South Africa's Weight Crisis: Why Willpower Myths Are Deadly

Nkosikhona Mlimi has heard the same dismissals too many times. Patients arrive at his bariatric and laparoscopic surgery practice at Mediclinic Medforum in Arcadia carrying not just the physical weight of obesity, but the accumulated shame of being told they simply lack willpower. His response is consistent: that shame is built on myth, and the myths are costing lives.

South Africa is in the grip of a health crisis that touches more than half its population. The Association for Diabetics in South Africa reports that over 50% of South Africans are overweight or living with obesity, the highest prevalence on the continent. Women bear a disproportionate burden, with 68% affected compared to 31% of men. Children face similarly alarming rates, among the highest in Africa.

The toll extends well beyond statistics. Obesity-related conditions, including type 2 diabetes, hypertension and cardiovascular disease, now constitute a significant portion of the country’s non-communicable disease burden. The economic weight is staggering: obesity costs South Africa more than R33 billion annually in direct healthcare expenditure alone.

Yet many people suffering from obesity never seek treatment.

Misunderstanding is a large part of why. The most persistent myth frames obesity as laziness, a failure of character rather than a medical condition. In reality, obesity is a complex disease shaped by genetics, hormones, metabolism, environmental factors, medications and lifestyle choices. Willpower alone cannot overcome those biological forces, and treating it as a moral failing keeps patients from care they need and deserve.

A second misconception holds that diet and exercise will always be enough. Healthy eating and physical activity matter, but many patients face biological obstacles that make sustained weight loss extremely difficult without medical intervention. For some, surgical options become necessary to achieve lasting results.

Bariatric surgery carries its own layer of misunderstanding. Some view it as an easy shortcut. It is not. The procedure represents a major medical intervention that demands commitment, significant lifestyle changes, careful nutritional management and ongoing follow-up care. It functions as a tool, not a cure.

What that tool can do, though, is substantial. Many patients experience significant improvement or even full resolution of type 2 diabetes, hypertension, sleep apnoea, fatty liver disease and obesity-related joint problems. The procedure addresses the cascade of health consequences that obesity triggers throughout the body, consequences that, left untreated, shorten life expectancy. This is not a cosmetic concern. It is a survival issue.

Patients who may benefit from bariatric surgery typically have a body mass index of 35 or higher and have experienced repeated unsuccessful attempts at weight loss through conventional means, usually while living with obesity-related complications that compromise their daily functioning.

Dr Mlimi is direct about what he wants those patients to hear. “Obesity is not a personal failure. It is a medical condition that deserves the same compassion, understanding, and treatment as any other chronic disease. No one should suffer in silence or feel ashamed to seek help. Effective treatment options are available, and with the right support, patients can achieve meaningful improvements in their health, confidence, and quality of life.”

His message to anyone who has tried and struggled is equally plain: “Individuals who struggle with obesity despite repeated efforts at diet and exercise should speak to their healthcare provider about available treatment options. Your journey to better health starts with a conversation.”

The harder question, as South Africa’s obesity rates continue to climb, is how many people will have that conversation before shame stops them from starting it.