Johannesburg – The growing demand for obesity treatment in South Africa is intersecting with a more troubling trend: the rise of unregulated, and in some cases illicit, access to weight-loss medication, driven not only by need, but by stigma.
At the Novo Nordisk South Africa World Obesity Roundtable held in Sandton, clinicians, industry leaders, a patient voice, and a health journalist outlined how the continued normalisation of obesity as a lifestyle issue is contributing to a parallel, largely invisible treatment market.
This is no longer a peripheral concern.
As Sara Norcross, General Manager of Novo Nordisk South Africa, indicated, increased demand for obesity treatment has been accompanied by reports of counterfeit medicines, cases before the courts, and instances of patient harm linked to unsafe or unregulated use.
“These are not theoretical risks. We are seeing real cases, real harm and real consequences where patients have accessed treatment outside of proper clinical pathways,” Norcross said.
In this context, the issue reflects an observable pattern in which stigma, delayed care, and limited engagement with formal healthcare systems influence how treatment is accessed.
A parallel care pathway is emerging.
Dr. Reyana Daya, Specialist Physician and Endocrinologist, described a clinical environment in which obesity is often not addressed at the point of presentation, even when it is evident.
“In clinical practice, obesity is often not discussed. It gets swept under the carpet, and by the time we address it, patients already have complications like diabetes or hypertension,” Dr. Daya said.
This delay has clinical implications.
“We are seeing patients much, much later. By then, the disease has progressed, and the risk of complications is significantly higher,” she added.
Delayed engagement with care influences subsequent behaviour.
Patients who do not enter formal treatment pathways early may seek alternatives.
The roundtable identified stigma as a primary factor shaping this shift. Obesity continues to be widely perceived as a matter of personal discipline rather than a chronic disease, which affects willingness to seek care.
Norcross said this perception is reflected in how patients access treatment.
“If I have diabetes, I will go and speak to my doctor. If I am carrying excess weight, I hesitate. I do not want to be judged. I do not want the conversation. I just want access to care,” she said.
This pattern is reflected in broader trends.
Norcross pointed to international developments, including in the United Kingdom, where increased use of digital and online prescribing has changed access to obesity treatment.
“We have seen a significant shift towards digital and anonymous care. People want to access treatment without having to explain themselves,” she said.
Changes in access also affect continuity of care.
“When you remove the relationship with a healthcare provider, you remove context. You lose the understanding of the patient’s history, their risk factors, their broader health profile,” she added.
In the South African context, where access to healthcare and regulatory oversight are uneven, these conditions allow unregulated markets to expand.
The discussion did not identify specific supply chains. It did, however, describe a pattern in which demand, combined with stigma and limited access, creates space for unverified products and informal distribution channels.
These include online platforms offering medication without clinical assessment, as well as counterfeit or diverted pharmaceutical products circulating outside regulated systems.
Thabeng Leping, Director of Market Access, Public Affairs, and Corporate Affairs at Novo Nordisk, and the session moderator, linked this to a broader misunderstanding of obesity.
“As long as obesity is seen as a lifestyle choice, people will continue to avoid formal healthcare systems and look for quicker, quieter solutions,” Leping said.
This pattern is reflected in lived experience.
Celeste Ntuli, comedian, actress and person living with obesity, described how multiple factors shape individual health behaviour.
“There is always a different reason. It is not just about what you eat. It is stress, it is work, it is sleep, it is mental health,” Ntuli said.
Standardised advice does not always align with lived realities.
“You are told to wake up early, to exercise, to fix your routine. But what if your life does not allow that? It becomes a catch-22,” she said.
This disconnect influences decision-making.
“It starts with how society views you. That is where the problem begins,” she added.
From a clinical perspective, delayed engagement with care has measurable consequences.
Dr. Daya said obesity is a chronic condition with established links to metabolic and cardiovascular disease.
She noted that clinical assessment is increasingly moving beyond Body Mass Index (BMI) to more precise indicators of risk.
“It is not just about BMI. We are now looking at abdominal fat and visceral fat, because these are what drive metabolic disease,” she said.
Without early intervention, these factors translate into long-term complications.
“We need to destigmatise obesity so that people can seek help earlier. If we do not, we will continue to see late presentation and a higher risk of complications,” she added.
The impact extends beyond individual health outcomes.
“This is not just about one person. It affects families, communities, and the broader economy,” Dr. Daya said, referring to the intergenerational effects of obesity.
Within this context, the emergence of unregulated treatment pathways presents a broader public health concern.
The role of media in shaping public understanding was also raised.
Ina Skosana, Editor at E-Health News, said limited specialist reporting contributes to both misinformation and normalisation.
“We do not have enough health journalists, and that affects how these issues are communicated,” Skosana said.
She said framing influences public response.
“When obesity is treated as a cultural or lifestyle issue rather than a health crisis, it influences how people respond to it,” she said.
This affects the information environment.
“In the absence of accurate information, people turn to whatever is available. That is where the risk of unregulated or unsafe treatment increases,” she added.
From a treatment perspective, Azi Booi, Registered Dietitian and Nutritionist, highlighted the need for structured, multidisciplinary care.
“We are in an information age, but not enough information is coming from qualified professionals,” Booi said.
She said simplified narratives do not reflect the clinical complexity of obesity.
“There are metabolic adaptations at play. The body resists weight loss. It is not just about eating less or moving more,” she explained.
Access constraints remain significant.
“Cost is a major barrier. Access is a barrier. And many people do not even know that dietitians are available, especially in the public sector,” she said.
These factors shape treatment pathways.
Obesity is increasingly recognised in clinical terms as a chronic disease.
The World Health Organization defines it as abnormal or excessive fat accumulation that poses a health risk.
Data presented at the roundtable indicate that approximately 13 million South African adults are living with obesity, with prevalence significantly higher among women at 46.7% compared to 23.3% among men.
When overweight is included, more than half of the adult population, an estimated 20 million people, are affected, with rising rates among adolescents.
Treatment options have expanded to include clinically proven GLP-1 receptor agonists, which regulate appetite and slow gastric emptying, supporting sustained weight loss when prescribed under medical supervision as part of a broader treatment plan.
Norcross said access to these interventions remains uneven, particularly between private and public healthcare systems.
“Less than one per cent of patients are currently being treated, which shows the scale of the gap between need and access,” Norcross said.
She said improving access, including for patients in the public sector, remains a priority.
“This is not just about innovation. It is about ensuring that patients who need treatment can access it in a safe and appropriate way,” she said.
Patterns of access continue to shift.
“We are seeing more patients choosing quicker, more anonymous ways to access treatment, often outside traditional clinical pathways. These are costly and dangerous.” Norcross warned.
