Obesity: a chronic crisis

South Africa’s healthcare sector is pushing to recognise obesity as a chronic disease rather than a cosmetic issue, but access to treatment remains constrained across both public and private care.

Globally, more than 1-billion people are living with obesity, a number expected to reach 1.91-billion by 2035. In South Africa, about 12-million adults and 2-million adolescents are obese, while more than 50% of adults — about 20-million people — are overweight or obese.

“We need to understand that this is a chronic disease. It’s not just a cosmetic issue; it’s actually a chronic condition that predisposes us to many health issues,” said endocrinologist Reyna Daya at Novo Nordisk South Africa’s World Obesity Roundtable.

What we see in clinical practice is that because of all the stigma attached to obesity, people shy away from speaking about it. It’s only if patients bring it up during a doctor’s consultation that it gets discussed; otherwise, it is swept under the rug.

—  Reyna Daya

According to Novo Nordisk — the manufacturer of the weight-loss medication Wegovy (semaglutide), with more than 25 years of experience in obesity research — the condition is linked to more than 200 health complications, including high blood pressure, diabetes, mental health issues, obstructive sleep apnoea, and cardiovascular disease.

Treatment itself is one hurdle, but stigma surrounding obesity remains a major barrier. Some 69% of adults living with obesity report bias from healthcare professionals, while 54% experience stigma from co-workers. Children with obesity are 63% more likely to be bullied.

“What we see in clinical practice is that because of all the stigma attached to obesity, people shy away from speaking about it. It’s only if patients bring it up during a doctor’s consultation that it gets discussed; otherwise, it is swept under the rug,” said Daya.

The economic impact is also significant, with global costs currently estimated at $2-trillion (R34-trillion) annually and projected to exceed $4-trillion by 2035.

Daya said obesity disproportionately affected individuals from lower-income backgrounds. In the public sector, very little is being done to address the condition, with severe resource constraints limiting access to care, structured treatment programmes and specialist support.

According to Statistics South Africa, roughly 85% of the population relies on public health services. In contrast, the private sector generally offers better access to facilities and specialist doctors, but treatment options are often not covered, leaving affordability a major barrier for many patients.

Thabeng Leping, director of market access and public affairs at Novo Nordisk, said that while medical aid schemes recognised obesity as a chronic disease, determining which patients should have access to treatment remained a key challenge.

Some schemes limit coverage to higher-risk patients, such as those with a BMI over 30 or at risk of serious complications, because the standard BMI threshold of 27 for semaglutide 2.4 mg would apply to too many members. “Seeing obesity as a medical condition is one thing, but seeing it as a treatable medical condition is another,” Leping said.

He added that early intervention could prevent hospitalisations and reduce the need for additional medication, offering substantial long-term savings despite high upfront costs.

However, schemes also face concerns about anti-selection, he said, with patients potentially switching plans or leaving after early results, making it difficult to achieve consistent outcomes over time.

Seeing obesity as a medical condition is one thing, but seeing it as a treatable medical condition is another.

—  Thabeng Leping

Pricing is another major challenge. Leping said South African law requires medicine prices to be uniform across all schemes and regions, preventing Novo Nordisk from offering lower prices to larger schemes that could benefit from economies of scale.

He said this made it difficult to balance accessibility for larger volumes with sustainability for smaller schemes, leaving some patients to rely on their savings portions in the interim.

Sara Norcross, vice-president and GM at Novo Nordisk, echoed these challenges, noting that the healthcare system often focuses on treating obesity-related complications rather than addressing the root cause. “That mindset doesn’t always exist, and that’s a challenge. Often we’re trying to help medical aid schemes understand that this has a huge benefit,” she said, explaining that early intervention can lead to healthier, more productive individuals and lower long-term costs for schemes and employers.

She added that the approach to obesity treatment is evolving, moving beyond simply reimbursing medication toward a more comprehensive strategy that integrates nutrition, health coaching and lifestyle guidance.

Progress was being made, Norcross said, and in the coming months Novo Nordisk hopes to announce initiatives that reflect this more holistic approach. “If we shift away from labels and focus more on understanding what causes obesity, rather than assigning blame, we can start to think about support and treatment differently.”

Looking ahead, Norcross said patients can expect a broader range of weight-loss options in South Africa, including new treatments, diverse weight-loss plans, and both injectable and oral medications to suit different needs.

With more options available, affordability is also likely to improve as prices come down. “The biggest shift I’m aiming for is integrating these treatments into the healthcare system” she added, signalling a move toward more co-ordinated and sustainable obesity care.

Novo Nordisk anticipates that the government will introduce semaglutide into the public sector.

Leping said it was unclear whether access will cover obesity or type-2 diabetes specifically, but the company was confident it can meet demand, citing global manufacturing capacity, high-volume pricing, and no reported supply constraints.

Business Times