South Africa's metabolic-health crisis is now visible in the death register. Diabetes mellitus accounted for 6.1% of all registered deaths in 2024, according to Statistics South Africa, making it the leading recorded cause of death. Hypertensive disease followed at 5.5% and cerebrovascular disease at 5.4%.
The numbers put a hard edge on a question too often softened into lifestyle advice, but what happens after the diagnosis?
This was the charge beneath one of the panels at the World Nutrition Summit, held under the theme The Cost of Getting it Wrong. The discussion, Holistic Support Beyond Clinical Treatment for Metabolic Conditions’ uncomfortable premise was that a person can leave a consultation knowing exactly what to do - and still have too little money, time, support or practical help to do it.
“Knowing what to do and actually being able to implement it are two different things,” said Faranak Amini, certified nutrition and metabolic health practitioner and founder of Health Wealth Nutrition. “If you just tell people what to do, if you don't help them to implement it into their daily life, you are not solving the problem.” Amini argued further that success begins with the person's own barriers, routines and reasons for wanting to be well.
Adam Lacy, metabolic health practitioner and co-director and co-producer of the 2026 film, Healing Humanity, described that doctors may have only a short appointment and months can pass before the next one; a coach, he said, can help turn clinical advice into small, workable actions between visits. “Obviously, they're not going to practise medicine,” he added. Support should strengthen, not substitute, clinically supervised care.
For Lynn Divoky, a former gastroenterology nurse and long-term patient, the absence of that broader conversation was personal. She told the panel that she had seen 17 doctors over 35 years while living with chronic illness and obesity. “Not once did any of the doctors that I saw actually talk to me about my weight and my diet,” she said. Her experience highlights treatment that measures disease while leaving sleep, stress, food, dignity and the realities of daily life largely outside the room.
Working in under-resourced communities, Nicolla Wire, community coach and wellness advocate with Eat Better South Africa (EBSA), identified “financial constraints and the lack of availability for healthy food” as one of the biggest obstacles. “Eating healthy doesn't mean you have to be wealthy,” she said, arguing for changes that start with what a household can actually buy, cook and sustain rather than an idealised shopping basket.
University of the Western Cape research involving more than 2,500 low-income adults in Langa, Khayelitsha and Mount Frere found that nearly 40% of daily energy intake came from ultra-processed foods; only 7% of participants met the World Health Organization's daily fruit-and-vegetable guideline. UNICEF has also warned that 23% of South African children are living in severe child food poverty, surviving on food from only one or two food groups a day. Hunger and obesity are not opposing stories. They can be the same food-system story, playing out in the same household.
Culture and family decide whether an intervention lasts, said Shashikant Iyengar, an accredited metabolic health coach and founder of Metabolic Health India. “People will not necessarily change their dietary practices just because of disease,” he told the panel. “Family support is a must for everyone.” Advice that ignores family meals, cultural food practices or who controls the household food budget will be experienced as instruction from outside.”
Kelsey Buchalter, a nutrition advisor, speaker, host of “The Human Theatre” podcast, and metabolic health coach at Ovadia Heart Health, added that language can either build collaboration or deepen shame. In work with eating disorders, addiction and mental health, she said, “the power of words makes a big difference.” Describing a person's approach as “blood-sugar-friendly” or “low-inflammatory”, rather than using a label that immediately polarises a conversation, can help a patient arrive at a medical appointment ready to ask questions and work with a clinician rather than fear judgement.
That is especially important in a country where treatment options are receiving intense attention. South African health regulators recently said they were revising standards around the compounding of sought-after GLP-1 medicines for diabetes and weight loss. Medication safety is vital. But the debate should not allow South Africa to confuse a prescription with a complete response to a chronic disease that is embedded in how people eat, live, work and care for one another. Dietary changes and any adjustment to medication must remain guided by an appropriately qualified treating clinician.
Getting it wrong is not only about bad advice or a bad choice. It is about giving people advice that cannot survive their circumstances, then calling the predictable collapse a lack of willpower. If South Africa wants the mortality line to move, care cannot stop at the clinic door.
