NINE NON-NEGOTIABLES FOR SUSTAINABLE WELLNESS

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Good health is not a destination — it is a daily practice built from consistent, informed choices. For South African women, understanding the science behind a healthy lifestyle has never been more important. The country faces a dual burden of disease, with noncommunicable diseases (NCDs) such as heart disease, diabetes, and cancer rising sharply alongside ongoing infectious disease challenges. Many of these conditions are preventable through lifestyle choices.

Sustainable wellness involves making small, consistent, and enjoyable lifestyle changes rather than drastic, overnight overhauls. Instead of intense, unsustainable routines, adopt small, repeatable habits like a 10-minute walk after dinner, drinking more water, or going to bed 20 minutes earlier.

By focusing on, “What can I add to my life?” rather than “What do I have to give up?”, you can make wellness a sustainable, enjoyable part of your daily life.

1. PHYSICAL ACTIVITY

Why It Matters

Physical inactivity is one of the leading risk factors for death worldwide. Regular exercise helps prevent and manage cardiovascular disease, type 2 diabetes, certain cancers, depression, and anxiety. Globally, women are less physically active than men by an average of 5 percentage points — a gap that translates directly into poorer health outcomes.

According to the World Health Organisation, regular physical activity improves cardiorespiratory fitness, muscular strength, bone health, and mental wellbeing.

Minimum recommendations
At least 150–300 minutes of moderate-intensity aerobic activity per week (e.g. brisk walking, cycling, dancing)

Or 75–150 minutes of vigorous-intensity activity per week (e.g. running, aerobics, fast swimming)

Or an equivalent combination of both

Muscle-strengthening activities (e.g. resistance training, yoga) on 2 or more days per week

Limit long periods of sitting — break up sedentary time throughout the day

During pregnancy and postpartum, WHO recommends at least 150 minutes of moderate aerobic activity per week, as it reduces the risk of gestational diabetes, pre-eclampsia, excessive weight gain, and postpartum depression.
Practical tips
Walk or cycle instead of driving for short distances

Join a community fitness group or dance class — popular and accessible across South Africa

Even 10-minute activity bursts count toward your weekly total

Start small and build up gradually if you are currently inactive

2. NUTRITION & HEALTHY EATING

Why It Matters

Diet is closely linked to the development of NCDs including heart disease, stroke, type 2 diabetes, and certain cancers — which are responsible for the majority of deaths in South Africa. Eating a wide variety of minimally-processed, nutrient-dense foods supports immune function, healthy weight, bone health, and energy levels.

Minimum recommendations
Eat at least 400 g (5 portions) of fruits and vegetables every day

Prioritise whole grains, legumes (beans, lentils), nuts, and seeds

Limit total fat to less than 30% of daily energy; choose unsaturated fats (olive oil, avocados, nuts) over saturated fats

Limit saturated fat to less than 10% of total energy intake, and trans fats to less than 1%

Limit free sugars to less than 10% of daily energy (ideally less than 5%) — this equals roughly 25 g or 6 teaspoons per day

Limit salt intake to less than 5 g per day (about 1 teaspoon), to reduce blood pressure risk

Include lean protein sources: fish, poultry, eggs, legumes, and plant-based proteins

Stay well hydrated — see the Hydration section below
The importance of carbohydrates & fibre

Carbohydrates should make up 40–70% of daily caloric intake, sourced primarily from whole grains, vegetables, fruits, and legumes. Aim for at least 25 g of dietary fibre per day, as it reduces the risk of heart disease, type 2 diabetes, and digestive cancers.

Traditional South African diets rich in vegetables, legumes (such as umngqusho), and whole maize can form an excellent nutritional base. However, rising consumption of ultra-processed foods, sweetened beverages, and fast food is contributing to increased rates of obesity, diabetes, and heart disease among South African women. Being mindful of portion sizes and processing levels is key.

3. HYDRATION

Why It Matters

Water makes up approximately 60% of the adult body and is essential for virtually every bodily function — from regulating temperature and supporting kidney function, to aiding digestion and maintaining cognitive performance. Even mild dehydration can impair concentration, cause headaches, and reduce physical performance.

Minimum recommendations
WHO recommends that women consume approximately 2.2–2.7 litres (about 9–11 cups) of total fluid per day from all sources, including water, other beverages, and water-rich foods. Note that approximately 20% of daily fluid intake comes from food (particularly fruits and vegetables).

Aim for at least 6–8 glasses (1.5–2 litres) of plain water per day as a practical baseline

Increase intake during hot weather (very relevant in South Africa’s warm climate), exercise, illness, or pregnancy/breastfeeding

A useful indicator of adequate hydration is light yellow to colourless urine

Limit sweetened beverages, energy drinks, and excessive alcohol, which can contribute to dehydration and excess caloric intake

Pregnant women should aim for approximately 2.3 litres (10 cups) per day, and breastfeeding women approximately 2.8 litres (12 cups) per day.

4. SLEEP

Why It Matters

Sleep is one of the most underrated pillars of health. Chronic sleep deprivation is linked to weight gain and obesity, type 2 diabetes, high blood pressure, heart disease, stroke, depression, impaired immune function, and increased risk of accidents. Good sleep allows the body to repair and the brain to consolidate memories and regulate mood.

Minimum Recommendations
The Sleep Research Society recommends that adults aged 18–60 sleep 7 or more hours per night on a regular basis to promote optimal health. Adults aged 61–64 should aim for 7–9 hours, and those 65 and older for 7–8 hours.

Sleeping less than 7 hours per night regularly is associated with increased risk of obesity, diabetes, heart disease, depression, and early death

Sleeping more than 9 hours may be appropriate for young adults, those recovering from sleep debt, or those who are ill
Sleep Hygiene Tips
Go to bed and wake up at the same time every day — including weekends

Keep your bedroom cool, dark, and quiet

Avoid screens (phones, tablets, TV) for at least 30 minutes before bed

Avoid large meals, caffeine (after midday), and alcohol close to bedtime

Exercise regularly, but avoid vigorous exercise within 1–2 hours of sleep

Manage stress — unresolved anxiety is a leading cause of poor sleep in women

5. MENTAL HEALTH & STRESS MANAGEMENT

Why It Matters

Mental health is integral to overall health — the WHO defines health as ‘a state of complete physical, mental and social well-being.’ Women are more likely than men to report higher stress levels, depression, and anxiety. Chronic, unmanaged stress is linked to cardiovascular disease, weakened immunity, hormonal disruption, menstrual irregularities, and mental health disorders such as depression and PTSD.

The American Psychological Association consistently finds that women report higher average stress than men, and are more likely to experience financial, relational, and caregiving stressors. In South Africa, additional stressors include socioeconomic inequality, gender-based violence, and limited access to mental health services.

What you can do — evidence-based strategies
Exercise regularly — aerobic exercise releases endorphins that reduce anxiety and depression, and improves sleep quality

Practice mindfulness or meditation — even 10 minutes daily can reduce cortisol (stress hormone) levels

Nurture social connections — face-to-face relationships with trusted people are strongly linked to better mental health

Set healthy boundaries at work and home to prevent burnout

Keep a journal to identify your stress triggers and patterns

Prioritise hobbies and activities that bring you joy and a sense of purpose

Limit alcohol — many women drink to cope with stress, but alcohol is a depressant and worsens anxiety over time

Seek professional help when needed — therapy (especially cognitive behavioural therapy) is effective for stress, anxiety, and depression

If you are feeling overwhelmed, you can contact the South African Depression and Anxiety Group (SADAG) helpline at 0800 456 789 (toll-free).

If you suffer from a mental health condition like depression or anxiety, you may qualify to join the Bonitas Mental Health Programme. This programme aims to improve your quality of life and empowers you to manage your condition more effectively. Once you’ve enrolled on the programme, a dedicated counsellor will be assigned to you to assist you. Your counsellor will collaborate with your doctor or therapist as needed, to ensure you get the support you need.

To find out more about this programme, call us on 0860 106 155 or send an email to mentalhealth@bonitas.co.za.

6. ALCOHOL & SUBSTANCE ABUSE

Why It Matters

Women metabolise alcohol differently from men — kilogram for kilogram, women absorb more alcohol and reach a higher blood alcohol concentration from the same amount. This means health risks begin at lower consumption levels for women. Alcohol is classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen, in the same category as tobacco and asbestos. It is directly linked to at least seven types of cancer, including breast cancer.

Current guidance
The WHO has stated clearly: there is no safe level of alcohol consumption that does not affect health. Breast cancer risk in women increases even at one drink per day. The more alcohol consumed, the greater the harm.

If you choose to drink, standard risk-reduction guidelines recommend no more than one standard drink per day for women, with alcohol-free days each week. Heavy drinking for women is defined as 4 or more drinks on any single day, or 8 or more drinks per week.

Less is always better — the safest approach for health is not to drink at all

Never drink during pregnancy — alcohol causes foetal alcohol spectrum disorders (FASDs), which are irreversible

Do not drink to cope with stress or anxiety — this increases risk of dependence

Avoid using tobacco in any form — smoking is the leading preventable cause of cancer worldwide

If you suspect you have a problem with alcohol, Bonitas offers comprehensive coverage for alcohol addiction, rehabilitation, and related mental health conditions as part of their Prescribed Minimum Benefits (PMBs). To learn more about accessing your PMBs with Bonitas, you can visit the Bonitas website or contact customer service at 0860 002 108.

7. PREVENTATIVE HEALTHCARE & REGULAR SCREENINGS

Why It Matters

Many serious conditions — including cervical cancer, breast cancer, diabetes, and hypertension — are far more treatable when detected early. South Africa has a high burden of several preventable diseases, and routine screening is one of the most powerful tools women have.

Key screenings for South African women
Cervical Cancer

South Africa’s age-standardised cervical cancer incidence rate is among the highest in the world — three times the global average. Cervical cancer is the leading cause of cancer deaths in South African women aged 15–44. It is caused by persistent HPV infection, which is preventable through vaccination.

Current clinical guidelines recommend:

One pap smear every 3 years, or 1 HPV PCR test eveyy 5 years, for women between the ages 21 and 65.

Women living with HIV should screening more frequently, from the time of HIV diagnosis

Breast Cancer

Breast cancer is the most common cancer among South African women. Women should be breast-aware from age 20 onwards — performing regular self-examinations and reporting any lumps, skin changes, or nipple discharge to a healthcare provider promptly.

A monthly breast self-examination helps women identify unusual changes, such as lumps, skin dimpling, or nipple discharge, by becoming familiar with their normal breast tissue. Perform this, ideally 3–5 days after your period ends, by visually inspecting in a mirror and manually checking both breasts while standing and lying down.

A mammogram every one to two years for women over 40.

If you have a family history of breast or ovarian cancer, speak to your doctor about genetic risk and enhanced screening

Blood Pressure, Blood Sugar & Cholesterol

Cardiovascular disease is the leading cause of death among women globally, accounting for approximately 30% of all female deaths. Many women are unaware of elevated blood pressure, high cholesterol, or early-stage diabetes, as these conditions often have no symptoms.

Blood pressure: checked at every routine health visit, at least annually from age 18

Blood glucose: screening for diabetes or prediabetes from age 35 if overweight/obese, or earlier if risk factors are present

Cholesterol: tested from age 20; more frequently if you have heart disease risk factors

HIV Testing

South Africa has one of the highest HIV burdens in the world. Women — particularly young women — are disproportionately affected. The South African National Department of Health recommends:

HIV testing at least annually, or more frequently if at risk

Knowing your status enables you to access treatment if needed, and to prevent transmission to partners and children

Pre-exposure prophylaxis (PrEP) is available in South Africa for women at high risk of HIV

Reproductive Health

Regular pelvic examinations and STI testing based on your risk factors

Access to family planning and contraceptive services

Antenatal care: attend at least 8 antenatal visits if pregnant, as per the South African National Department of Health guidelines
The Bonitas Be Better Benefit

8. HEALTHY WEIGHT MANAGEMENT

Why It Matters

Overweight and obesity are major risk factors for type 2 diabetes, heart disease, stroke, certain cancers, and joint problems. South Africa has one of the highest rates of female obesity in sub-Saharan Africa.

What to aim for
WHO recommends maintaining a Body Mass Index (BMI) between 18.5 and 24.9 kg/m² for adults. BMI is calculated by dividing your weight in kilograms by the square of your height in metres (kg/m²). While BMI has limitations (particularly for different body types), it remains a widely used screening tool.

An easier way for you to assess whether not you’re overweight is by measuring your waistline. Assessing healthy weight via waist circumference helps determine if you are carrying excess abdominal fat, which increases risks for heart disease and type 2 diabetes. A healthy target is keeping your waist measurement to less than half your height. A waistline over 80cm indicates higher health risks in women.

How to Measure Your Waist

Locate: Find the top of your hip bone and the bottom of your ribs.

Measure: Place a tape measure midway between these points, just above the belly button.

Position: Ensure the tape is snug against the skin, not compressing it, and parallel to the floor.

Action: Measure after breathing out naturally.

Rather than focusing solely on weight, emphasise overall healthy habits: a balanced diet, regular movement, adequate sleep, and low stress levels. These behaviours support a healthy weight far more sustainably than short-term dieting.

The Bonitas Weight Management Programme is designed to help you get started on your weight loss journey. Visit Bonitas care Programmes or call 0860 106 155 for more information.

9. SOCIAL CONNECTION & PURPOSE

Why It Matters

Strong social relationships are one of the most consistent predictors of good health and longevity. Social isolation and loneliness are associated with increased risk of depression, cognitive decline, and even premature death — risks comparable to smoking 15 cigarettes a day, according to some studies. Women who maintain meaningful social bonds tend to manage stress better, recover more quickly from illness, and report higher life satisfaction.

What you can do
Invest in close, trusting relationships with family and friends

Engage with your community — religious groups, sports clubs, neighbourhood associations, or volunteer work

Reach out for support when you are struggling, rather than withdrawing

For older women, be proactive about maintaining social networks as life circumstances change

QUICK REFERENCE SUMMARY

The table below summarises the core evidence-based minimum recommendations covered in this guide.

NINE NON-NEGOTIABLES FOR SUSTAINABLE WELLNESS

NINE NON-NEGOTIABLES FOR SUSTAINABLE WELLNESS

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

1. PHYSICAL ACTIVITY

2. NUTRITION & HEALTHY EATING

3. HYDRATION

4. SLEEP

5. MENTAL HEALTH & STRESS MANAGEMENT

6. ALCOHOL & SUBSTANCE ABUSE

7. PREVENTATIVE HEALTHCARE & REGULAR SCREENINGS

8. HEALTHY WEIGHT MANAGEMENT

9. SOCIAL CONNECTION & PURPOSE

QUICK REFERENCE SUMMARY

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