The four treatments at a glance
In the Netherlands, there are roughly four treatments you can use to work towards lasting weight loss. Which treatment suits you depends on your BMI, any health conditions, your history and your personal preference.
- Lifestyle on your own: nutrition, exercise, sleep and behaviour without professional medical supervision.
- Combined lifestyle intervention (GLI): a structured two-year programme with lifestyle coaches.
- GLP-1 programme: medically supervised weight loss with prescription medication, combined with lifestyle support.
- Bariatric surgery: an operation such as a gastric reduction for severe obesity.
1. Lifestyle on your own
With this approach, you work on your eating habits, exercise, sleep and behaviour yourself, without professional medical supervision. Sometimes with support from a dietitian, a fitness coach or an online programme.
Who it's suitable for
Working on your lifestyle is relevant for everyone, regardless of your BMI. It's also the foundation of every other treatment. On its own, lifestyle change is often enough if your BMI is between 25 and 30 and you don't have any underlying health conditions. With obesity (BMI of 30 or above), lifestyle changes alone are usually not enough to lose weight permanently, according to the NHG-Standaard Obesitas. A structured programme with medical or lifestyle support tends to work better in those cases.
What's realistic
If you stick with it consistently, 5 to 10% weight loss is achievable. The risk of relapse is high without structure or support. That's why lifestyle changes on your own tend to work best when combined with some form of guidance.
Read more: Slimming pills and lifestyle: what really works.
2. Combined lifestyle intervention (GLI)
The GLI is a structured two-year programme with a lifestyle coach, and with some programmes also a dietitian and exercise professional. It is recognised by Zorginstituut Nederland, with the aim of helping you make lasting lifestyle changes.
Who it's suitable for and reimbursement
The GLI is covered by basic health insurance if your BMI is 35 or above, or if your BMI is between 25 and 35 combined with a large waist circumference (88 cm or more for women, 102 cm or more for men) or with health conditions such as type 2 diabetes, cardiovascular disease or sleep apnoea. Your GP will refer you.
What's realistic
The RIVM evaluation of Dutch GLI programmes shows an average weight loss of around 3.8% after 24 months. About half of participants lose at least 5% of their body weight. Recognised programmes include BeweegKuur, CooL, SLIMMER and Samen Sportief in Beweging. Medication is not part of the GLI.
Read more: The GLI programme: what is the combined lifestyle intervention.
3. Medically supervised weight loss with GLP-1 medication
GLP-1 receptor agonists are medications that are usually injected. They reduce feelings of hunger and slow down gastric emptying. In the Netherlands, Wegovy (semaglutide), Saxenda (liraglutide) and Mounjaro (tirzepatide) are registered in the EU for chronic weight management in adults with obesity or overweight with weight-related conditions. Ozempic is primarily registered for type 2 diabetes and is sometimes prescribed off-label for weight loss in practice. A doctor will assess whether medication is appropriate for you.
Who it's suitable for
Adults with a BMI of 30 or above, or from 27 combined with weight-related health conditions. A BIG-registered doctor assesses your suitability based on a questionnaire, consultation and medical history.
Reimbursement
GLP-1 medications are usually not covered by basic health insurance for weight loss. For type 2 diabetes, reimbursement may apply under the Bijlage 2 conditions of Zorginstituut Nederland.
Side effects
Gastrointestinal complaints such as nausea and constipation are most common in the first few weeks. The dose is built up gradually to minimise this. The full side effect profile is available in the Farmacotherapeutisch Kompas and the EMA package leaflet for the relevant medication.
More information: medication overview, Wegovy, Saxenda, Mounjaro and the programme.
4. Bariatric surgery
Bariatric surgery is an umbrella term for operations that reduce the size of the stomach or reroute digestion. The most common procedures in the Netherlands are the gastric bypass and the sleeve gastrectomy.
Who it's suitable for
Adults with a BMI of 40 or above, or from 35 combined with serious weight-related health conditions such as uncontrollable type 2 diabetes. Referral goes through your GP to a specialist hospital. A multidisciplinary team assesses the indication according to the guidelines of the Nederlandse Vereniging voor Heelkunde and the IFSO criteria. You will often need to demonstrate previously documented supervised weight-loss attempts.
Reimbursement and outcomes
When there is a medical indication, the procedure is covered by basic health insurance. In the long term, studies report 25 to 35% weight loss with adherence to the post-operative diet.
Limitations
Surgery is a major intervention and cannot be reversed. You will need to take vitamins and minerals for the rest of your life and permanently adjust your eating habits. Not every form of obesity has a surgical indication.
Comparison table
A high-level overview. A doctor always assesses whether a treatment is right for your situation.
| Criterion | Lifestyle | GLI | GLP-1 programme | Bariatric surgery |
|---|---|---|---|---|
| BMI requirement (from) | For everyone | 25 with complications or waist circumference, or 35 | 27 with complications, or 30 | 35 with complications, or 40 |
| Duration (typical) | Open-ended | 2 years | 12 to 24 months | One-time procedure, lifelong aftercare |
| Intensity of support | None to dietitian | Weekly to monthly | Ongoing medical supervision | Pre- and post-operative multidisciplinary |
| Covered by basic health insurance | No | Yes, when indicated | Not for weight loss | Yes, with medical indication |
| Medication involved | No | No | Yes, by prescription | No, supplements required |
| Irreversible | No | No | No | Yes |
How do you choose a clinic for medically supervised weight loss?
Several Dutch clinics offer support for GLP-1 programmes. Which clinic suits you depends on your personal preferences and medical situation. The following points can help you evaluate providers.
- BIG registration of doctors. Verify your treating doctors via the BIG register.
- Online or in-person consultation. Online works well if you're self-disciplined and value flexibility. An in-person consultation suits those who prefer face-to-face contact. Both are medically valid.
- Type of support. Just medication and check-ins, or medication combined with lifestyle modules and personal coaching? People who receive more intensive support tend to maintain their weight loss more often in the long run.
- Cost transparency. A clinic shows you the full price of the programme, medication and pharmacy upfront, with no hidden costs.
- Registration and reviews. The clinic is registered with the CIBG healthcare providers portal. Read reviews on independent platforms.
- Cancel monthly. Less lock-in means more flexibility if the approach doesn't suit you.
- Accessibility of the treatment team. How often do you have contact with a doctor or coach, and through which channel? A complaints procedure should be in place.
Which clinic suits you depends on your personal preferences and medical situation.
What does Lean Clinic do?
Lean Clinic is a 100% online clinic for medically supervised weight loss in the Netherlands. BIG-registered doctors assess your eligibility. The programme combines medication where medically indicated with lifestyle modules, personal coaching and an online community.
- Who it's for: adults with a BMI of 27 or above combined with health conditions, or a BMI of 30 or above.
- Assessment by BIG-registered doctors based on an online questionnaire and consultation.
- Cancel monthly, with transparent programme costs on the programme page.
- Ongoing medical supervision and monitoring of side effects.
Frequently asked questions
- Which treatment suits my BMI?
- BMI is a first indicator, not a prescription. If your BMI is between 25 and 30 with no health conditions, working on your lifestyle is usually the starting point. If your BMI is between 25 and 35 with a large waist circumference or health conditions such as type 2 diabetes, cardiovascular disease or sleep apnoea, you may qualify for a combined lifestyle intervention (GLI) through your GP. If your BMI is 30 or above, or 27 or above with weight-related health conditions, medically supervised weight loss with GLP-1 medication may be appropriate. Bariatric surgery is considered for a BMI of 40 or above, or 35 or above with serious health conditions. Your doctor always assesses what is suitable in your situation.
- What is the difference between the GLI and a GLP-1 programme?
- The GLI is a two-year lifestyle programme with a lifestyle coach, and in some programmes also a dietitian and physiotherapist. No medication is involved. The GLI is covered by basic health insurance if you meet the criteria. A GLP-1 programme combines prescription medication with lifestyle support and ongoing medical supervision by a doctor. The two differ mainly in how they work: the GLI focuses entirely on behaviour, while a GLP-1 programme adds medical support where indicated.
- Is weight loss with injections covered by insurance in the Netherlands?
- GLP-1 medications for weight loss are usually not covered by basic health insurance. For the treatment of type 2 diabetes, reimbursement may apply under the Bijlage 2 conditions of Zorginstituut Nederland. Your GP or treating doctor will know the current criteria. Some supplementary insurance plans do cover part of lifestyle coaching.
- What does medically supervised weight loss cost?
- Costs vary depending on the treatment. Working on your lifestyle independently costs nothing, apart from any dietitian support you choose. The GLI is fully covered if you meet the criteria. A GLP-1 programme involves costs for medical supervision plus the medication itself through the pharmacy. Bariatric surgery is covered when there is a medical indication. You can find the current programme prices on the Lean Clinic programme page.
- Can you combine lifestyle changes with GLP-1?
- Yes, and that is actually the intention with medically supervised weight loss. GLP-1 medications are only used as part of a broader programme that includes nutrition and exercise guidance. People who combine both approaches tend to maintain their weight loss better after stopping medication than those who receive medication alone.
- When does bariatric surgery become an option?
- Bariatric surgery is a major procedure and in the Netherlands only comes into consideration at a BMI of 40 or above, or from 35 in combination with serious weight-related health conditions such as uncontrollable type 2 diabetes. Referral goes through your GP to a specialised hospital with a multidisciplinary team. The decision is irreversible and requires lifelong adjustments.
- Can I switch between treatments?
- Yes. Many people start with lifestyle changes, find that the results don't stick well enough, and later move on to a GLI or a GLP-1 programme. The reverse is also possible. Switching always happens in consultation with your doctor, because some medications cannot be stopped abruptly and because dosage and guidance need to stay aligned.
- How do I know if a clinic is reliable?
- Check whether the doctors are BIG-registered via the BIG-register, whether the clinic is listed in the CIBG healthcare providers portal, and whether the total costs are clearly communicated upfront. Read independent reviews and pay attention to how easy it is to reach the treatment team. A reliable clinic always combines medication with lifestyle guidance and has a complaints procedure in place.
Sources
- Farmacotherapeutisch Kompas, general information about GLP-1 receptor agonists. farmacotherapeutischkompas.nl
- Zorginstituut Nederland, combined lifestyle intervention and Bijlage 2 conditions. zorginstituutnederland.nl
- RIVM, accredited GLI programmes and evaluation of weight loss. rivm.nl
- NHG-Standaard Obesitas, Nederlands Huisartsen Genootschap. nhg.org
- Richtlijnendatabase, surgical treatment of obesity (NVvH). richtlijnendatabase.nl
- BIG-register, check whether a doctor is BIG-registered. bigregister.nl
This page is for informational purposes only and does not replace medical advice. Always consult a doctor before starting medication or a treatment programme.
