Understanding obesity as a chronic disease: New treatment options on the rise in South Africa
BEACON OF HOPE
While more exercise and fewer calories used to be the go-to medical advice for those needing help with obesity, there is growing recognition that this approach is not helpful for many people trying to control their weight.
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In South Africa, alarming statistics indicate that nearly a third of men and two-thirds of women are classified as obese, a condition that significantly raises the risk of serious health issues such as type 2 diabetes and hypertension. However, recent advancements in healthcare have ushered in a transformative shift in the understanding and management of obesity, now viewed as a chronic disease rather than a personal failing. This evolving perspective offers a beacon of hope for effective prevention and management strategies.
“We don’t think of obesity as a personal failing anymore – it is a chronic disease, just like high blood pressure. It relapses and progresses, and we need to treat it that way,” says Dr Charlene Wolberg, a general practitioner and nutritional science expert based at Netcare Linksfield Hospital. In her view, the past decade has witnessed significant developments in how obesity is managed, moving away from outdated beliefs toward a more informed approach.
Earlier this year, Cape Town hosted Southern Africa’s largest obesity congress at the International Convention Centre, where Dr Wolberg joined a diverse pool of healthcare professionals to discuss the burgeoning global epidemic of obesity. “Numerous societies, including the World Health Organization, now define obesity as a ‘chronic, relapsing, progressive disease state,’” explains Dr Wolberg.
Traditionally, the medical response to obesity focused solely on advising patients to exercise more and consume fewer calories. However, a growing body of evidence underscores that such advice alone often fails to help patients sustain long-term weight control. A more nuanced understanding of obesity’s underlying causes has prompted the exploration of pharmaceutical treatments to support weight management.
Among the latest innovations, semaglutide has emerged as a promising option for patients struggling with obesity. Originally indicated for type 2 diabetes, semaglutide is now recognised for its capacity to aid long-term weight management. “There is a significant correlation between being overweight and the development of other chronic conditions,” Dr Wolberg explains, while emphasising that lifestyle modifications must remain integral to any treatment plan.
As a glucagon-like peptide-1 (GLP-1) analogue, semaglutide mimics a hormone released from the gut in response to eating, influencing appetite regulation and feelings of fullness. “This medication not only supports sugar control but exhibits beneficial effects on various organs, including the cardiovascular system, brain, kidneys, and liver,” adds Dr Wolberg, noting the impressive findings from studies that have shown GLP-1s can reduce heart disease risk by 20% and lower stroke incidence by 39% among high-risk patients.
Importantly, GLP-1 analogues not only help diminish hunger but can also mitigate emotional eating. “I often describe it as if you’ve had a perfect dinner — physiologically full — yet you still find yourself craving a treat, often leading to excessive consumption. GLP-1s help curb those impulses so patients can enjoy a few squares of chocolate and feel satisfied,” she explains.
Dr Charlene Wolberg, a general practitioner with a master’s degree in nutritional science who practises at Netcare Linksfield Hospital, says the new paradigm in medical weight management offers greater hope for individuals to reach and maintain a healthy weight, while also helping to ward off many health risks associated with obesity.
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However, awareness surrounding the potential interactions and side-effects of semaglutide is crucial. Patients are advised to inform healthcare providers about any other medications or supplements they are taking, as semaglutide may influence the efficacy of oral contraceptives, potentially leading to unintended pregnancies.
Dr Wolberg cautions that without ongoing management, patients may regain weight if they abruptly stop using the medication after reaching their target weight. Collaborating closely with healthcare practitioners to establish the minimum effective dosage is recommended for sustained success.
As research continues to unearth new discoveries in the field of weight management, optimism flourishes. “Several different dosing strategies are being investigated for chronic weight management, and there is more hope than ever for not only reaching and sustaining a healthy weight, but also for mitigating the significant health risks obesity poses for otherwise healthy individuals,” concludes Dr Wolberg.