Obesity is a big driver of healthcare spending in South Africa, yet most medical schemes still limit cover for effective treatments. The gap between the scale of the problem and the funding response is widening, with long-term consequences for patients, insurers and the public purse.

Obesity has become one of South Africa's most expensive health problems. Between 1998 and 2017, the prevalence of obesity in the country rose by 38%, leaving close to 11 million adults living with the condition, a number that's still climbing.

The financial impact is massive. In 2020, overweight and obesity cost South Africa an estimated R33-billion, nearly 16% of government health spending, according to the South African Metabolic Medicine and Surgery Society (SAMMSS).

In the private sector, medical schemes bore an additional R21.8-billion cost because of obesity in 2022, according to the Discovery Health Vitality ObeCity Index.

Despite this economic burden, health funders do not consistently treat obesity as a chronic disease.

Medical schemes under pressure

Obesity threatens the funding model of medical schemes, which relies on a balance between healthy and sick members, by pushing more people toward high-cost, long-term chronic conditions.

Bariatric surgeon Dr Thinus Smit warned that within a decade, more than 50% of new fund members could be living with obesity, rendering the subsidy model -- where healthy members support the sick -- "no longer viable".

Medical schemes remain cautious, funding downstream complications like diabetes and heart disease, but are generally unwilling to pay for direct...