Obesity in South Africa: rates, causes and where to get help

How common is obesity in South Africa?

Obesity is very common in South Africa: almost one adult in three lives with it today. The latest WHO estimates put the adult rate at 31.8 %, ranking South Africa 49th of 196 countries.

That makes South Africa one of the most affected countries in Africa. By number of people, about 15 million adults live with obesity, more than in any other country in sub-Saharan Africa except Nigeria.

A very large gap between women and men

The most striking feature of obesity in South Africa is the difference between the sexes. According to WHO, 47.5 % of women live with obesity, compared with 14.5 % of men.

In other words, women are more than three times as likely to be affected. Few countries in the world show such a wide gap.

What South African surveys show

South Africa's national surveys measure people directly and tell the same story. The South Africa Demographic and Health Survey found obesity in 41 % of women and 11 % of men aged 15 and over.

The same survey found that two-thirds of women and one-third of men had overweight or obesity. A more recent National Food and Nutrition Security Survey, quoted by the Heart and Stroke Foundation South Africa, found overweight or obesity in 67.9 % of adult women and 38.2 % of adult men.

These figures are a little different from WHO's because they cover different age groups and years, and WHO adjusts the data so that countries can be compared. The direction and the gap between women and men are the same.

Children and teenagers

WHO estimates that 7.8 % of South Africans aged 5 to 19 live with obesity, with girls (9.5 %) more affected than boys (6.2 %). That is just below the world average for this age group.

When overweight is included, the numbers are much higher. Data from the National Income Dynamics Study show overweight or obesity in 13 % of children under five, 16 % of 5- to 9-year-olds, 22 % of 10- to 14-year-olds and 18 % of 15- to 17-year-olds.

At the same time, many young children are still too short for their age because of poor nutrition. A study team in the Free State notes that 28 % of children under five are stunted, alongside rising overweight. See our page on obesity in children for ways families can help.

How obesity in South Africa has changed since 1990

Adult obesity in South Africa has more than doubled since 1990, from 15.2 % to 31.8 % today.

Among women, the rate went from 25.0 % to 47.5 %. Among men, it went from 5.4 % to 14.5 %, though it has barely moved over the last decade or so.

The rise among young people has been even steeper in relative terms. In 1990, fewer than 1 % of 5- to 19-year-olds lived with obesity; today the figure is 7.8 %, more than ten times higher.

Most of the adult increase came in the first two decades after 1990. Since then, the curve has flattened but not turned down, and it is still edging up among women.

Why is obesity so common in South Africa?

Obesity in South Africa grows out of fast urbanisation, a food supply full of cheap processed food and sugary drinks, and deep poverty and inequality. Our page on the causes of obesity explains how these forces add up for individuals.

Healthy food is hard to afford and reach

Many South Africans know what healthy eating looks like, but cannot get it. Professor Susan Goldstein of the SAMRC/Wits Centre for Health Economics and Decision Science puts it plainly: knowledge is not necessarily the problem.

In her words, people, including children, cannot afford or even get to healthy food. She also argues that the national strategy does not yet tackle these structural barriers.

Our page on the food environment explains how price and availability steer what ends up on the plate.

Hunger and obesity side by side

South Africa lives with both undernutrition and obesity. As noted above, stunting in young children remains common while overweight rises, a pattern known as the double burden of malnutrition.

Research on women caregivers in the Free State, published in Nutrients, found that 73 % were unemployed, 80 % of households lived on less than R1,000 a month and 69 % had experienced food shortages. Under that kind of pressure, the cheapest calories tend to win.

Sugary drinks

Sugary drinks are a concentrated source of sugar that adds energy without filling you up. South Africa chose to tax them, as described below.

A survey of schoolchildren in North West province, published in Public Health Nutrition, found that they drank sugary drinks less often in the years after the levy. Their intake of healthy foods, however, did not rise in its place.

Why are women so much more affected?

The very high rate among women is not fully explained, and research is still filling in the picture. Studies point to income, food insecurity and living conditions, as well as how people see body size.

A recent analysis of national survey data in BMC Public Health looked at how Black South African women see their own body size. It found that dissatisfaction with body size was linked to obesity, low education, marital status and living in urban informal settlements.

A mismatch between perceived and actual body size, by contrast, was driven mainly by BMI itself.

Understanding these views matters for care. Support works best when it respects people's culture and starts from their own goals, rather than from blame.

How obesity affects health in South Africa

The biggest health effect of obesity in South Africa is the high level of type 2 diabetes. A review of national studies in the International Journal of Environmental Research and Public Health put type 2 diabetes at about 15 % of adults aged 25 and over.

The review also found that around 8 % of adults had diabetes without knowing it, and almost 10 % had impaired glucose tolerance, an early warning stage.

The Heart and Stroke Foundation South Africa sees obesity as a major driver of heart disease and stroke in the country. It also links obesity to high blood pressure, some cancers, gallstones, sleep apnoea and joint disease.

Our page on health risks of obesity explains these conditions and how even modest weight loss lowers the risk.

How is South Africa tackling obesity?

South Africa taxes sugary drinks by their sugar content, and it has a national obesity strategy and draft rules for warning labels on unhealthy food.

The Health Promotion Levy on sugary drinks

The Health Promotion Levy taxes sugary drinks according to how much sugar they contain, with roughly the first teaspoon of sugar left untaxed. This encourages makers to cut sugar.

A study by PRICELESS SA at the University of the Witwatersrand followed the purchases of more than 3,000 households. After the levy started, the sugar people bought in drinks fell by 51 %, calories by 52 % and the volume of taxed drinks by 29 % per person per day.

The fall in sugar was bigger than the fall in volume, which shows that companies reformulated their drinks. Another study in Economics and Human Biology confirmed that both reformulation and changes in what people bought played a part.

A national obesity strategy

The Department of Health's Strategy for the Prevention and Management of Obesity in South Africa sets out six strategic objectives. Its vision is that all South Africans lead a healthy lifestyle, and its mission includes fair access to healthy food, places to be active and a health system able to prevent and treat obesity.

Experts quoted by Spotlight welcomed it as a start but said it does not go far enough. One early action is training tuck shop owners and street vendors near schools in healthy food options.

Warning labels on food

The Department of Health has drafted new labelling rules, known as R3337. They would require front-of-pack warning labels on foods high in sugar, salt or saturated fat, and limit marketing of those foods.

The rules are not yet final. Once they are signed, food makers will get a 24-month period to comply, according to the department.

Where to get help for obesity in South Africa

For most South Africans, the first stop is a public primary health care clinic or community health centre. Ask for your weight, waist, blood pressure and blood sugar to be checked; these quick tests can pick up diabetes and high blood pressure early.

If you have medical aid, a general practitioner is the usual starting point, and you can ask for a referral to a registered dietitian.

The Heart and Stroke Foundation South Africa has dietitians on its team and provides public information on healthy eating and heart health. It works with the Association for Dietetics in South Africa and the national Department of Health.

Our doctor visit checklist can help you prepare. If you are supporting a partner or parent, our page on supporting a loved one has practical ideas.

South Africa compared with the world

South Africa's adult obesity rate is about double the world average: 31.8 % against 16.2 %. For women, the gap is even larger.

In 1990, South Africa was already well above the world, at 15.2 % against 6.7 %. Both have more than doubled since.

In southern Africa, South Africa has the highest adult rate. Eswatini (29.6 %) comes close, while Lesotho (22.2 %), Botswana (19.8 %), Namibia (18.3 %), Zimbabwe (14.7 %) and Mozambique (10.6 %) are lower.

For rates in every country, see our overview of obesity by country.

How Obesity Foundation can help you in South Africa

Obesity Foundation gives free support online, so it costs nothing beyond your data. Our aim is to help you lose weight and feel stronger through good food, the right kind of exercise and walking. Please talk to your doctor or clinic first before making changes.

• Affordable, filling meals. Our free eating plan can be built on budget foods: beans, lentils, eggs, cabbage, spinach, pumpkin, sweet potato, pilchards and a smaller portion of pap, with water instead of fizzy drinks.
• Walking as the first step. Our walking plan needs no equipment. Walking with a friend or group can feel safer and more fun.
• Low impact exercise at home. Try our low impact cardio sessions in a small space, with no jumping.
• Talk to a real person. Book a free video meeting (in English) and tell us what you need.
• Get support over time. Our free Club sends practical tips and helps you track progress.
• Know your numbers. Use our free calculators for BMI, waist and a healthy pace.

For the basics of how obesity is defined, read what obesity is.