Obesity is an undeniable problem of the modern world, threatening the health of humanity. It is a challenge for social and health policy. It is particularly evident among children and adolescents. It is a medical disease that affects human health in a psychological and social context, and causes more than 200 health complications. 

HEALTH CARE SYSTEM IN POLAND

The health care system in Poland is based on a system of universal health insurance and provides every eligible person with organized health care and access to health services. The goals of health care are:

• prevention of disease and injury
• early detection of diseases
• treatment
• care
• prevention and reduction of disabilities

Services covered by universal health insurance are:

• POZ: primary health care (health services are provided by a general practitioner)
• coordinated care in primary care is the diagnosis and treatment of chronic disease in a continuous and comprehensive manner (the patient’s coordinated care is handled by a team consisting of a primary care physician, specialist physicians, a nurse practitioner and a dietician)
• Outpatient specialty care (AOS) provides treatment with specialists
• inpatient treatment (on the basis of a referral from a general practitioner or specialist doctor

ACCESS TO PREVENTION AND TREATMENT OF CHILDHOOD AND ADOLESCENT OBESITY

Prevention and treatment of young people suffering from overweight or obesity are systemic measures, especially education and ensuring accessibility to health services. Early diagnosis and systematic control of the condition, as well as the implementation of comprehensive and individualized treatment measures, determine the effectiveness of successful treatment.

Currently, there is no uniform data determining the number of children and adolescents who are obese or overweight. There are no studies covering the entire population of people under 18 years of age, performed according to a single methodology, repeated periodically, so that it is possible to determine the scale and trend of the phenomenon. Despite the growing scale of obesity and its negative consequences, the disease is still downplayed in Poland. Excessive weight is constantly identified as a defect of a visual nature or a failure to eat properly and take care of one’s health. This attitude, as well as inadequate resources of medical staff and very long waiting times for an appointment at an outpatient clinic, negatively affect the effective prevention and treatment of overweight and obesity. The Polish health care system does not bear the high cost of treating overweight and obesity. This is due to the fact that it mainly treats complications of obesity disease, largely caused by failure to treat excessive weight in its early stages.

Prevention should be multidirectional and should be carried out at many levels, both family, school, local government and central government. Many factors influence a child’s behavior. It’s important to provide nutrition education, adequate infrastructure to encourage physical activity and real accessibility to health care. The development of medical standards for the treatment of overweight and obesity is crucial.

Poland lacks a system of care for children and adolescents with excessive body weight. Scientific and expert communities recommend the development of standards and a model of comprehensive care of a conservative nature.  In 2014, medical experts prepared a document talking about the principles of management of overweight and obesity in the practice of a family doctor. The document was updated in 2018. Its overarching goal was to provide doctors with tools to help correctly diagnose the disease and implement treatment. The publication was necessary due to the lack of availability in the health care system, within the framework of universal insurance, of comprehensive treatment of excessive body weight.

The preventive and curative path recommended by the scientific and expert communities consists of three key activities:

• wide-ranging prevention activities
• Mechanisms to facilitate early diagnosis of the disease
• rapid availability of effective treatment

In the Polish health care system, it is the primary care physician who is responsible for the preventive treatment of overweight and obesity. Specialists are in charge of treating complications. This is due to easier access to a primary care doctor than to a specialist. Unfortunately, doctors working in primary care do not feel competent to manage an overweight or obese patient, due to insufficient knowledge of psychology and dietetics. In addition, time constraints prevent sufficient attention to the patient. Including dietary advice in the package of guaranteed benefits would contribute to more effective treatment of obesity and counteract other health complications.

In view of the real threat of an obesity pandemic and given the wide range of complications of this disease, it is important to effectively implement measures aimed at preventing overweight and early implementation of treatment of obesity and its complications.  Preventive measures, that is, promotion of proper eating habits and physical activity, are very important. They should take place in many areas at the same time, with the involvement and cooperation of those initiating and implementing tasks in this area. More importantly, there should be rapid access to effective treatment of obesity to prevent its complications in time.

COMPREHENSIVE MEDICAL CARE PROGRAM FOR PATIENTS WITH GIANT OBESITY (KOS-BAR)

In August 2021, a regulation was issued on the pilot program for comprehensive specialized care for recipients treated for giant obesity (KOS-BAR). The expected outcome of the pilot program is the earliest possible return to work, a lower incidence of complications, a reduction in the length of hospitalization, but also a reduction in costs to the state, patients and their families.

Under KOS-BAR, the patient will be provided with comprehensive at all stages of treatment:

1. Qualification for the KOS-BAR program based on the patient’s health status
2. Pre-operative care provided by a multi-specialist team based on an individualized treatment plan
3. qualifying a patient for bariatric surgery
4. operation
5. follow-up visit after surgery
6. individual therapeutic rehabilitation plan

Psychological support and monitoring of effects

Each patient qualified for the KOS-BAR program will receive psychological and dietary support and assistance. In order for the treatment to be effective, it is necessary to modify the patient’s lifestyle, incorporate a reduction diet, educate on the aspect of proper nutrition, as well as increase physical activity and therapeutic rehabilitation. Ongoing care to monitor the effects of treatment will be implemented for one year from the day the patient is discharged from the hospital.