Faith Nyasuguta
A concerning rise in obesity across Africa has drawn comparisons to the HIV epidemic, with stigma, limited treatment options, and a disproportionate impact on women fueling the crisis. According to a recent study by the World Obesity Federation, nearly half of all African women will be overweight or obese by the end of the decade.
While wealthier nations have turned to weight-loss medications such as Wegovy and Mounjaro, these groundbreaking treatments remain largely unavailable in sub-Saharan Africa, raising concerns about the continent’s ability to address the growing health crisis. Access to treatment for obesity-related illnesses, including diabetes, heart disease, and hypertension, is also limited, exacerbating the problem.
Obesity Crisis Echoes HIV Epidemic
Dr. Nomathemba Chandiwana, an expert in obesity and non-communicable diseases (NCDs) at the Desmond Tutu Health Foundation in South Africa, has likened the obesity crisis to the early days of the HIV epidemic.
“Obesity feels like HIV but more compressed,” she explained. “We have a disease that we don’t fully understand, it exists, but we’re not taking enough action. The drugs are there but inaccessible, and stigma plays a major role.”
Similar to HIV, obesity disproportionately affects women in Africa. While 25% of African men are overweight or obese, the figure jumps to 40% for women. In many other parts of the world, the gender gap in obesity rates is smaller or even reversed. The trend is accelerating, by 2030, 45% of African women and 26% of men will be overweight or obese, according to the World Obesity Atlas.
Why Are More Women Affected?
Dr. Chandiwana attributes the rising obesity rates among African women to several interlinked factors:
Urbanization and lifestyle changes have reduced opportunities for physical activity, with many African cities lacking safe spaces for exercise.
Long working hours and caregiving responsibilities limit women’s ability to engage in fitness routines.
HIV and antiretroviral therapy (ART) contribute to weight gain, particularly drugs like dolutegravir, which have been linked to increased body mass.
Biological factors, including menopause, hormonal differences, metabolism, and reproductive health, play a significant role.
“It will only get worse,” Chandiwana warned, citing the growing availability of ultra-processed foods, climate change, and gender inequalities that prevent women from prioritizing their health.
South Africa is already experiencing alarmingly high obesity rates, with two-thirds of women classified as overweight or obese, the second-highest rate in Africa, following Eswatini.
A Warning for the Future
Research suggests that obesity trends often start with higher rates among women and wealthier populations before spreading across the broader population. This pattern has been observed in many countries and could indicate a more widespread obesity crisis in Africa’s future.
Dr. Chandiwana expressed optimism about the latest generation of anti-obesity medications, such as GLP-1 receptor agonists (e.g., Wegovy, Mounjaro). These drugs, which have gained popularity among celebrities and politicians in the West, could revolutionize obesity treatment if made widely available.
“I believe these drugs are a gamechanger,” Chandiwana said. “They also help legitimize obesity as a chronic disease. Without treatment, people assume weight gain is a personal failure, but when there’s medical intervention, we acknowledge it as a health condition.”
However, she emphasized that inequality in access to these medications is a major issue. In South Africa, for instance, some diabetes patients have had to revert to using outdated insulin vials instead of modern measured-dose pens due to cost and availability issues.
“Regardless of where you live, you should have access to lifesaving treatments,” she added.
Cultural and Policy Challenges
Cultural attitudes toward body weight present another obstacle to combating obesity in Africa. Johanna Ralston, CEO of the World Obesity Federation, noted that in some African, Caribbean, and Middle Eastern societies, excess weight is often seen as desirable or a sign of prosperity.
Brenda Chitindi of the Zambia NCD Alliance echoed this sentiment, stating that many Zambians fail to recognize obesity as a disease. Speaking at the NCD Alliance Global Forum, she highlighted how fast food consumption is rising due to perceived social status.
“The food industry has introduced these fast foods into our country, and people are drawn to them,” Chitindi said. “They ignore our traditional, healthier foods, choosing fast food instead to showcase their wealth.”
She also pointed out that governments are often reluctant to regulate fast food industries due to the revenue they generate.
Urgent Need for Policy Interventions
The latest edition of the World Obesity Atlas assessed countries’ readiness to combat obesity, examining factors such as:
Access to NCD treatments
Policies for prevention (e.g., sugar taxes, restrictions on junk food advertising to children)
The report concluded that many African nations lack the necessary policies to tackle obesity effectively. The authors emphasized that reversing current obesity trends would require dramatic government interventions and comprehensive policy changes.
Looking Ahead
Without immediate action, Africa faces a health crisis that could rival HIV/AIDS in terms of long-term impact. With nearly half of African women projected to be overweight or obese by 2030, governments, healthcare providers, and international organizations must work together to implement effective prevention, treatment, and education strategies.
Chandiwana’s final message was clear: “We must act now. The future health of Africa depends on it.”
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