In-Depth - SA's Obesity Problem and the Promise of New Weight Loss Medicines SpotlightNSP: SouthAfrica
Obesity is a complicated public health issue that can be devastating on both the societal and the individual level.
I've tried all the diets, cut sugar, cut carbs - I do end up losing a little if I follow them to the 'T' but the weight always comes back. -*Claire Rates in children and teenagers are also extremely high. According to UNICEF, almost one in every three girls between the ages of 15 and 19 is living with obesity or is overweight.
The World Obesity Federation estimates that, by 2030, adult obesity rates in SA will increase to 37%. "For me, these statistics are a wake-up call for us to take concerted efforts to slow down and reverse the trend," says Mabunda. No one can deny the fact that lifestyle factors such as unhealthy eating habits and a lack of physical activity drive obesity rates and that a strong focus on these two interventions is important to prevent obesity as well as to prevent someone with obesity from gaining more weight. But for patients who already find themselves in the obese or overweight categories, he says, the lifestyle prescription alone is a completely inadequate treatment that fails much more often than it succeeds.
"Hunger is such an unpleasant feeling and sensation, and it is very hard to fight. There is a big focus on willpower when it comes to obesity, but it's not down to willpower when the body is doing its damnedest to conserve calories," he says.He says it is"cruel" to continue to only offer this advice to patients, knowing it won't achieve positive results but only adds to their psychological burden.
Mbalati says that compared to unhealthy options, healthy food is costly - a problem that can only be solved via regulation, for example, by subsidising healthy options and taxing products high in sugar, salt, and fat. After a lengthy process that was vehemently opposed by industry, a tax on sugary beverages, called the Health Promotion Levy, was introduced in South Africa in early 2018. It has resulted in relatively modest reductions in consumption of these drinks but notably resulted in positive actions by industry. For example, many products were reformulated to contain less sugar, and packaging sizes were made smaller.
He says that the drugs allow patients to eat healthily, without needing to conform to a strict diet, without"the constant craving and background noise that makes you so tired all the time" and helps people"maintain a health plan with much less effort than before"."GLP-1 is actually a naturally occurring hormone found in the human body," explains Johannesburg-based endocrinologist Dr Sundeep Ruder.
"There is also some data to suggest that GLP-1 may improve the gut microbiome to a pattern that is more favourable to weight loss. We also think there is some other direct effect on fat because appetite alone does not explain the level of weight loss that we see," he says. According to Andy Gray from the University of KwaZulu-Natal's Division of Pharmacology, there are a number of GLP-1 agonists on the global market, including albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, and tirzepatide. Only four of these have been registered in South Africa.
According to a 2022 study published in JAMA, a leading medical journal, after 68 weeks of taking the drugs, obese patients on semaglutide lost an average of 16% of their body weight compared to 6% for those taking liraglutide.Although considered relatively safe, it is accepted that the benefit outweighs the risks in most cases as there are some side-effects and contraindications.
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