SOUTH AFRICA’S DEEPENING OBESITY CRISIS DEMANDS URGENT ACTION

Tue 17 June 2025:

Experts call for a multi-faceted approach, drawing lessons from the nation’s historic public health battles.

South Africa is facing a severe public health challenge as an obesity crisis places immense strain on the nation’s healthcare system. According to the World Health Organization (WHO), more than half of the adult population is now classified as overweight or obese, with the prevalence among women being particularly high at over two-thirds. This escalating health issue is now responsible for more deaths and disability than HIV/AIDS or tuberculosis combined, consuming an estimated 15% of the government’s total health expenditure.

The problem begins early. A 2021/2022 survey found that 16% of children aged 6 to 18 were “severely overweight,” and projections suggest that childhood obesity rates could double by 2030. Experts link this trend to an “obesogenic” environment, where unhealthy, calorie-dense foods high in sugar, salt, and fat are aggressively marketed and widely available. This environment, coupled with increasing urbanisation and sedentary lifestyles, creates a complex web of factors driving the obesity crisis.

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A Complex Disease Requiring a New Approach

Internationally, there is a growing consensus to reframe how obesity is understood. A recent Lancet Commission, involving 58 global experts, argues that obesity should not merely be seen as a risk factor for other conditions like diabetes and heart disease, but in many cases, as a chronic disease in its own right.

Professor Francois Venter, Director of Ezintsha at the University of the Witwatersrand, notes that this shift is crucial for treatment. He highlights that in South Africa, as with the HIV response, a combination of “advocacy, community engagement, collaboration and long-term commitment” is essential for tackling the problem effectively.

However, applying global diagnostic models to South Africa presents challenges. While the standard Body Mass Index (BMI) is widely used, it is considered a crude measure at the individual level. More precise tools like DEXA scanners are economically out of reach for widespread public health use. Furthermore, health experts like Dr Yogan Pillay, a former deputy director-general at the national health department, point out that even basic BMI monitoring is not consistently performed in the public sector. This diagnostic gap hinders the ability to identify and manage the health complications directly caused by excess body fat, such as joint pain, sleep apnoea, and respiratory issues. The national response to the obesity crisis must therefore be tailored to the local context, acknowledging both the lack of resources and the unique demographic factors at play.

The government has already implemented some measures, such as the sugar-sweetened beverage tax introduced in 2018, which has successfully reduced the purchase of sugary drinks. However, experts like Professor Susan Goldstein of the South African Medical Research Council stress the importance of prevention, calling for a greater focus on food control and regulating ultra-processed foods. This includes making healthy, unprocessed foods more affordable and accessible, particularly in low-income communities.

Simultaneously, there is a push to scale up chronic care programmes for those already living with obesity, integrating treatment into primary and community-level healthcare, much like the successful rollout of HIV services. Addressing the obesity crisis will require a sustained, dual approach of robust prevention strategies and accessible, rights-based treatment for all who need it.