WATCH: Inside South Africa’s illegal weight-loss drug trade 

• People become obese for many reasons. Genetics, their environment, what they eat, how much they exercise and some medicines — including some HIV treatments — all play a role. Obesity increases the chances of health problems such as type 2 diabetes and heart disease.
• Study after study has shown that diet and exercise alone rarely result in sustained weight loss.
• Obesity could be remedied by a new generation of weight-loss drugs — glucagon-like peptides (GLP-1s) — that help control blood sugar, curb appetite and slow digestion.
• But the medicines cost between R3,000 and R6,000 per month, far too expensive for most people — and they have to be taken lifelong or the weight comes back. 
• This has opened up a black market for cheaper but unregistered and untested versions of the medicine to enter countries like South Africa. 
• Some local companies, such as iDexis, have also compounded its GLP-1 medicines and have now been ordered by the Pretoria High Court to stop making the medicine. 
• Moreover, the country’s medicines regulator, Sahpra, has ordered iDexis to recall the weight-loss products it’s already produced. 
• Even some doctors are prescribing illegal versions of weight-loss drugs. Sahpra says it’s hard to keep track of illegal sales in this burgeoning industry.
• The unregistered drugs, or the ingredients that companies use to compound them, are often imported as “cat food” or “calcium”, say those in the know, but users have no idea what’s in these cheaper versions bought online and even offered on gym WhatsApp groups.
• Solving the illegal surge and our obesity crisis, according to public health researcher Francois Venter of the health organisation Ezintsha at Wits University, will require cheaper generic versions of GLP-1 medicines and a change of attitude — that diet and exercise alone cannot help people lose weight — sooner rather than later.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.