Every night, Nolitha Ndaba, 44, prepares her lunch for the following day. But by mid-morning, she has already eaten it, leaving her to buy fish and chips or amagwinya before lunchtime.
“The first thing I do when I get to work is indulge in my lunch. By lunchtime, I go out to buy fish and chips or fat cakes. I didn’t think they had much impact on my life,” she said.
Ndaba is among the 740,000 people who have been screened for diabetes and hypertension by the City of Cape Town.
According to the city, more than 128,000 residents have already received treatment through its clinics.
A recent internal survey revealed a worrying trend among municipal employees: 30% have high blood pressure and 15% have abnormal blood sugar levels, placing them at increased risk of heart disease and diabetes.
Ndaba herself had no idea she was living with diabetes until a workplace health awareness day.
“I was surprised when I was diagnosed. I am glad it was detected early. I will change my lifestyle because I don’t want to complicate my life,” she said.
Her story reflects a broader national crisis. Research published by the University of the Witwatersrand shows diabetes is now the second leading cause of death in South Africa after tuberculosis, affecting about 12% of the adult population.
Healthy food in South Africa is paradoxically more expensive per calorie. When a family must feed four to five people on a limited income, the cheapest calories are often found in white bread, maize meal, sugary drinks and fried snacks. So the epidemic is not caused by ignorance; it is caused by the food environment.
— Dr Anika Coetzee, a senior lecturer and endocrinologist in the division of endocrinology at Stellenbosch University
More than 4-million people are living with diabetes, and roughly one in two do not know they have it. Health experts estimate that up to 50% of South Africans with diabetes remain undiagnosed.
Dr Anika Coetzee, a senior lecturer and endocrinologist in the division of endocrinology at Stellenbosch University, said the rise in diabetes in Cape Town is driven by multiple overlapping pressures.
“Diabetes rises when several pressures hit the same population at the same time, and Cape Town unfortunately has all of them,” she said.
“In the last 25 to 30 years, people have shifted from physically demanding lifestyles — walking, manual work, cooking from raw foods — to transport-based movement, seated jobs, ultra-processed foods and late-night eating patterns.”
By the time diabetes is diagnosed, she explained, the disease process has often been under way for 10 to 15 years.
Compounding the problem is what she describes as South Africa’s “food paradox”.
“Healthy food in South Africa is paradoxically more expensive per calorie. When a family must feed four to five people on a limited income, the cheapest calories are often found in white bread, maize meal, sugary drinks and fried snacks. So the epidemic is not caused by ignorance; it is caused by the food environment.”
Government and local authorities are attempting to respond. National legislative efforts such as the sugar tax, provincial initiatives such as Western Cape on Wellness, and community health worker programmes promoting healthy eating and physical activity are part of the prevention strategy.
The National Strategic Plan has proposed a 90-60-50 cascade target for diabetes and hypertension:
• 90% of adults older than 18 should know their blood pressure and blood glucose status;
• 60% of those diagnosed should receive treatment; and
• 50% of those on treatment should achieve control.
However, experts warn that achieving these goals is a significant challenge.
Within its own workforce, the City of Cape Town has introduced the Good for You Healthy Guidelines to encourage healthier eating. Food vendors have been supported to offer healthier options, and an incentive system has been introduced to promote compliance with the guidelines.
Coetzee stressed that many people misunderstand diabetes prevention.
“Diet determines whether diabetes develops. Exercise determines how fast it develops. Medication treats it once it is established,” she said.
She recommends removing sugary drinks, including cooldrinks, fruit juice, sweetened tea or coffee and energy drinks, as a first step.
“This alone can dramatically reduce diabetes risk.”
She added that what many consider a “healthy” breakfast can be highly diabetogenic.
“The most diabetogenic meal in South Africa is cereal plus toast plus juice,” she said, advising instead to opt for eggs, unsweetened yoghurt or peanut butter on wholegrain bread.
“Morning glucose control determines the rest of the day’s insulin pattern. A 10–15 minute walk after the evening meal is one of the most underrated interventions; it significantly lowers post-meal glucose, improves sleep and supports weight regulation. Sleep deprivation raises cortisol, increases liver glucose output and worsens insulin resistance.”
Ultimately, she argues, diabetes in Cape Town is not primarily a failure of individual discipline.
“It is a predictable biological response to constant calorie availability, refined carbohydrates, reduced movement and intergenerational metabolic programming.”
For Ndaba, the diagnosis was a wake-up call. She has since joined a morning parkrun in her neighbourhood and is rethinking what goes into her lunchbox.
What began as a mid-morning craving has become a turning point, not just for her, but as a reflection of a city grappling with a silent epidemic hiding in plain sight.
TimesLIVE
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