The slimming squeeze

For South Africans looking for an alternative way to lose weight, the latest pitch is to get the treatment now and pay for it over time.

A new doctor-led service is trying to make popular GLP-1 medicines easier to access through virtual consultations and payment options.

The appeal is easy to understand. Registered GLP-1 medicines typically cost between R3 000 and R6 000 a month, before consultation fees.

For many people using them for weight management rather than diabetes, the price puts treatment out of reach.

Obiflex, the doctor-led health service, is selling itself on affordability and says pricing created a market for cheaper compounded versions.

“Now the compounding route has been shut down by the South African Health Products Regulatory Authority (Sahpra) and South African Pharmacy Council (SAPC). So, unless there’s legitimate, affordable access, that demand doesn’t disappear; it risks people seeking other unregulated or illicit options,” co-founder and CEO Shaun Barns says.

Compounded medicines are prepared for an individual patient when a suitable commercial product is not available.

In practice, however, regulators say some sellers went much further, producing and marketing GLP-1 products for wider distribution.

Sahpra and the SAPC have cracked down on pharmacies they say were illegally compounding weight-loss medicines, including semaglutide and tirzepatide.

Their investigation focused on products made at a Pretoria pharmacy under the iDexis brand.

The regulators flagged questions about how active pharmaceutical ingredients were imported, whether products were properly tested for identity, potency and purity and whether the equipment and conditions were suitable for sterile preparation. They also warned doctors and pharmacists that prescribing or dispensing the flagged medicines could lead to disciplinary action.

“While compounding is strictly limited to the preparation of medicines for individual patients based on a valid prescription, the facility was found to be manufacturing and marketing GIP/GLP-1-based products, including semaglutide, tirzepatide, and combination formulations, for broader commercial distribution,” the watchdogs said after their operation in June.

Danish pharmaceutical company Novo Nordisk is the patent owner and original developer of semaglutide and brands such as Ozempic, Wegovy and Rybelsus.

Since its patent has been reproduced on the black market for far less, undercutting its profits, it has launched an awareness campaign, warning that its testing shows that compounding semaglutide often involves synthetic processes that can compromise safety.

According to Obiflex, however, the regulatory crackdown in South Africa has exposed a broader challenge: What happens to patients who cannot afford the regulated products?

The company estimates that as many as 300 000 South Africans have been affected and puts the local appetite for weight-loss GLP-1 medicines at about R3-billion.

Its alternative is a virtual consultation with a doctor who can prescribe a registered medicine, with the cost structured to make treatment easier to manage.

Barns says many patients turned to unregistered compounded products because they were cheaper.

Closing that route without creating an affordable alternative, he argues, will not make the demand disappear.

Barns says the company’s doctors have received specialist training in endocrinology and cardiology of weight management from co-founder Dr Riaz Motara. The aim, he says, is to look at the factors behind unhealthy weight changes rather than focusing only on the number on the scale.

The appeal of a slimmer silhouette sometimes leads patients to the black market, with the hope of getting drugs quicker and cheaper.

Although there has been a shift and progress to be accepting of all body types, being thin remains a sought-after goal.