Diabetes is now the leading recorded cause of death in South Africa, and the reasons reach far beyond the consulting room. Statistics South Africa figures show that diabetes mellitus accounted for 6.1% of all registered deaths in 2024, ahead of hypertensive disease at 5.5% and cerebrovascular disease at 5.4%. Behind those numbers lies a question that touches every household living with the disease: what actually happens to a person after a diagnosis, when the advice is clear but the money, time and support are not?
That question sat at the centre of a panel discussion at the World Nutrition Summit, held under the theme The Cost of Getting it Wrong. The session, titled Holistic Support Beyond Clinical Treatment for Metabolic Conditions, confronted an uncomfortable premise. A patient can leave a consultation knowing exactly what to do, and still be unable to do it.
For the public, the gap between instruction and implementation is not a technical detail. It is the difference between a manageable illness and a fatal one. “Knowing what to do and actually being able to implement it are two different things,” said Faranak Amini, a 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 that success starts with the individual’s own barriers, routines and reasons for wanting to be well.
Adam Lacy, a metabolic health practitioner who is co-director and co-producer of the 2026 film Healing Humanity, described the structural reality many patients face. 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. The point, panelists stressed, is that such support should strengthen, not substitute, clinically supervised care.
The cost of leaving daily life outside the consultation was made personal by Lynn Divoky, a former gastroenterology nurse and long-term patient. She told the panel 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 account points to a form of treatment that measures disease while leaving sleep, stress, food, dignity and the realities of daily life largely outside the room.
Money and access shape outcomes just as sharply. Working in under-resourced communities, Nicolla Wire, a community coach and wellness advocate with Eat Better South Africa, 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.
The research backs her up. 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, and only 7% of participants met the World Health Organization’s daily fruit-and-vegetable guideline. UNICEF has warned that 23% of South African children live in severe child food poverty, surviving on food from only one or two food groups a day. Hunger and obesity, the panel’s evidence suggests, are not opposing stories. They can be the same food-system story playing out in the same household.
Culture and family decide whether any intervention lasts, according to 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.
Language matters too, said Kelsey Buchalter, a nutrition advisor, speaker, host of “The Human Theatre” podcast and metabolic health coach at Ovadia Heart Health. In work with eating disorders, addiction and mental health, she said, “the power of words makes a big difference.” Describing an 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.
Meanwhile, these conversations arrive at a moment when treatment options themselves are under scrutiny. 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, and dietary changes or any adjustment to medication must remain guided by an appropriately qualified treating clinician. But the debate should not allow the country to confuse a prescription with a complete response to a chronic disease embedded in how people eat, live, work and care for one another.
Getting it wrong, the panel’s message suggests, is not only about bad advice or bad choices. 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.