Bariatric surgery should lead South Africa’s obesity treatment strategy

Abstract

Obesity is a chronic relapsing disease driven by complex biological, environmental, and socio-economic factors. South Africa (SA) has one of the highest obesity prevalence rates in sub-Saharan Africa, with obesity representing a major driver of non-communicable disease morbidity and mortality, including cardiovascular disease, chronic kidney disease, non-alcoholic fatty liver disease, obstructive sleep apnoea, osteoarthritis, and obesity-related malignancies.^1,2

Despite its scale and cost, obesity care in SA remains fragmented and largely focused on managing downstream complications rather than treating obesity as a primary disease. In a resource-constrained healthcare system, interventions that provide durable clinical benefit and long-term economic value are essential. The robust clinical effectiveness and cost-effectiveness of metabolic and bariatric surgery (MBS) position it centrally in SA’s obesity treatment strategy for patients with severe disease.