Obesity has surged in South Africa, affecting nearly 11 million adults and costing R33 billion in 2020, equivalent to 16% of government health spending. Despite effective treatments like bariatric surgery and GLP-1 drugs such as Ozempic and Wegovy, medical schemes limit coverage, exacerbating the financial strain on patients and funders. New guidelines aim to reframe obesity as a chronic disease to improve access.
Obesity prevalence in South Africa increased by 38% from 1998 to 2017, impacting close to 11 million adults, with numbers continuing to rise. The condition imposed a R33-billion cost in 2020, representing nearly 16% of government health expenditure, according to the South African Metabolic Medicine and Surgery Society. In the private sector, medical schemes faced an additional R21.8-billion burden in 2022, as reported by the Discovery Health Vitality ObeCity Index.
Medical schemes struggle with the funding model, where healthy members subsidize the sick, but obesity pushes more individuals into chronic conditions. Bariatric surgeon Dr Thinus Smit predicts that over 50% of new fund members could be obese within a decade, threatening viability. Schemes typically cover complications like diabetes and heart disease but hesitate on direct treatments due to legacy budgeting and views of obesity as a lifestyle issue.
"The single biggest barrier to upscaling the treatment of obesity in South Africa is the fact that funders are slow to understand the evidence-based health economics," said Dr Jeanne Lubbe, head of upper gastrointestinal and metabolic surgery at Tygerberg Hospital.
Bariatric surgery, which modifies the digestive system for sustained weight loss, is the most effective long-term option. Discovery Health Medical Scheme funds it under strict criteria, capped at R200,000 annually with co-payments, approving 430 procedures from January 2024 to October 2025. However, 80% of qualified patients abandon it due to costs, Smit noted. Public access is limited to facilities like Tygerberg Hospital, where Lubbe described high-volume lists insufficient for the 70% of females and 40% of males affected.
Emerging GLP-1 drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) promise weight loss without surgery but require lifelong use and high costs. Smit highlighted that tirzepatide expenses exceed bariatric surgery over time. In public settings, affordability blocks access, per Dr Marli Conradie of Stellenbosch University. Discovery covers these from savings accounts, limiting reach, though Chief Clinical Officer Dr Noluthando Nematswerani anticipates price reductions for broader funding.
Stigma persists, with obesity often seen as self-inflicted, but November 2025 SAMMSS guidelines mark a shift, providing a formal standard for funders. "This is the first time we have a formal researched document," Smit said. Treatment could extend life by 12-15 years and delay costly interventions, like hip replacements. The National Department of Health's 2023-2028 strategy emphasizes prevention, yet Lubbe stresses treating existing cases for financial gains.
The Obesity Community Fund uses corporate BBBEE contributions to sponsor surgeries, aiming for 10,000 annually long-term after aiding eight in its first year.
