Glucagon-like peptide-1 (GLP-1) receptor agonists have been around for some 20 years – Ozempic is just one of the most recent, says Dr Angela Murphy, a specialist physician in Gauteng with a particular interest in endocrinology, diabetes and obesity.
They were developed for managing type 2 diabetes but began grabbing public attention when studies revealed their weight-loss effects, and celebrities from Oprah Winfrey and Whoopi Goldberg to Rebel Wilson and Elon Musk spoke out about using them.
The global GLP-1 market was valued at $52 billion by 2024 and is projected to grow to $186 billion by 2032. South Africa is not immune, although to date only one GLP-1 receptor agonist has been registered here specifically for weight loss – Saxenda (liraglutide). Now a second, Wegovy (semaglutide) has been officially launched as of August 16 [2025], says Dr Murphy.
Others are registered for diabetes 2 only and have been prescribed off-label for weight loss by many health practitioners, including Ozempic (semaglutide), Trulicity (dulaglutide), Soliqua (lixisenatide combined with glargine insulin) and Victoza (liraglutide). “Generic liraglutide, Giliptra, is now available for type 2 diabetes,” says Dr Murphy. “The new dual agonist GLP-1/GIP medication Mounjaro (tirzepatide) is currently registered for type 2 diabetes in South Africa, but registration for weight loss is imminent.”
Who qualifies for GLP-1 drugs?
GLP-1s and GLP-1/GIP (gastric inhibitory polypeptide) drugs are indicated for the treatment of both diabetes and obesity, says Dr Murphy.
For diabetes: The indications are for type 2 diabetes with poor control despite lifestyle and other medications, high risk of or established cardiovascular disease (heart attack, stroke, peripheral artery disease), and concurrent obesity.
“In South Africa, these medications are usually given as third- or fourth-line agents. However, American and European guidelines recommend them as second-line agents in patients with type 2 diabetes and cardiovascular risk,” she says.
For obesity: The indications are at present usually BMI-based, but other parameters such as waist circumference, waist to hip ratio and waist to height ratio are used, says Dr Murphy. They include a diagnosis of overweight plus risk factors for cardiovascular disease, especially type 2 diabetes, as well as hypertension and hyperlipidaemia (abnormally high levels of fats in the blood).
Safe use of GLP-1s for weigh loss
“It’s essential to consult with a qualified medical practitioner to determine if a GLP-1 receptor agonist is appropriate for you,” says Johannesburg-based dietitian Lila Bruk. Like all medications, they can have side effects, and these should be discussed with your doctor. They may include nausea, indigestion, bloating, and less commonly, vomiting and diarrhoea, although this can often be reduced by eating small portions, avoiding fatty meals and chewing food well.
These are not “miracle” drugs, and diabetes and obesity require lifestyle changes and medical monitoring, Bruk emphasises.
“A healthy, calorie-controlled diet and regular exercise are essential as part of holistic treatment, as well as addressing any psychosocial concerns,” says Dr Murphy. “Treatment is chronic – that is, long term, for both diabetes and obesity. The medications cannot work if they are not being taken. There is substantial long-term evidence of the benefit and safety of GLP-1 receptor agonists in people with type 2 diabetes. The long-term safety data in obesity is still being gathered but to date is reassuring.”
GLP-1 drugs require a prescription from a licensed medical practitioner and should be bought from a licensed pharmacy. Their cost can be anything from R1,200 a month to R5,000 or more depending on the type and the dose needed.
The South African Health Products Regulatory Authority has warned of falsified, compounded and substandard GLP-1-containing products being made available to the public via websites, social media and other informal channels, which can be a health risk.
Are GLP-1 drugs covered by medical aids for weight loss?
“Funding for GLP-1/GIP medication for diabetes is becoming more difficult every year, with some medical aids requiring established cardiovascular disease to qualify for reimbursement on chronic medication,” says Dr Murphy. “No funder will cover it from chronic medication for obesity, as obesity is not recognised as a primary medical benefit (PMB).
“For both indications, cost needs to be discussed with the patient as the medications are expensive.”
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