South Africa has a weight problem. Not the kind you fix with a January gym contract or cutting carbs for a few weeks. The kind that is quietly reshaping the country’s health system, economy and workforce. More than half of adults are overweight or living with obesity. The cost is over R33 billion a year. But those numbers do not tell the full story. The real impact shows up later, in hospital wards, chronic disease diagnoses and lives that could have looked very different. We spoke to Thabeng Leping, Director of Market Access, Public Affairs, Communications, and Sustainability at Novo Nordisk South Africa to unpack what is really going on.
Obesity as a Chronic Disease
South Africa’s obesity crisis is now being described as a socioeconomic emergency. According to Thabeng, the way we think about obesity needs to shift. Obesity has long been seen as a risk factor for other conditions, but the World Health Organization now classifies it as a chronic relapsing disease. “This means we no longer see it as just a risk factor,” Thabeng explains. “It is a standalone disease deserving treatment beyond just lifestyle changes such as diet and exercise. Treatment needs to go beyond diet and exercise. It can also include pharmacotherapy.”
The socioeconomic dimension of obesity in South Africa is particularly significant. Access to treatment is heavily influenced by wealth and health coverage. Private medical schemes generally do not cover anti-obesity medications and public hospitals rarely have these treatments available. For the majority of South Africans who cannot afford out-of-pocket expenses, this leaves them without proper care.
READ MORE: Dr Sivuyile Madikana Unpacks Obesity and How It’s Manageable
“If left untreated, people are likely to develop type 2 diabetes, cardiovascular disease and other complications,” Thabeng says. “The system ends up treating the consequences rather than preventing the disease itself.”
Why This Is a National Issue
Obesity is often framed as an individual lifestyle problem. Thabeng argues it should be seen as a national health and economic crisis. “South Africa already spends over R33 billion a year on obesity and related diseases,” he says. “This is a public health concern that affects budgets, hospital capacity and long-term healthcare planning.”
The World Health Organization’s recognition of obesity as a chronic disease has also created an imperative for governments worldwide to include obesity therapies in essential medicines lists. South Africa is exploring how GLP-1 medicines can be made accessible in the public sector, but it remains unclear if this will extend beyond patients with type 2 diabetes to those living with obesity or overweight conditions.
The Emotional and Societal Impact
Obesity is not just about numbers on a scale. Thabeng highlights the emotional and societal dimensions, including stigma and cultural perceptions. “In some contexts, being heavier is seen as a sign of health or prosperity,” he says. “Children who are overweight may be called fresh or cute. Society shapes how people view themselves, which can make addressing obesity more challenging.”
There are also tangible impacts on everyday life. Certain industries, such as airlines or mining, impose restrictions or extra costs on people with higher weight. This can affect employment opportunities and personal finances.
“People who develop type 2 diabetes as a result of obesity may find their livelihoods affected,” Thabeng notes. “If medical boards determine a person is not fit to work underground in a mine, for example, this is a direct consequence of unmanaged obesity.”
Understanding BMI and Its Limitations
Body mass index, or BMI, is commonly used to classify obesity, but it has limitations, particularly in a diverse population like South Africa’s. “BMI is just one tool in the toolbox,” Thabeng explains. “It helps separate overweight from obese, but it does not apply equally to everyone. A rugby player with a high BMI may not actually be obese, while someone else may face health risks at a lower BMI.”
READ MORE: This Is Why BMI Is Inaccurate and Misleading in 2024
Understanding the nuances of BMI is important for practitioners and patients alike. It is a starting point for diagnosis and treatment, not a definitive measure of health.
The Triple Burden of Malnutrition
South Africa faces a unique challenge with a triple burden of malnutrition, which Thabeng describes as undernutrition, micronutrient deficiencies and rising obesity rates.
“In children, we see undernutrition alongside micronutrient deficiencies,” he says. “Both contribute to the obesity crisis as children grow. For adults, policies and socioeconomic factors shape dietary habits, access to nutritious food and the prevalence of unhealthy eating.”
Urbanisation, long commutes and time constraints also influence what people eat. Many South Africans live in areas where fresh, healthy foods are expensive or inaccessible. These factors combine to create an environment where unhealthy eating becomes the default. Addressing these overlapping challenges requires interventions that start early and reach communities directly.
Prevention Starts Early
While much of the conversation around obesity focuses on adults, Thabeng stresses that prevention has to start much earlier. One of the most practical examples of this is the work being done in schools in Soweto.
“We are working with the City of Johannesburg on a childhood prevention initiative,” he explains. “We have adopted 22 schools in Soweto where we are implementing programmes focused on healthier lifestyles.”
READ MORE: Why Type 1 Diabetes Hits Harder Than You Think—Especially for Men
The initiative, now called Asibe Healthy: Jozi Kids, is designed to shift behaviour at a young age. It helps children understand what healthy eating looks like while encouraging physical activity as part of their daily routine. “We are trying to make it fashionable again to eat from the ground up,” Thabeng says. “So we are introducing food gardens in schools and incorporating nutrition education into the curriculum.”
The programme also makes healthy eating practical and accessible. Simple initiatives, such as learners bringing fruits or vegetables to use collectively, teach children that healthy food does not have to be expensive or complicated. “It becomes a shared experience,” Thabeng explains. “You are showing children that healthy food can be part of everyday life.”
Early intervention at this stage is critical in a country facing the triple burden of malnutrition, where undernutrition, micronutrient deficiencies and obesity all exist simultaneously. “If we can change behaviour early, we can reduce the burden later,” he says.
Why Obesity Increases Disease Risk
Excess weight significantly raises the risk of type 2 diabetes, cardiovascular disease, hypertension and other conditions. Thabeng explains that this is due to how the body processes blood sugar, lipids and hormones.
“When someone carries excess weight over time, insulin resistance develops, inflammation increases and hormonal changes occur,” he says. “These factors contribute directly to chronic diseases.”
READ MORE: How Monitoring Your Blood Pressure Can Transform Your Health
Obesity is a progressive disease. The longer excess weight persists, the higher the risk of complications. Early intervention can prevent or delay these outcomes, improving long-term health.
The Male Perspective
While obesity rates are higher among women, men are still heavily affected. Thabeng points out that men often develop central or abdominal obesity, which carries particular health risks.
“One in three men are overweight or living with obesity,” he says. “This contributes to early onset of type two diabetes, cardiovascular disease and hormonal changes, such as reduced testosterone.”
READ MORE: 12 Research-Backed Reasons Men Struggle to Lose Belly Fat
Sedentary lifestyles, social habits and lack of awareness exacerbate the problem for men. Thabeng emphasises that early intervention is crucial, particularly because many men do not seek medical help until complications arise.
Tackling Obesity in Adults
For adults, preventing obesity is far more effective than treating its consequences. Thabeng stresses that intervention should begin as soon as excess weight appears.
“The longer excess weight persists, the greater the risk of complications,” he says. “Insulin resistance, inflammation and hormonal changes worsen over time. Early intervention reduces the likelihood of strokes, heart disease, type 2 diabetes and other conditions.”
Lifestyle interventions, including diet and physical activity, remain fundamental. However, for meaningful weight loss, medication may be necessary. Anti-obesity treatments, such as GLP-1 medicines, are most effective when combined with healthy eating and regular exercise. “Physical activity and diet may only yield minimal weight loss for some individuals,” Thabeng explains. “To achieve meaningful results, treatment as a chronic disease is often necessary.”
READ MORE: Here’s What Doctors Say About the Triple-Action Weight Loss Drug
Expanding access to these treatments in both private and public healthcare sectors could reduce the long-term disease burden. “If we act now, we can prevent a rise in hospitalisation, specialist visits and chronic medication use,” Thabeng says. “If left untreated, the costs in 10 to 20 years will be enormous, both economically and socially.”
Thabeng explains that for many people, lifestyle changes alone are insufficient. “Physical activity and diet may only yield minimal weight loss for some individuals,” he says. “To achieve meaningful results, treatment as a chronic disease is often necessary.”
GLP-1 medicines, including semaglutide and liraglutide, are becoming more widely used in South Africa for type 2 diabetes and obesity. These treatments must be carefully prescribed based on a patient’s metabolic profile, and they are most effective alongside diet and exercise.
The Public Sector Challenge
The impact of obesity in the public sector is particularly significant because the majority of South Africans rely on public healthcare. Thabeng is committed to improving access to obesity treatments for underserved populations.
“Uncontrolled obesity leads to diabetes, which can cause amputations, strokes and other complications,” he says. “These outcomes are preventable. The public sector must begin addressing obesity as a chronic disease rather than waiting for complications to arise.”
Early intervention, education and policy changes could help curb the health and economic consequences of obesity nationwide.
Meet Thabeng Leping
Thabeng Leping brings years of hands-on experience as a strategic healthcare leader, with expertise in Patient Access, Public Affairs and Health Policy across South Africa and the wider African region. He currently serves as Director: Market Access & Corporate Affairs at Novo Nordisk South Africa, where he leads strategies to expand fair access to therapies in diabetes, obesity and other chronic diseases.
At Novo Nordisk, he shapes partnerships, programs and daily initiatives that make healthcare systems more equitable, sustainable and patient-focused. Thabeng is passionate about NCDs, universal health coverage and health equity, delivering impact through collaboration and policy innovation.
