The Epidemic Nobody Talks About
Civilisation diseases — type 2 diabetes, hypertension, obesity, metabolic syndrome — belong to the noncommunicable diseases which, according to the World Health Organization, caused at least 43 million deaths in 2021, that is three quarters of all deaths not related to the pandemic (WHO, 2025). A large proportion of them can be prevented.
Medication is essential in these diseases and a spa stay does not replace it. What no tablet can do, however, is change for several weeks the things these diseases grow from: a sedentary day, hurried meals, chronic stress and a lack of time to recover. This is exactly where the spa adds what an outpatient clinic cannot — and for some of these diagnoses it is also covered spa care.
How the Spa Steps In Where the Clinic Falls Short
1. Diabetes
Diabetes mellitus and its subsequent complications are listed in the Czech indication list under code IV/1; the basic stay is 21 days in both comprehensive and contributory care, a repeat stay 21 days in contributory care (14 in justified cases). Mariánské Lázně (Marienbad) treats this group.
The foundation of the programme is the drinking cure from the local sulphate and bicarbonate springs — traditionally above all the Cross Spring and Ferdinand Spring, which have been used for metabolic disorders in Mariánské Lázně for two centuries. The spring, daily volume and timing are determined by the spa physician according to the diagnosis and other conditions. A review of 22 studies of balneotherapy in diabetes and obesity reports that baths, sauna and drinking sulphate and bicarbonate waters were associated in the included studies with lower blood glucose and weight; only three of these studies had more than one hundred participants (Maeda et al., 2026, Int J Biometeorol). In an Italian pilot study of 50 obese men, 21 of whom had type 2 diabetes, weight, blood lipids, blood glucose and the inflammatory marker CRP fell after three weeks of a low-calorie diet combined with baths and peloids; the study had no control group, so the contributions of the diet and the treatments cannot be separated (Fioravanti et al., 2015, Int J Biometeorol).
The spa programme for diabetics in Mariánské Lázně usually includes:
- a drinking cure with an individually selected spring,
- carbonic baths — in a randomised trial in 24 patients with arterial disease of the lower limbs, a four-week series increased tissue oxygen and pain-free walking distance (Hartmann et al., 1997, Angiology); the sample was small and the patients were not diabetics,
- guided exercise — the terrain cure with blood glucose monitoring,
- nutritional counselling — setting up a meal plan for the months ahead.
Diabetes treatment is led by the diabetologist; after the initial examination the spa physician draws up a plan that complements it and monitors blood glucose during the stay.
2. Hypertension
Hypertension of grade II to III is a covered indication under code II/3: the basic stay is 28 days in comprehensive care or 21 days in contributory care, a repeat stay 21 days (14 in justified cases) in contributory care. Persistent hypertension above 120 mmHg diastolic, on the other hand, is among the general contraindications to spa treatment.
The main treatment is CO₂ therapy — carbonic baths and dry gas baths. Carbon dioxide penetrates the skin, dilates the small vessels and lowers peripheral resistance. What has been measured: in 35 spa patients, 24-hour blood pressure fell after three weeks of balneotherapy with carbonic and mud baths in people with medium and high baseline values, while in people with low pressure it did not change; the study had no control group (Ekmekcioglu et al., 2000, Altern Ther Health Med). In a randomised trial in 70 women with climacteric syndrome, mean daytime systolic pressure fell by 13.7% after ten dry CO₂ baths; the control group received no treatment and the result applies to this specific group of women (Chekhoeva et al., 2024, Bull Rehabil Med). A review of 12 randomised trials of bathing in thermal mineral water in hypertension (1,122 participants) concludes that baths alone and as an adjunct to medication had no adverse effects and favourably influenced blood pressure in most studies; the authors point to the heterogeneous and methodologically weaker nature of the studies (Yuan et al., 2019, Int J Biometeorol).
The cure does not replace medication. The aim is more stable blood pressure, better exercise tolerance and a regimen you take home with you; any adjustment of medication is made by the spa physician in cooperation with your treating doctor. We write in more detail about the cardiovascular cure in the article on spa treatment of the circulatory system.
3. Obesity and Metabolic Syndrome
Neither obesity nor metabolic syndrome is a separate item in the indication list; a covered stay for these depends on an associated diagnosis (most often diabetes or hypertension), otherwise they are self-paid metabolic programmes. A spa stay is not a slimming cure. It is several weeks in which exercise, diet, treatments and rest work together at once — and it is precisely for a programme composed like this that the best data of all the civilisation diseases exist:
- In a French randomised trial in 257 people with overweight or obesity (BMI 27–35), body mass index had fallen by 1.91 points one year after a three-week spa programme, compared with 0.20 with usual care (Hanh et al., 2012, Evid Based Complement Alternat Med). The analysis was per protocol, i.e. only in those who completed the programme.
- Education decides whether the result lasts. In a controlled study in 340 people, the group with spa plus an educational programme had lost 2.69 kg after five months compared with 1.24 kg with the spa alone; at 11 months only the education group had maintained the result (Schnebelen‑Berthier et al., 2019, Obes Res Clin Pract). The study was not randomised.
- Metabolic syndrome: in a cohort of 63 patients, 76% of those followed no longer met the criteria for metabolic syndrome one year after a three-week stay with education (Gin et al., 2013, Therapie); however, 35% of participants were lost to follow-up and there was no control group.
- Exercise that lasts. In a randomised trial in 228 spa patients, 81% of people were meeting the recommended amount of physical activity one year after a stay with activity coaching, compared with 67% (Fillol et al., 2021, J Med Internet Res); the data were self-reported.
The programme in Mariánské Lázně builds on the same components: the terrain cure in the contoured terrain of the spa forests, a drinking cure from the sulphate springs traditionally used for digestive and metabolic disorders, peat wraps as a heat treatment for the musculoskeletal system, a dietary regimen prepared by the spa kitchen and the rest that is usually missing at home. A randomised trial in 84 patients with hypertension and obesity confirmed that a series of baths had no adverse effect on metabolic or inflammatory indicators (Oláh et al., 2011, Contemp Clin Trials).
Why Weeks at the Spa Change More than a Year at the Clinic
At the clinic you spend 15 minutes. The doctor tells you "lose weight, exercise, eat healthily". You know that yourself. Hardly anyone, though, shows you how — and above all nobody gives you the space to start doing it.
At the spa you have:
- Time — two to four weeks depending on the indication, without work and obligations
- Structure — a daily programme with treatments, exercise and meals
- Experts — a spa physician, physiotherapists, nutrition specialists
- Environment — forest, a foothill climate, mineral springs
- Feedback — regular blood pressure and blood glucose measurements that show what exercise, food and rest do to your values
According to the studies cited, it is education and the exercise habit that decide the result after one year. The spa is the starting line, not the finishing tape.
Indications for Spa Treatment of Civilisation Diseases
| Condition | Position in the indication list | Covered length of basic stay |
|---|---|---|
| Diabetes mellitus and subsequent complications | IV/1 — metabolic disorders | K 21 days, P 21 days |
| Hypertension of grade II–III | II/3 — diseases of the circulatory system | K 28 days, P 21 days |
| Obesity | not a separate item; self-paid programmes or according to the associated diagnosis | according to the associated indication, otherwise by agreement with the spa physician |
| Metabolic syndrome | not a separate item; self-paid programmes or according to the associated diagnosis | according to the associated indication, otherwise by agreement with the spa physician |
K = comprehensive care (the insurer covers treatment, accommodation and meals), P = contributory care (the insurer covers treatment). Repeat stays and conditions can be found on the page indications and contraindications.
The inclusion of individual treatments in the treatment plan is decided by the spa physician after the initial examination; the general contraindications to spa treatment apply, including, for indication groups II and IV, nicotine dependence.
How to Start
- Consult your doctor — ask about a spa stay as part of your treatment; for guests insured in the Czech Republic the referral is issued by a general practitioner, diabetologist or cardiologist
- Consider insurance — for diabetes (IV/1) and hypertension of grade II–III (II/3), the stay may be covered by Czech health insurance; the procedure is described in the spa treatment insurance guide
- Plan your journey — Mariánské Lázně is 2 hours from Prague
- Book accommodation — the length of stay is recommended by the spa physician according to the indication
