IN CONVERSATION WITH MALULEKE COLBETH
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A growing obesity crisis in South Africa is drawing comparisons to the early days of the HIV epidemic — with stigma, lack of access to treatment, and disproportionate impact on women once again at the centre.
According to the World Obesity Federation, nearly two-thirds of South African women are currently overweight or obese, making the country’s women among the most affected on the continent — second only to Eswatini. Projections show that by 2030, nearly half of all women in Africa will fall into this category, compared to just over a quarter of men.
Dr Nomathemba Chandiwana, a South African physician and chief scientific officer at the Desmond Tutu Health Foundation, is sounding the alarm. “Obesity feels like HIV but more compressed,” she says. “It’s a condition we don’t fully understand, treatment is limited, and the stigma is real. We’re repeating history.”
A Gendered Health Crisis
In South Africa, women are bearing the brunt of this rising health burden. Obesity is deeply linked to a range of serious non-communicable diseases (NCDs), including diabetes, hypertension, and heart disease, all of which are difficult to treat in under-resourced public health systems.
Unlike men, many South African women face structural and social barriers that limit their ability to prevent or manage weight gain. “Urbanisation and shifts in lifestyle are a big factor,” explains Chandiwana. “Women often work long hours, juggle childcare and domestic responsibilities, and live in environments that aren’t safe or accessible for exercise.”
While some men engage in physical activity through work or leisure, women’s daily routines are increasingly sedentary — not by choice, but by design.
ART and Weight Gain: The Hidden Side of HIV Treatment
South Africa’s high HIV burden adds another layer of complexity. Many women living with HIV are on antiretroviral therapy (ART), and some drugs, particularly dolutegravir, have been linked to rapid and unexplained weight gain — a side effect that disproportionately affects women.
“This is a double bind,” says Chandiwana. “Women living with HIV are being hit twice — once by the virus, and again by the medication meant to save their lives.”
Biological factors like hormonal fluctuations, menopause, reproductive cycles, and even genetic predispositions further compound the issue.
Stigma, Culture and Access: A Triple Threat
The stigma surrounding obesity mirrors that of early HIV discourse. “People see obesity as a personal failure,” Chandiwana says. “But without access to treatment or support, how are women supposed to manage it?”
Cultural expectations also play a role. In some South African communities, larger body sizes are associated with beauty, wealth or even good health, making it harder to have open conversations about the risks of obesity.
Johanna Ralston, CEO of the World Obesity Federation, adds: “In several African countries, including South Africa, there’s a long-standing cultural acceptance of larger female bodies. In some cases, it’s even considered desirable. But that doesn’t make it healthy.”
Solutions Exist — But Not for Everyone
Groundbreaking obesity treatments like GLP-1 receptor agonists (such as Wegovy or Mounjaro) are gaining traction in wealthier nations, but remain out of reach for most South African women. “We’re seeing an equity issue here,” Chandiwana says. “Patients in the U.S. or Europe have access to best-in-class drugs, while our public healthcare system is struggling to provide even basic care.”
She nearly secured U.S. funding for a trial of semaglutide in South African women living with HIV — until the project was derailed by political budget freezes under the Trump administration.
For now, many diabetic patients in South Africa are still using glass vials of insulin, decades behind international standards. “It doesn’t matter where you are — your disease doesn’t change. So why should your treatment options?” asks Chandiwana.
Urgent Need for Women-Centred Interventions
With obesity
According to the World Obesity Federation, nearly two-thirds of South African women are currently overweight or obese, making the country’s women among the most affected on the continent — second only to Eswatini. Projections show that by 2030, nearly half of all women in Africa will fall into this category, compared to just over a quarter of men.
Dr Nomathemba Chandiwana, a South African physician and chief scientific officer at the Desmond Tutu Health Foundation, is sounding the alarm. “Obesity feels like HIV but more compressed,” she says. “It’s a condition we don’t fully understand, treatment is limited, and the stigma is real. We’re repeating history.”
A Gendered Health Crisis
In South Africa, women are bearing the brunt of this rising health burden. Obesity is deeply linked to a range of serious non-communicable diseases (NCDs), including diabetes, hypertension, and heart disease, all of which are difficult to treat in under-resourced public health systems.
Unlike men, many South African women face structural and social barriers that limit their ability to prevent or manage weight gain. “Urbanisation and shifts in lifestyle are a big factor,” explains Chandiwana. “Women often work long hours, juggle childcare and domestic responsibilities, and live in environments that aren’t safe or accessible for exercise.”
While some men engage in physical activity through work or leisure, women’s daily routines are increasingly sedentary — not by choice, but by design.
ART and Weight Gain: The Hidden Side of HIV Treatment
South Africa’s high HIV burden adds another layer of complexity. Many women living with HIV are on antiretroviral therapy (ART), and some drugs, particularly dolutegravir, have been linked to rapid and unexplained weight gain — a side effect that disproportionately affects women.
“This is a double bind,” says Chandiwana. “Women living with HIV are being hit twice — once by the virus, and again by the medication meant to save their lives.”
Biological factors like hormonal fluctuations, menopause, reproductive cycles, and even genetic predispositions further compound the issue.
Stigma, Culture and Access: A Triple Threat
The stigma surrounding obesity mirrors that of early HIV discourse. “People see obesity as a personal failure,” Chandiwana says. “But without access to treatment or support, how are women supposed to manage it?”
Cultural expectations also play a role. In some South African communities, larger body sizes are associated with beauty, wealth or even good health, making it harder to have open conversations about the risks of obesity.
Johanna Ralston, CEO of the World Obesity Federation, adds: “In several African countries, including South Africa, there’s a long-standing cultural acceptance of larger female bodies. In some cases, it’s even considered desirable. But that doesn’t make it healthy.”
Solutions Exist — But Not for Everyone
Groundbreaking obesity treatments like GLP-1 receptor agonists (such as Wegovy or Mounjaro) are gaining traction in wealthier nations, but remain out of reach for most South African women. “We’re seeing an equity issue here,” Chandiwana says. “Patients in the U.S. or Europe have access to best-in-class drugs, while our public healthcare system is struggling to provide even basic care.”
She nearly secured U.S. funding for a trial of semaglutide in South African women living with HIV — until the project was derailed by political budget freezes under the Trump administration.
For now, many diabetic patients in South Africa are still using glass vials of insulin, decades behind international standards. “It doesn’t matter where you are — your disease doesn’t change. So why should your treatment options?” asks Chandiwana.
Urgent Need for Women-Centred Interventions
With obesity
