Obesity is a big driver of healthcare spending in South Africa, yet most medical schemes still limit cover for effective treatments. The gap between the scale of the problem and the funding response is widening, with long-term consequences for patients, insurers and the public purse. Obesity has become one of South Africa’s most expensive health problems.
Between 1998 and 2017, the prevalence of obesity in the country rose by 38%, leaving close to 11 million adults living with the condition, a number that’s still climbing. The financial impact is massive. In 2020, overweight and obesity cost South Africa an estimated R33-billion, nearly 16% of government health spending, according to the South African Metabolic Medicine and Surgery Society (SAMMSS).
In the private sector, medical schemes bore an additional R21.8-billion cost because of obesity in 2022, according to the Discovery Health Vitality ObeCity Index. Despite this economic burden, health funders do not consistently treat obesity as a chronic disease. Obesity threatens the funding model of medical schemes, which relies on a balance between healthy and sick members, by pushing more people toward high-cost, long-term chronic conditions.
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Bariatric surgeon Dr Thinus Smit warned that within a decade, more than 50% of new fund members could be living with obesity, rendering the subsidy model — where healthy members support the sick — “no longer viable”. Medical schemes remain cautious, funding downstream complications like diabetes and heart disease, but are generally unwilling to pay for direct obesity treatments. “The single biggest barrier to upscaling the treatment of obesity in South Africa is the fact that funders (both public and private) are slow to understand the evidence-based health economics — the personal benefit to the patient and the financial benefit to the funder when obesity is treated before complications and the multitude of obesity associated comorbidities develop,” said Dr Jeanne Lubbe, head of upper gastrointestinal and metabolic surgery at Tygerberg Hospital.
This reluctance stems partly from outdated views of obesity as a lifestyle choice, not a complex, biologically driven disease. Smit said that schemes are constrained by legacy budgeting, as obesity treatment is relatively “newer” and funds are historically earmarked for established costs like heart disease. Metabolic bariatric surgery, which alters the digestive system to limit food intake and change hunger hormones, is widely recognised as the most effective long-term treatment for obesity, leading to sustained weight loss and improved obesity-related diseases.
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