Africa is facing an obesity crisis, with 45% of women on the continent estimated to be overweight or obese by the end of the decade, posing a healthcare dilemma fuelled by inaccessibility to medical treatment, and prompting a call for urgent policy intervention.
And further compounding the problem, writes MedicalBrief, is the rising incidences of type 2 diabetes across the continent, which has doubled over six years in certain regions, with South Africa having the highest (overall) incidence diabetes.
A study by the World Obesity Federation compared the rise in obesity in Africa with the HIV epidemic, with the stigma and lack of treatment having a disproportionate impact on women. The concerned experts and campaigners are calling for urgent policy interventions.
They have warned that almost half – 45% – of the women in Africa will be obese or overweight by the end of the decade, while 26% of the men will have the same problem, unlike most other countries, where the gap is reversed or even smaller.
And while people in richer countries embrace the use of weight loss jabs to slim, few have any confidence that the ground-breaking medicines will be available in sub-Saharan Africa in the near future.
Treatment for the host of diseases accompanying obesity, including diabetes, heart disease and high blood pressure, can also be equally hard to access.
Dr Nomathemba Chandiwana, specialising in obesity and non-communicable diseases (NCDs) and who is chief scientific officer at the Desmond Tutu Health Foundation in South Africa, told The Guardian that “obesity feels like HIV, but more compressed”.
“We’ve got a disease we don’t quite understand; it’s there, we’re not doing much about it. The drugs are kind of there, but not available. Stigma is also an issue. So you can make a lot of parallels.”
In another similarity between the conditions on the African continent, women are more likely than men to be infected with HIV. And while 25% of men in Africa are overweight or obese, for women the figure is 40%. In most other regions around the world, the gap is narrower, or the other way around.
The trend is accelerating. While 45% of women in Africa will be overweight or obese by 2030, for men the figure is 26%, according to the World Obesity Atlas.
Chandiwana said the question of why obesity was rising faster among women in Africa was complex, and involved multiple intersecting factors.
“Urbanisation and lifestyle shifts play a major role – many African cities lack safe spaces for physical activity, and long working hours, caregiving responsibilities, and safety concerns, etc, make movement harder for women. Unlike men, who may engage in occupational or leisure physical activity, women’s daily routines are becoming more sedentary.
“HIV and antiretroviral therapy (ART) add another layer. In high HIV-burden settings like South Africa, ART-related weight gain, especially with drugs like dolutegravir, is becoming more noticeable, disproportionately affecting women.”
Biological factors such as reproductive health, menopause and differences in cravings, metabolism, genetics and hormones are additional factors, she said.
“It is definitely going to get worse as ultra-processed foods become more ubiquitous, climate change increases and (because of) gender inequity,” Chandiwana added, with women facing more barriers to activities, like exercise, because of their other commitments. “We need prevention and treatment targeted specifically at women in South Africa.”
Already, two-thirds of women in the country are overweight or obese, the second highest rate on the continent, after eSwatini.
This could be a warning sign. Research suggests that countries’ experiences of rising obesity typically begin with higher levels in women and higher-income groups before spreading through the population.
Chandiwana said she was excited by the possibilities of the new generation of anti-obesity drugs – the GLP-1 receptor agonists, like Wegovy or Mounjaro.
She said she had been about to get US funding for the first trial of semaglutide in women with HIV, shortly before the Trump administration froze most research spending.
“I think these drugs are a game-changer and also, they legitimise obesity as a chronic disease,” she said. “Without treatment, people always look at it as a personal failure. It’s you, you haven’t done enough. But when you have treatment, we’ve got more in our toolbox.”
There is “an equity issue” she said, where patients’ access to the new, “best-in-class drugs” depends on where they live in the world.
For example, she said diabetes patients in South Africa are having to return to using insulin in glass vials, rather than the more modern alternative of pens with measured doses.
“It doesn’t matter where you are, there’s a drug that’s available to help you with your disease. We have to try the best we can to give people access.”
Johanna Ralston, CEO at the World Obesity Federation, said cultural norms and expectations around obesity in some African countries might play a role in making women more vulnerable to obesity.
“As is the case in many Caribbean and Middle Eastern countries, it is more culturally acceptable for women to have excess weight, and in some cases is desirable.
“Gender-responsive action is needed to address these disparities and more research is needed to understand the nuances.”
Brenda Chitindi of the Zambia NCD Alliance agreed that cultural attitudes to obesity were an obstacle to tackling the condition in her country.
“Obesity is a very big challenge here because we have not taken it seriously. Most of the time we think that when you are obese, you eat well – without knowing that it is a disease,” she said.
Speaking at the NCD Alliance Global Forum, a conference for NCD advocates last month, Chitindi said: “The other big challenge is where the (food) industry right now has brought these fast foods into the country. Where a lot of people have been attracted and, ignoring the regional food … they rush to these fast foods to show people ‘we are well off, we eat well’, without knowing they contribute to obesity.
“The government is looking at the revenue they get from this industry, which is a big challenge as well.”
The latest edition of the World Obesity Atlas assessed countries’ “readiness” to address obesity by looking at factors such as their ability to provide treatment for NCDs, and policies for prevention like taxes on sugary drinks, and restrictions on marketing unhealthy food to children.
These were lacking in many countries, the report’s authors found, warning that a reduction in the number of overweight or obese adults will require “dramatic policy interventions”.
Diabetes stats alarming
The pleas for urgent intervention – and strategies like increased awareness about exercise and diet, and upping the sugar tax – were echoed by researchers involved in a second study, which found that type 2 diabetes rates have doubled over a six-year period among middle-aged people in South Africa, Kenya, Ghana, and Burkina Faso.
The authors attributed this to lifestyle-related factors.
The findings of the study, led by Dr Raylton Chikwati from the University of the Witwatersrand’s (Wits) Sydney Brenner Institute for Molecular Bioscience, were published in The Lancet.
The incidence of both types of diabetes can be attributed to genetic factors, but insulin resistance in type 2 is caused by too much body fat – thus being linked mainly to lifestyle, according to the National Institutes of Health (NIH).
In The Lancet study, and the first of its kind in sub-Saharan Africa, the scientists found that the risk for middle-aged people (between 40 and 60) to develop diabetes increases due to their lifestyle and to physiological changes in their bodies.
Chikwati, by monitoring 10 702 participants, found that the incidence of type 2 diabetes is increasing much faster than initially expected, in contrast to previous estimates, showing about 6% of the population of the region would suffer from type 2 diabetes by 2045.
The researchers now believe it will be much more, with Chikwati’s study showing that the incidence already stands at 10.9%, reports News24. The disease is also more common in urban areas than among rural people.
Plans need to be devised to reduce the risks of developing this disease, said the study authors, whose findings also supported the international trend that more men than women suffer from type 2 diabetes.
In 2021, nearly 18m more men than women worldwide had the disease.
“We found various factors, like body mass index (BMI), waist circumference, high levels of triglycerides and glucose, lack of exercise, high blood pressure, unemployment, and family history play a major role in a person’s chances of developing the disease,” Chikwati said.
Another interesting finding was that West Africans developed diabetes at a lower BMI than people from East and Southern Africa.
“The incidence of type 2 diabetes has doubled at all of the places where the research was conducted, but there are still significant differences between the countries. The highest (overall) incidence was in South Africa, followed by East and then West Africa," Chikwati said.
The study team added that the effect of dolutegravir, the ARV drug used in the fight against HIV/Aids, needs to be examined – side effects include weight gain.
Chikwati said reducing the risk of diabetes was essential, and that the government could, among other things, expand testing campaigns, heighten awareness about the importance of exercise and diet, and raise the sugar tax.
Study details
Incident type 2 diabetes and its risk factors in men and women aged 40–60 years from four sub-Saharan African countries: results from the AWI-Gen study
Raylton Chikwati, Nigel Crowther, Michèle Ramsay et al.
Published in The Lancet in March 2025
Summary
Background
The incidence of type 2 diabetes in sub-Saharan Africa is expected to increase, but few longitudinal studies have characterised its risk factors. This study aimed to determine the incidence of type 2 diabetes over 33 481 person-years and identify its principal risk factors in middle-aged adults (ie, those aged 40–60 years) from four sub-Saharan African countries.
Methods
Longitudinal data were available from 6553 participants aged 40–60 years at baseline from study centres in South Africa, Kenya, Ghana, and Burkina Faso. Sociodemographic, behavioural, clinical, and biochemical data were collected at baseline and after an interval of 5–6 years. The prevalence of type 2 diabetes was determined at each timepoint and diabetes incidence was calculated. A two-stage individual participant data meta-analysis was used to identify baseline risk factors for incident diabetes.
Findings
The overall incidence of type 2 diabetes was 14·6 (95% CI 13·4–16·0) cases per 1000 person-years. The incidence was highest in South Africa with 21·8 (19·5–24·4) cases per 1000 person-years, and lowest in west Africa with 5·5 (4·4–6·9) cases per 1000 person-years. Baseline glucose (adjusted odds ratio 1·37; 95% CI 1·16–1·42), being male (1·32; 1·12–1·54), family history of type 2 diabetes (1·22; 1·01–1·46), unemployment (1·19; 1·03–1·37), hypertension (1·21; 1·01–1·45), BMI (1·03; 1·02–1·04), and waist circumference (1·02; 1·01–1·03), were associated with a higher risk of incident type 2 diabetes, while adequate baseline physical activity (0·87; 0·76–1·00) was associated with lower risk.
Interpretation
The high incidence of type 2 diabetes in this middle-aged sub-Saharan Africa population is influenced by several modifiable risk factors that should inform interventions to mitigate the disease burden.
World Obesity Atlas (Open access)
News24 article – Alarming rise in type 2 diabetes among middle-aged Africans (Restricted access)
See more from MedicalBrief archives:
Rising global obesity presents ‘unparalleled’ health threat – Lancet report
SA scientists warn of HIV-like obesity epidemic
Obesity should be treated as urgent ‘gateway’ medical condition, say experts
Obese, overweight South Africans costing the country billions of rands
More than 1.3bn people will have diabetes by 2050, study predicts
2 studies look at potential weight gain for women taking dolutegravir