthalmologist.

Tirzepatide can weaken the effect of the contraceptive pill, because it slows the absorption of oral medicines. For 4 weeks after treatment starts, and after every increase in dose, a barrier method or a form of contraception other than the pill has to be used as well. Before any planned general anaesthesia the patient has to tell the anaesthetist about the drug, because the slowed emptying of the stomach raises the risk of aspiration. If vision suddenly worsens during treatment, an ophthalmologist has to be seen urgently.

What a patient risks with semaglutide bought outside a pharmacy

GLP-1 analogues are prescription-only medicines, sold in pharmacies alone. Poland's Chief Pharmaceutical Inspectorate has already warned about counterfeit semaglutide pens sold outside pharmacies. In 2025, together with Poland's Chief Sanitary Inspectorate, it also warned about semaglutide sold online as a research peptide, without a prescription and with no control over dose or purity. Such a product may contain a different substance, or a different amount of semaglutide, than the seller declares, and the patient cannot check either the contents or the dose at home. We do not treat patients who are taking preparations from sources like these until they switch to a drug from a pharmacy.

Diet in obesity treatment means the patient eats 500 to 750 kcal a day less than they need. Starving brings the weight down at the cost of muscle and after a few weeks ends in overeating, with which the body makes up the shortfall. The dietitian builds the meal plan around the drugs the patient is taking: on GLP-1 analogues the portions are smaller, so every one of them has to contain protein, otherwise the body loses muscle instead of fat. We match the recommended 150 to 300 minutes of exercise a week to the state of the joints and to fitness: a patient with knee pain starts in the swimming pool or on a stationary bike.

Where evening binges come from and how the specialist in the psychology of eating works on them

Many of our patients eat not out of hunger but out of tension or boredom, or after a hard day, and the evening binge ends in guilt and another resolution that tomorrow will be different. This mechanism resembles other compulsive behaviours and does not disappear simply because a drug has reduced appetite. We therefore build work on eating behaviour and therapy into the obesity treatment plan: the patient learns to recognise the situations in which they reach for food, and practises other ways of releasing tension. Our therapists do this as part of addiction therapy in Wrocław, at the practice or online.

A gram of pure alcohol supplies 7 kcal, almost as much as a gram of fat, and the body burns it first, storing the fat from food in the meantime. Regular drinking, even without dependence, therefore encourages fat to settle in the abdomen, the so-called beer belly, and makes losing weight harder despite a good diet. At the first appointment we ask how much and how often the patient drinks, and we count alcohol into the calories along with food.

During treatment with GLP-1 analogues, alcohol worsens nausea and dehydration, and in people with diabetes it raises the risk of hypoglycaemia. Many patients report that once treatment starts they simply feel less like drinking. A randomised trial from 2025 supports this: in 48 people with alcohol use disorder, low doses of semaglutide reduced alcohol craving and the amount drunk in a single day. This was, however, an early trial in a small group, and semaglutide has no indication for the treatment of alcohol dependence. If a patient has a separate problem with drinking, we treat it separately, as part of alcohol addiction treatment in Wrocław, and we fit the obesity treatment plan around that second diagnosis.

We hold the first assessment appointment at our practice at ul. Dworcowa 11b in Wrocław, and the follow-up appointments every 4 weeks take place online. At the practice we measure waist circumference, blood pressure and body weight, and we compare every later check against a reading taken on the same scales. A patient from outside Wrocław can start treatment online by supplying their own measurements and blood test results. At an online follow-up the doctor talks to the patient, checks how well the drug is tolerated, sets the dose and issues an e-prescription to be dispensed at any pharmacy. Obesity treatment online therefore covers the same ground as treatment at the practice, and the patient does not have to take time off to travel.

Whatever the patient prefers, we ask them to come in at a BMI of 40 or more, with heart or kidney disease that calls for a physical examination, and whenever we suspect a secondary cause of the weight gain. Appointments with the dietitian and with the specialist in the psychology of eating are available in both forms. Anyone who cannot take the drugs for the time being, because of a planned pregnancy for instance, receives the same eating plan and the same psychological care, only without the drug treatment.

Under the PTLO guidelines, every doctor a patient comes to is responsible for diagnosing and treating obesity, the GP above all. In practice an appointment at a GP surgery lasts a quarter of an hour and rarely ends in a treatment plan, and there are few obesity clinics in the country under the NFZ. No drug licensed for the treatment of obesity is reimbursed; the patient pays the full price at the pharmacy. Semaglutide in the product licensed for patients with type 2 diabetes is reimbursed only in diabetes, and only when the criteria are met, and a discount on a prescription issued for obesity is a reimbursement wrongly claimed, which the NFZ can recover from the doctor.

Privately the patient pays for the medical consultation and the follow-up appointments according to the price list (the first medical appointment PLN 250), and for the drug at the pharmacy. The monthly cost of a GLP-1 analogue depends on the substance and the dose; in 2026 it runs from about PLN 550 to PLN 2000, and the higher the dose, the more expensive. We talk about this at the first appointment, because treatment a patient cannot afford for a whole year breaks off after a few months and the weight returns. With people whose BMI is 35 or more with complications, or 40 or more, we also discuss bariatric surgery under the NFZ. The KOS-BAR programme of comprehensive care ran as a pilot until 30 June 2026, and the Ministry of Health has announced that it will be brought in as a service covered by public health insurance. Until then the operation itself is reimbursed under the general rules, with a referral to a surgical department.

Bariatric surgery, most often a sleeve gastrectomy or a gastric bypass, is the most effective treatment for class III obesity. Under the 2022 position statement of the international surgical societies, surgery is considered at a BMI of 35 or more regardless of complications, and at a BMI of 30 or more in patients with type 2 diabetes in whom treatment without surgery does not work. The Polish criteria for surgery refer to class II and class III obesity.

We carry out the assessment and prepare the patient for surgery: before the operation the patient should lose a few percent of their weight, get emotional eating under control and bring diabetes or high blood pressure to target, because this lowers the risk of complications. Once that preparation is done we refer the patient to a bariatric centre. The operation is a service covered by public health insurance under the NFZ, and the KOS-BAR pilot, which until June 2026 brought together the preparation, the operation and a year of care afterwards, is waiting to be brought in as a permanent service. After surgery the patient still needs weight monitoring, supplements and psychological support; that part of the treatment can carry on with us.

Patients travel to the practice on ul. Dworcowa from across Lower Silesia, among others from Oleśnica, Oława, Trzebnica, Środa Śląska, Kąty Wrocławskie, Siechnice, Jelcz-Laskowice, Brzeg Dolny, Wołów, Strzelin, Milicz, Legnica, Lubin and Świdnica. Obesity treatment calls for a check every 4 weeks, so a patient from outside Wrocław usually asks how many of those checks can be done remotely.

A patient from outside Wrocław has the first appointment either at the practice or online; the online option is open to anyone who has blood tests done beforehand at a laboratory in their own town and measures their own body weight and waist circumference. We run the later checks and the appointments with the dietitian and the specialist in the psychology of eating online, and the e-prescription can be dispensed at any pharmacy, including the one nearest home. We ask patients to come in only when the doctor has to examine them in person, for example in class III obesity or where secondary obesity, caused by another illness, is suspected.

According to measurements taken at GP surgeries between January and July 2025, 58.3 percent of adults in Wrocław are overweight or obese. Across the Lower Silesian province 693,000 adults have obesity itself (figures from the NFZ and the Ministry of Health cited by Poland's Supreme Audit Office). Wrocław aims its municipal health programmes on obesity at children and adolescents; for adults the city funds only the prevention of type 2 diabetes in people aged 35 to 64, and it does not fund obesity treatment. An adult in Wrocław who has obesity therefore ends up with a GP or at a private clinic.

Nasz Gabinet Wrocław sees patients at ul. Dworcowa 11b, where it has treated addictions for years, so a patient who alongside obesity has a problem with alcohol or with eating under the influence of emotion is treated for both by the same team.