Ozempic, Obesity, and Mental Health: Inside South Africa’s R41 Billion Prescription Drug Spend

In 2024, South Africa saw a significant surge in the distribution of prescription medications, revealing critical insights into the nation’s physical and mental health challenges. According to international healthcare analytics firm IQVIA, a staggering USD 2.28 billion (R41.3 billion) worth of prescription drugs reached South African shelves and patients, highlighting a growing reliance on medical treatment for chronic conditions, obesity, and mental health issues.

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Weight Loss and Diabetes Medications Dominate in South Africa

A significant portion of the medication spend—roughly R3.4 billion—was allocated to weight loss and diabetes treatments. Ozempic, a top seller globally for diabetes and weight management, accounted for R636 million alone. This aligns with national health concerns, as the Human Sciences Research Council (HSRC) reported in 2024 that over 50% of South Africans are overweight or obese.

Excess weight is linked to various health risks, including high blood pressure, stroke, type 2 diabetes, and respiratory issues. With such health risks escalating, medications like Ozempic have become more than just a trend—they’re part of a larger public health response to obesity.

HIV, Cancer, and Chronic Illnesses Also in Focus

While weight and diabetes treatments dominated spending, medications for HIV accounted for 20% of the top 20 most distributed drugs. Additional leading categories included cancer treatments, antibiotics, renal care, and arthritis medications. This shows a healthcare system heavily invested in managing both infectious and non-communicable diseases.

Mental Health: The Silent Crisis in South Africa

South Africa’s mental health landscape is equally concerning. Nearly 16% of the population reportedly suffers from mental health disorders, according to the National Planning Commission. Conditions like depression, anxiety, bipolar disorder, and PTSD are on the rise, but treatment access remains uneven.

Fedhealth, a major medical scheme, noted that only 4% of its members are registered for depression-related chronic medication, figures that likely underestimate the real scope, as many mental health issues are underreported or not covered by basic plans. The top antidepressants distributed by Fedhealth include Lexamil, Cilift, and Nuzak, with R5.8 million spent on these drugs alone.

Discovery Health also revealed a 224% increase in mental health-related payouts over the past decade. A breakdown showed that 58% of claims were for antidepressants, 22% for anxiolytics, and 20% for antipsychotics.

Counselling, Not Just Prescriptions

Despite the high spend on prescription medications, mental health professionals caution against overreliance on pharmaceutical solutions. Counselling psychologist Ereen Mitchell emphasizes that medication should be part of a broader, multidisciplinary treatment plan. Her approach integrates therapy, nutrition, and lifestyle adjustments before resorting to medication.

“People don’t understand what is good for them in terms of food or lifestyle, which leads to frustration and dependency on medications like Ozempic,” Mitchell explained. She advocates for gradual changes, setting out achievable goals and working closely with doctors to monitor patients.

Dr. Donny Fick from Meldene Medicross supports using medication only for moderate to severe mental health cases, especially where safety is a concern. For mild symptoms, therapies like cognitive behavioural therapy (CBT), mindfulness, exercise, and sleep hygiene are preferred.

“Medication such as benzodiazepines can be habit-forming and should only be used short-term. Long-term treatment may require SSRIs, which come with their side effects,” he said.

Prescription Monitoring and Abuse Prevention

With rising prescription rates, responsible prescribing is essential. Dr. Fick insists that physicians monitor patients regularly, conduct follow-ups, and counsel appropriately to avoid abuse or dependence.

South Africa at a Health Crossroads

South Africa’s R41.3 billion spent on prescription medications reflects both progress and concern. On one hand, access to effective treatments has improved; on the other, it highlights deeper societal issues like obesity, chronic illness, and untreated mental health conditions.

To build a healthier nation, experts agree: Medication must be complemented by lifestyle changes, psychological support, and better public education. The future of South African healthcare lies not just in prescriptions but in prevention, awareness, and accessibility for all.