ByTanya Pampalone, Anna-Maria van Niekerk and Mia Malan
study about weight loss medications that was published in the British Medical Journal in January didn’t seem like good news.
Oxford researchers looked at 37 studies, which involved more than 9 300 people. They found that less than two years after stopping medications like Ozempic, the weight came back. All health benefits the drugs provide — lower blood pressure, improved cholesterol levels, reduced risk of type 2 diabetes and heart disease — disappeared even faster, returning to pre-treatment levels in just 1.4 years.
While the researchers were surprised how quickly the weight returned, some experts say the drugs are acting just as they would expect — a chronic disease needs chronic treatment. You wouldn’t expect your blood pressure to stay low after you stop taking your hypertension medication. You can’t stop HIV treatment and expect the virus to remain suppressed. So why should obesity be any different?
[WATCH] OBESITY: THE CHRONIC DISEASE THAT ISN’T TREATED LIKE ONE
About one in three adult South Africans live with obesity, which is associated with dozens of noncommunicable diseases (NCDs), such as type 2 diabetes, high blood pressure, kidney disease and some types of cancer.
Unlike the World Health Organisation, South Africa’s current obesity strategy prioritises prevention, with less emphasis on obesity as a chronic disease. It’s an important point: classifying obesity as a chronic disease could open up healthcare treatment coverage and make it less of a societal stigma, rather than being seen as a personal failing or lack of willpower.
Endocrinologist Angela Murphy, who worked on the first clinical practice guidelines in the country for the treatment of adult obesity (these are not the country’s official guidelines), which was published in the South African Medical Journal last year, hopes the guidelines might influence the health department to rethink its position.
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As Murphy explained to Bhekisisa recently, up to 70% of the reason a person lives with obesity is genetic.
“It’s not an issue of willpower,” she says. “It’s a biological response to weight loss because the body wants to defend the weight it sees as the normal weight. We also have to have healthy, balanced diets, and we have to have exercise. But the statistics tell us that a healthy lifestyle alone, on average, can possibly get up to 5% weight loss.”
Part of the guidelines she worked on recommend GLP-1s (glucagon-like peptide-1 receptor agonists) like Ozempic, which help lower blood sugar levels, slow digestion and increase the feeling of fullness.
But monthly prices range from about R3 000-R6 000, according to experts we spoke with, putting the drugs far out of reach for nearly every South African; even those with medical aids have to fork out cash because weight loss is not included under the conditions medical aids are legally required to cover.
Mia Malan spoke to Nomathemba Chandiwana, chief scientific officer of the Desmond Tutu Health Foundation, in a recent episode of Bhekisisa’s TV programme Health Beat, about why South Africa needs to shift how it thinks about obesity, what lessons our HIV response can offer and why access to drugs like GLP-1s in the public health sector could be a gamechanger for millions.
Mia Malan (MM): Are GLP-1s the solution to the obesity crisis?
Nomathemba Chandiwana (NC): There is no one solution or magic bullet. But I think drugs, especially GLP-1s, are an amazing thing in our toolbox. The medications should definitely be part of the solution, especially when we’re looking at the average South African; about 80 to 85% of the population use the public health service. Drugs such as this should be made available, because with good drugs, you don’t want to push the gap between those who have them and those who don’t.
MM: Do you have any hopes for those drugs becoming cheaper?
NC: We’ve seen this with HIV, where these drugs were very expensive at the beginning. What happened was sustained advocacy by the civil society, researchers and governments coming to the party. If we use that blueprint for obesity, working together with [drug producers], we’re going to have generics in the market. Also, there are so many drugs coming that competition naturally reduces prices.
However, we can’t wait. We can’t say all these things will become available in five to 10 years. Obesity is a disease of our time.
[WATCH] HEALTH BEAT #34 | SOUTH AFRICA’S BIG FAT HEALTH CRISIS
By addressing it as a disease, you’re able to reduce the risk of all these other [associated] diseases that we don’t have the manpower, the facilities to deal with. Addressing obesity using drugs, but also having an enabling environment around food policies, [unhealthy food] advertising towards children and being able to know what’s in our food, is part of what we can do to make a dent in obesity.
MM: How does obesity look among children?
NC: Obesity is malnutrition. We’ve got some of the highest obesity rates among children. Having overweight children results in overweight adults. Obesity in childhood is a big concern for our country, because you’re going to see that bulge in 20 to 30 years.
MM: What kind of diet would cause a child to be overweight as a result of malnutrition?
NC: The majority of children and adults are eating what we call ultraprocessed food. All our food has been processed; for example, mealie meal we process from corn. But ultraprocessed means when you look at the back of a packet at all those words that you can’t say — the flavourants, the preservatives. Up to 40% of the average South African’s diet is ultraprocessed food. They tend to be cheaper because of all that processing, but it’s not always good for us. With poverty, it’s not [about] choosing good food versus worse food, or healthier versus less healthy. Often it’s between food and no food.
MM: What is it that the food industry is doing that is so successful in getting children hooked on the wrong foods?
NC: The food industry has been smart, and they’ve used some of the tactics that we saw with the tobacco industry, where you get a customer for life by introducing them to cigarettes. And we’re seeing this with our children. Fast foods are targeted at children, direct marketing with toys and books and everything for children to enjoy these foods at an earlier age. And then you have a customer for life.
MM: How do we deal with the obesity crisis going forward? Are there lessons that we can learn from how we’ve dealt with HIV, where we now have a chronic, but manageable disease?
NC: HIV taught us a lot of lessons about advocacy, about research and about the healthcare system. But one thing about HIV and … obesity is that they’re similar threats to public health.
We saw images that any South African would remember — having relatives [take people] in wheelbarrows to hospitals, women having children born with HIV. There was an urgency, and that urgency drove a lot of advocacy.
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But when it comes to obesity and its complications, which are affecting so many more people, it’s almost silent. We don’t see obesity being the killer that it is in the long term. The heart disease, type 2 diabetes that happens decades after people start gaining weight. So we need to use that same urgency that we used for HIV.
Two, it’s addressing stigma. At the beginning of the HIV epidemic, people were so scared to talk about their disease; they were scared to go to the hospital. At the same time, doctors and nurses and community members didn’t know how to deal with it. Addressing HIV-related stigma opened the doors for many conversations to happen.
We need to do the same for obesity, where someone comes in, and we can centre care around health, not body size. It’s not about shaming people … but about helping people with evidence-based ways of dealing with their weight. We know that “move more, eat less” doesn’t actually work for a lot of people. Because obesity is a combination of your genes, of the environment, of your sex, and all these things come together to make this a very complicated disease. So having medication is so important, because someone can then come and say, “You know what, I have obesity, and because I have obesity, can you help me?”
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This interview was first broadcast on Bhekisisa’s TV programme Health Beat. Additional support by the Health Beat team, including Jessica Pitchford, Thatego Mashabela, Tim Wege, Jeannine Snyman and Albert Tibane.
Tanya Pampalone
Tanya Pampalone is Bhekisisa’s consulting editor. Pampalone is the former managing editor of the Global Investigative Journalism Network and former executive editor of the Mail & Guardian.
Anna-Maria van Niekerk
Anna-Maria van Niekerk is Bhekisisa’s news editor. She joined the centre after six years as the managing editor of the investigative television show, Carte Blanche. Anna-Maria has an extensive career in in-depth health and human rights reporting and has been named both the Vodacom Journalist (2002) and Discovery Health Journalist of the Year (2010) for exposés on the selling of human body parts for muti in Limpopo and the devastating consequences of HIV denialism.
Mia Malan
Mia Malan is the founder and editor-in-chief of Bhekisisa. She has worked in newsrooms in Johannesburg, Nairobi and Washington, DC, winning more than 30 awards for her radio, print and television work.
