Obesity drugs remain private as state yet to review public rollout

Almost a year after the World Health Organisation (WHO) backed GLP-1 drugs for long-term obesity treatment, South Africa’s health department has yet to begin assessing whether to make them available to public sector patients, a senior official has confirmed.

The national essential medicines committee is considering adding GLP-1 medicines to the list of drugs that can be prescribed for diabetes patients who rely on state healthcare facilities, but it has not started to review the evidence for their use in obesity care, according to the department’s chief director for health promotion, Rebone Ntsie.

The WHO added GLP-1 drugs to its essential drugs list for managing diabetes in September 2025 and released guidelines for their use as a chronic treatment for obesity in December last year.

Consideration of GLP-1 medicines for obesity treatment is “on the radar”, but work has not yet commenced, Ntsie said on the sidelines of the Global Obesity Forum in Madrid. The event is taking place this week in parallel with the Global Obesity Summit hosted by the Spanish health ministry and the WHO.

South Africa has the highest prevalence of obesity in Sub-Saharan Africa, and the third highest in Africa, according to the Global Obesity Observatory. The issue is of growing public health concern because it is contributing to rising rates of other noncommunicable diseases such as diabetes and cardiovascular disease.

In 2016, 31% of adult males, 67% of adult females, and 13% of children under five years old living in South Africa were either overweight or living with obesity, according to the most recent national survey data. A person with a body mass index (BMI) of more than 25 is considered overweight, and obese if the figure is above 30. BMI is the ratio of a person’s weight to their height squared.

While a growing number of GLP-1 medicines are now registered in South Africa, they are only available in the private sector. Medical scheme cover is limited, and their out-of-pocket cost renders them unaffordable for most patients.

Novo Nordisk’s patent on semaglutide — the active ingredient in its weight loss treatment Wegovy and diabetes therapy Ozempic — expired in South Africa earlier this year, but only one cheaper generic alternative is available on the local market.

Sun Pharma launched a generic semaglutide, branded Semagard, in South Africa in August at a price that is about 18% below that of Ozempic, according to Bhekisisa.

The health department’s deputy director-general for primary healthcare, Jeanette Hunter, said she was optimistic that the price of GLP-1 medicines would rapidly fall when more generic products reached the market and rival pharmaceutical manufacturers competed for customers. The South African Health Products Regulatory Authority is reviewing more than a dozen applications for generic semaglutide, according to Reuters.

Other weight loss treatments available in South Africa included Novo Nordisk’s liraglutide and Eli Lilly’s tirzepatide, branded Mounjaro, which is marketed and distributed locally by Aspen Pharmacare.

Hunter told delegates to the Global Obesity Forum that the health department wanted to see healthcare professionals pay more attention to obesity care at the primary healthcare level.

“Clinicians will put people on diabetes treatment without addressing the fact that they are overweight or obese. It’s like the elephant in the room,” she said.

• Kahn’s coverage of the Global Obesity Forum was supported by the World Obesity Federation.

Business Day