Obesity: the chronic disease that isn’t treated like one

A study about weight loss medications that was published in theBritish Medical Journalin January didn’t seem like good news. Oxford researchers looked at 37 studies, which involved more than 9 300 people. They found that less than two years after stopping medications like Ozempic, the weight came back.

All health benefits the drugs provide — lower blood pressure, improved cholesterol levels, reduced risk of type 2 diabetes and heart disease — disappeared even faster, returning to pre-treatment levels in just 1.4 years. While the researchers were surprised how quickly the weight returned,some expertssay the drugs are acting just as they would expect — achronic diseaseneeds chronic treatment. You wouldn’t expect your blood pressure to stay low after you stop taking your hypertension medication.

You can’t stop HIV treatment and expect the virus to remain suppressed. So why should obesity be any different? Aboutone in three adult South Africanslive with obesity, which isassociated with dozens of noncommunicable diseases(NCDs), such as type 2 diabetes, high blood pressure, kidney disease and some types of cancer.

[paywall]

Unlike theWorld Health Organisation, South Africa’scurrent obesity strategy prioritises prevention, with less emphasis on obesity as a chronic disease. It’s an important point: classifying obesity as a chronic disease could open up healthcare treatment coverage and make it less of a societal stigma, rather than being seen as a personal failing or lack of willpower. EndocrinologistAngela Murphy, who worked on the first clinical practiceguidelines in the country for the treatment of adult obesity(these are not the country’s official guidelines), which was published in theSouth African Medical Journallast year, hopes the guidelines might influence the health department to rethink its position.

As Murphyexplained toBhekisisarecently,up to 70%of the reason a person lives with obesity is genetic. “It’s not an issue of willpower,” she says. “It’s abiological response to weight lossbecause the body wants to defend the weight it sees as the normal weight.

We also have to have healthy, balanced diets, and we have to have exercise. But the statistics tell us that a healthy lifestyle alone, on average, can possibly get up to5% weight loss.” Part of the guidelines she worked on recommend GLP-1s (glucagon-like peptide-1 receptor agonists) like Ozempic, which help lower blood sugar levels, slow digestion and increase the feeling of fullness. But monthly prices range from about R3 000-R6 000, according to experts we spoke with, putting the drugs far out of reach for nearly every South African; even those with medical aids have to fork out cash because weight loss is not included under theconditions medical aidsare legally required to cover.

Mia Malan spoke toNomathemba Chandiwana, chief scientific officer of theDesmond Tutu Health Foundation, in a recent episode ofBhekisisa’s TV programme Health Beat, about why South Africa needs to shift how it thinks about obesity, what lessons our HIV response can offer and why access to drugs like GLP-1s in the public health sector could be a gamechanger for millions. Mia Malan (MM):Are GLP-1s the solution to the obesity crisis?

[/paywall]