With demand for weight-management medications soaring, prescription treatments are rapidly transforming how South Africans approach weight loss.
However, as GLP-1 agonists and similar therapies surge in popularity, medical experts warn that the flood of unregulated alternatives, dosage misinformation, and black-market products poses a severe health threat.
According to sports and exercise physician Dr Gerhard Vosloo, losing weight safely requires far more than chasing quick results or turning to social media trends; it demands rigorous clinical oversight, personalised dosing, and a realistic look at what these medications can and cannot do.
Vosloo says nearly 70% of adult South African women are obese, compared with around 40% of men.
Since women make up a significant portion of the weight-management market, they can also be more exposed to irresponsible medical practices and black-market products that operate without proper clinical oversight.
Why are prescription weight-management treatments so popular?
For some patients, prescription treatments offer an option after years of trying different diets, exercise programmes and other approaches without achieving lasting results.
“Prescription-based weight-management treatments have opened a door that years of dieting, exercise, and repeated attempts to lose weight could not for some patients. They can help reduce appetite, improve satiety, and support clinically meaningful weight loss when prescribed appropriately for the individual patient,” Vosloo says.
However, their growing popularity has also created several misconceptions about who should use these treatments, how they should be taken and what results they can deliver.
Here are several misconceptions Dr Vosloo says patients should note:
Wanting to lose weight doesn’t automatically make you a candidate
Prescription weight-management medication is not suitable for everyone. A patient’s medical history, current health, existing medication, possible contraindications and overall treatment needs all need to be considered before medication is prescribed.
A higher dose doesn’t always mean better results
It can be tempting to assume that increasing the dose will lead to faster or greater weight loss, but this isn’t necessarily the case. People respond differently to medication, and increasing the dose too quickly can increase the risk of side effects without necessarily improving results.
Treatment should therefore be tailored to the individual, with doses adjusted according to how the patient responds rather than simply aiming for the highest possible dose.
Black-market products aren’t just cheaper alternatives
The availability of weight-loss products through unregulated or black-market channels can make them seem like an affordable alternative to legitimate prescription treatment. But these products don’t come with the same safeguards.
Without regulated prescribing and dispensing, proper storage and handling, or ongoing medical monitoring, patients may be left without appropriate support if something goes wrong.
Medication is only one part of weight management
Prescription medication should not be viewed as a standalone solution. Where clinically appropriate, it can form part of a broader treatment plan that also considers nutrition, exercise, behaviour, metabolic health and the underlying factors contributing to a person’s weight and overall wellbeing.
What should a doctor assess before prescribing?
Before prescribing weight-management medication, a doctor needs to establish whether treatment is actually appropriate for the individual.
This means looking beyond a patient’s desire to lose weight and considering their broader health picture.
“Doctors must be prepared to say no when the prescribed treatment is not appropriate for the patient. That decision depends on a thorough understanding of the patient’s health status, weight history, previous treatment, current medication and clinical goals.
“A doctor also needs to look for factors that could make treatment unsuitable or require greater caution, including contraindications, medicine interactions, existing medical conditions and relevant symptoms.
"For women, pregnancy, breastfeeding, reproductive plans, and hormonal health may also affect treatment decisions,” he says.
A detailed medical history and screening process can help identify potential risks before treatment begins and ensure that the medication, dose and approach are appropriate for the patient.
Why rushing the dosage can be risky
One of the biggest concerns with weight-management medication is increasing the dosage too quickly or taking more than prescribed in the hope of seeing faster results.
“The main risk with inappropriate dosing is that the treatment can advance faster than the patient’s body can safely tolerate. These treatments are deliberately increased gradually because side effects such as nausea, vomiting, diarrhoea, constipation, and abdominal discomfort can become more pronounced as doses rise,” Vosloo says.
He adds that if appetite suppression becomes too strong, patients may struggle to eat enough to meet their nutritional needs, which poses a danger to their overall health.
This is why dosage changes should be made gradually and under medical supervision rather than based on advice from social media, friends or unregulated suppliers.
What does a safe, medically supervised programme look like?
A responsible weight-management programme should begin with understanding the patient as a whole, rather than simply focusing on the number on the scale.
“A safe, medically supervised programme should be built around the patient, with medication considered only where clinically appropriate.
"Screening in my practice starts before the consultation and includes a detailed review of medical history, current medication, previous weight-management treatment, risk factors, symptoms, and treatment goals before prescription therapy is even considered.
“The consultation then establishes what is happening metabolically, not simply confirm that someone wants to lose weight,” Vosloo says.
Ongoing monitoring is just as important as the initial assessment. Patients should have their progress, side effects, nutritional intake and overall health reviewed regularly so that treatment can be adjusted when necessary.
kamogelo.makhura@nationalmg.co.za