An estimated one billion people worldwide are living with obesity: 650 million adults, 340 million adolescents, and 39 million children. By 2025, 167 million people are expected to be directly affected by being overweight or living with obesity.
Tackling obesity in South Africa remains a significant public health challenge, as the condition contributes extensively disease burden. More than 50% of South African adults are either overweight (23%) or living with obesity (27%). Overweight is defined as a BMI of ≥25kg/m², and obesity as a BMI ≥30kg/m². Overweight and obesity increase the risk of non-communicable diseases (NCDs) such as type 2 diabetes (T2DM), hypertension, cardiovascular disease (CVD), osteoarthritis, pulmonary diseases, and cancer. South African data from 2016 show that 57.4% of deaths were due to NCDs, with ~60% occurring in individuals under 70 years old. Obesity-associated conditions significantly contributed to these deaths.
Individuals with obesity face physical limitations and psychiatric disorders due to stigmatisation and social discrimination. Disorders like anxiety, eating disorders, and depression frequently co-occur with obesity, with substantial co-occurrence rates for various psychiatric conditions. Childhood and adolescent obesity pose risks for early puberty, menstrual irregularities, and long-term health concerns, with over 80% continuing into adulthood.
In response to the obesity crisis, several health strategies have been implemented. International guidelines recommend anti-obesity medications (AOM) for individuals with a BMI of ≥30kg/m², or ≥27kg/m² with comorbid conditions. Approved medications in South Africa include orlistat, phentermine, naltrexone/bupropion, and liraglutide. These medications are designed to reduce appetite, enhance insulin secretion, and delay gastric emptying, thus supporting weight loss efforts.
Phentermine, in particular, has been demonstrated through various studies to be effective in reducing weight, particularly when combined with a comprehensive weight reduction program that includes diet, exercise, and behavioural modifications. It is recommended for short-term use and has been found to be safe, with no significant increase in the risk of cardiovascular events. Economic evaluations have indicated that phentermine, along with topiramate, represents a cost-effective strategy for managing adolescent obesity.
Aside from pharmaceutical interventions, tackling obesity also involves addressing broader social and environmental factors. Policies targeting the affordability and availability of unhealthy foods, especially in school environments, are being considered. Moreover, the national Department of Health is urged to speed up the implementation of health-promoting policies such as clear front-of-pack labelling to assist consumers in making healthier food choices.
The obesity epidemic is a complex issue that requires a multifaceted approach, combining medical treatments with societal and policy-level interventions to create a healthier future for all citizens.