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Weight Loss in 2026: Jabs, Diets and What the Evidence Says

The short answer: obesity is now recognised as a chronic, relapsing condition, not a lack of willpower. The newest weight-loss injections (semaglutide and tirzepatide) produced average weight losses of roughly 15% to 20% in major clinical trials, but they are prescription-only, have real side effects, and weight tends to return when they are stopped. No supplement, tea or "Nature's Ozempic" comes close, and the basics of food quality, protein, strength training and sleep still matter, with or without a jab.

Why obesity is now seen as a chronic condition

Body weight is regulated by a complex system involving appetite hormones, the brain, genetics, sleep, stress, medicines and the food environment we live in. After weight loss, the body pushes back with increased hunger and lower energy use, which is why weight regain is so common. That is why doctors increasingly manage obesity like blood pressure or diabetes: as a long-term condition that needs ongoing support rather than a one-off diet.

In South Africa the numbers are high, especially for women. The 2016 South Africa Demographic and Health Survey found that about 41% of women and 11% of men aged 15 and older were living with obesity, as cited in a 2022 analysis in BMC Public Health. Excess weight is linked to type 2 diabetes, high blood pressure, heart disease, joint problems, sleep apnoea and several cancers, so even modest, sustained weight loss can improve health markers.

What are GLP-1 "weight-loss jabs"?

GLP-1 receptor agonists copy a gut hormone (glucagon-like peptide-1) that signals fullness to the brain, slows stomach emptying and helps regulate blood sugar. Tirzepatide also acts on a second hormone receptor (GIP). In practice, people feel less hungry and think about food less.

  • Semaglutide: sold as Ozempic (registered in South Africa for type 2 diabetes) and Wegovy (for weight management). Wegovy launched in South Africa in August 2025 as a Schedule 4, prescription-only medicine.
  • Tirzepatide: sold as Mounjaro. Launched in South Africa for type 2 diabetes in December 2024; SAHPRA approved it for chronic weight management from October 2025, alongside a reduced-calorie diet and more physical activity.

Because obesity is not one of the prescribed minimum benefit conditions, medical schemes generally do not cover these medicines for weight loss, so most people pay out of pocket. Prices change, so ask your pharmacist for current costs.

How well do they work?

Approach What trials found Key caveats
Semaglutide 2.4 mg weekly (STEP 1) Average 14.9% weight loss over 68 weeks vs 2.4% on placebo, in 1,961 adults Nausea and other gut side effects common; 4.5% stopped because of gut side effects
Tirzepatide weekly (SURMOUNT-1) Average 16% to 22.5% weight loss over 72 weeks depending on dose, vs 2.4% on placebo, in 2,539 adults Nausea in roughly a quarter to a third of participants
Berberine supplements About 0.84 kg over 18 weeks in one review; the effect disappeared when low-quality studies were removed Gut upset; can interact with medicines; long-term safety unknown
Sleeping longer (80 adults who slept under 6.5 hours) Adding about 1.2 hours of sleep cut intake by about 270 calories a day over two weeks Short study; not a weight-loss trial on its own

These are averages from trials where people also had lifestyle support. Real-world results vary, and some people lose much less.

Side effects and who should not use them

The most common side effects are nausea, vomiting, diarrhoea, constipation and tiredness, usually worst when the dose is increased. Less common but serious problems listed by the NHS include allergic reactions, inflammation of the pancreas, sudden vision problems and, in people with diabetes, low blood sugar or worsening of diabetic eye disease. The NHS advises that semaglutide should not be used in pregnancy, should be stopped at least two months before trying to conceive, and is not recommended while breastfeeding. These medicines need a doctor's assessment and follow-up; they are not for cosmetic weight loss.

The muscle question: protein and strength training

When you lose weight quickly, some of what you lose is lean tissue, including muscle. In SURMOUNT-1, a body-composition sub-study found fat mass fell by about 34% and lean mass by about 11%. A 2025 joint advisory from four US obesity and nutrition organisations lists muscle and bone loss, nutrient shortfalls from eating much less, and weight regain after stopping as key challenges, and recommends:

  • Resistance (strength) training on most weeks, such as weights, bands or body-weight exercises.
  • Prioritising protein at each meal: eggs, fish, chicken, dairy, amasi or yoghurt, beans and lentils.
  • Choosing nutrient-dense whole foods, because small portions leave little room for empty calories.
  • Planning for what happens after the medicine, not just during it.

We are preparing a separate, more detailed guide on eating well while on GLP-1 medicines.

What happens when you stop?

A review published in The BMJ in January 2026, led by University of Oxford researchers, pooled 37 studies with 9,341 adults. After stopping weight-loss medicines, people regained weight faster than after ending behavioural programmes. For the newer drugs (semaglutide and tirzepatide), regain averaged about 0.8 kg a month. Weight was estimated to return to starting levels within roughly one and a half to two years, and markers such as blood sugar, blood pressure and cholesterol within about 1.4 years. In other words, for many people these are long-term medicines, and lifestyle habits are what help hold on to the gains.

Fake, compounded and "grey market" jabs

SAHPRA has repeatedly warned South Africans about falsified and compounded GLP-1 products sold through websites, social media and informal sellers. Its warnings note that unregistered products may contain no active ingredient, the wrong dose, or harmful substitutes such as insulin, and may not be sterile. To stay safe:

  • Only use products prescribed by a doctor and dispensed by a registered pharmacy or dispensing doctor.
  • Do not buy pens or vials online, from salons, gyms or social media sellers.
  • Report suspected fakes to SAHPRA's hotline on 0800 204 307.

"Nature's Ozempic": what about supplements?

Berberine, apple cider vinegar, "GLP-1 boosting" drinks and fibre capsules are often marketed as natural alternatives. The evidence does not support those claims. A December 2025 review by the US Department of Defense's Operation Supplement Safety found that berberine's small average effect on weight disappeared when only higher-quality studies were considered, and that long-term safety data are lacking. Berberine can also interact with prescription medicines. No supplement has shown results anywhere near those of prescription GLP-1 medicines, and no supplement should be used as a substitute for medical care for obesity.

The basics that still matter

Ultra-processed food

In a tightly controlled 2019 US National Institutes of Health study, 20 adults ate an ultra-processed diet and a minimally processed diet for two weeks each. Even though the meals were matched for calories, sugar, fat and fibre on offer, people ate about 500 more calories a day on the ultra-processed diet and gained about 0.9 kg; on the minimally processed diet they lost a similar amount. Cooking more meals from basic ingredients is a practical first step.

Sleep

Short sleep is linked to higher appetite. In the 2022 sleep-extension trial in the table above, simple sleep coaching helped people sleep longer and eat less without being told to diet. See our guide to sleep support that actually helps.

Realistic expectations

You do not need to reach an "ideal" weight to benefit: modest weight loss that you keep off can still improve health markers. Focus on habits you can keep for years: regular meals with protein and vegetables, fibre-rich foods such as beans and whole grains (our gut health guide covers fibre in more detail), daily movement, two or more strength sessions a week, and enough sleep.

See a doctor if…

  • You are thinking about a weight-loss medicine: you need an assessment, a prescription and follow-up.
  • You have gained or lost weight quickly without trying, or have extreme thirst, frequent urination or swelling.
  • You are on a GLP-1 medicine and develop severe stomach pain that spreads to your back, persistent vomiting, yellow skin or eyes, or signs of dehydration.
  • You snore heavily, stop breathing in your sleep or feel very sleepy in the day.
  • Food, weight or body image is causing you distress. For mental health support, contact SADAG on 0800 567 567.

In an emergency, call 112 from a cellphone or 10177 for an ambulance.

Frequently asked questions

Are Ozempic and Mounjaro legal in South Africa?

Yes, when prescribed by a doctor and dispensed by a registered pharmacy or dispensing doctor. Ozempic is registered for type 2 diabetes; Wegovy and Mounjaro are registered for chronic weight management.

Do I have to stay on a weight-loss jab forever?

Not necessarily, but studies show most people regain weight after stopping. Discuss a long-term plan, including diet and strength training, with your doctor before you start.

Will I lose muscle on a GLP-1 medicine?

Some lean mass loss is expected with any large weight loss. Eating enough protein and doing regular strength training are the main recommended ways to limit it.

Is berberine a natural alternative to Ozempic?

No. Higher-quality studies do not show a meaningful weight effect, and it can interact with medicines.

Is compounded semaglutide safe?

SAHPRA has warned that compounded and unregistered GLP-1 products have not been evaluated for safety, quality or effectiveness. Use only registered, prescribed products.

Sources

This article is for general information only and isn't medical advice. Elevate gummies are food supplements and are not intended to diagnose, treat, cure or prevent any disease. Speak to your doctor or pharmacist before starting any supplement, especially if you are pregnant, breastfeeding, taking medication or have a medical condition.

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