Perspective on Diagnostic Criteria for Obesity and Abdominal Obesity in Korean Adults

Nam, Ga Eun,Park, Hye Soon Korean Society for the Study of Obesity 2018 Journal of obesity & metabolic syndrome Vol.27 No.3

<P>Excessive body weight is associated with increased health risks in humans. In general, the risk of mortality increases with greater obesity. The 2018 guideline for the management of obesity by the Korean Society for the Study of Obesity proposed the body mass index (BMI) cut-off levels of 25 kg/m<SUP>2</SUP> and 23 kg/m<SUP>2</SUP> as diagnostic criteria for obesity and overweight (pre-obese) in Korean adults, respectively. Abdominal obesity has been defined as waist circumference (WC) ≥90 cm in men and WC ≥85 cm in women. In this review, the validity of these criteria for Korean adults was examined based on the evidence regarding the associations of obesity index with mortality and morbidity. The American Association of Clinical Endocrinologists/American College of Endocrinology algorithm and American Diabetes Association guideline for the medical care of obese and overweight patients support a BMI of 25 kg/m<SUP>2</SUP> and 23 kg/m<SUP>2</SUP>, respectively, as the cut-off levels for Asians (and some ethnicities) corresponding to the BMI values of 30 kg/m<SUP>2</SUP> and 25 kg/m<SUP>2</SUP>, respectively, for Caucasians. In the future, the optimal cut-off levels for obesity and abdominal obesity may require adjustment as the demographic characteristics of the Korean population change. In addition, development of more valid indicators that better reflect health risks of obesity is needed.</P>

Prevalence of Obesity and Incidence of Obesity-Related Comorbidities in Koreans Based on National Health Insurance Service Health Checkup Data 2006–2015

Seo, Mi Hae,Kim, Yang-Hyun,Han, Kyungdo,Jung, Jin-Hyung,Park, Yong-Gyu,Lee, Seong-Su,Kwon, Hyuk-Sang,Lee, Won-Young,Yoo, Soon Jib Korean Society for the Study of Obesity 2018 Journal of obesity & metabolic syndrome Vol.27 No.1

<P><B>Background</B></P><P>The prevalence of obesity and related comorbidities is increasing worldwide, including in Korea. The Korean Society for the Study of Obesity released the Obesity Fact Sheet 2017 to address this problem in the Korean population.</P><P><B>Methods</B></P><P>Data from the National Health Insurance Service Health Checkup database from 2006 to 2015 were standardized by age and sex using the 2010 Census. The definition of obesity was a body mass index (BMI) ≥25 kg/m<SUP>2</SUP>, and that of abdominal obesity was a waist circumference ≥90 cm in men and ≥85 cm in women. Multivariate adjusted Cox regression analysis was conducted, and hazard ratios (HRs) with 95% confidence intervals were calculated for comorbidities.</P><P><B>Results</B></P><P>From 2009 to 2015, the prevalence of obesity increased from 29.7% to 32.4%, and that of abdominal obesity increased from 18.4% to 20.8%. Obesity with abdominal obesity also increased from 15.1% to 17.7%. Between 2014 and 2015, the prevalence of obesity increased until 30–40 years of age, but decreased from 40–50 years of age in men. In women, it increased until the mid-70s, and decreased thereafter. Abdominal obesity increased from 20–30 years of age to 70–80 years of age, but decreased thereafter. The HRs for type 2 diabetes mellitus, hypertension, dyslipidemia, myocardial infarction, and ischemic stroke were elevated in subjects with abdominal obesity, and their incidence increased as the BMI increased, but slowed down at BMI ≥35 kg/m<SUP>2</SUP>.</P><P><B>Conclusion</B></P><P>Based on the Obesity Fact Sheet 2017, strategies for reducing the prevalence of obesity and abdominal obesity are essential.</P>

Exposure and Exercise Training in Hypoxic Conditions as a New Obesity Therapeutic Modality: A Mini Review

Park, Hun-Young,Kim, Jisu,Park, Mi-Young,Chung, Nana,Hwang, Hyejung,Nam, Sang-Seok,Lim, Kiwon Korean Society for the Study of Obesity 2018 Journal of obesity & metabolic syndrome Vol.27 No.2

<P>Obesity is an important health problem caused by positive energy balance. Generally, low calorie dietary intake combined with regular exercise is the most common modality to lose bodily fat in obese people. Although this is the first modality of choice for obesity treatment, it needs to be applied to obese patients for at least 12 weeks or more and it does not provide consistent results because it is difficult to suppress increased appetite due to exercise. Recently, many researchers have been applying hypoxic conditions for the treatment of obesity, as many studies show that people residing in high altitudes have a lower percentage of body fat and fewer obesity-related illnesses than people living at sea level. Hypoxic therapy treatment, including hypoxic exposure or hypoxic exercise training, is recommended as a way to treat and prevent obesity by suppression of appetite, increasing basal metabolic rate and fat oxidation, and minimizing side effects. Hypoxic therapy inhibits energy intake and appetite-related hormones, and enhances various cardiovascular and metabolic function parameters. These observations indicate that hypoxic therapy is a new treatment modality for inducing fat reduction and promoting metabolic and cardiovascular health, which may be an important and necessary strategy for the treatment of obesity. As such, hypoxic therapy is now used as a general medical practice for obesity treatment in many developed countries. Therefore, hypoxic therapy could be a new, practical, and useful therapeutic modality for obesity and obesity-related comorbidities.</P>

Comparison of the Effects of Cognitive Behavioral Therapy and Behavioral Treatment on Obesity Treatment by Patient Subtypes: A Systematic Review and Meta-analysis

차진영,김서영,신인수,박영배,임영우,Cha, Jin-Young,Kim, Seo-Young,Shin, In-Soo,Park, Young-Bae,Lim, Young-Woo The Society of Korean Medicine for obesity Researc 2020 한방비만학회지 Vol.20 No.2

Objectives: The present study aimed to compare the impacts of cognitive behavioral therapy (CBT) and behavioral treatment (BT) on weight loss and psychological outcomes among patients with three different subtypes of obesity: simple obesity, obesity with binge eating disorder, and obesity with depression. Methods: Embase, PubMed, the Cochrane Central Register of Controlled Trials, Research Information Sharing Service, and Korean Studies Information Service System were systematically searched for randomized controlled trials conducted on or before May 2020, that used CBT to treat obesity. Methodological quality was assessed using Cochrane's risk of bias tool 2 and publication bias was evaluated through the funnel plot using the trim and fill method, Egger's test, and Begg and Mazumdar rank correlation test. A meta-analysis was conducted using a random-effects model and the standardized mean difference with 95% confidence interval (CI) was used to determine effect size. Results: Twenty-one randomized controlled trials with a total of 22 intervention arms and 2,590 patients were included. Our study results revealed that the effects of CBT, compared with BT, on weight loss distinctly differed across all patient subgroups. In the simple obesity group, CBT was more effective than BT (Hedges' g=0.138, CI=0.012~0.264); however, in the obesity with binge eating disorder group, BT was more effective than CBT (Hedges' g=-0.228, CI=-0.418~-0.038); in the obesity with depression group, the effect of CBT was not statistically different from that of BT (Hedges' g=0.276, CI=-0.307~0.859). Further studies with larger sample sizes are required to confirm the outcomes observed in this study. Conclusions: Our results indicated that the effects of CBT on obesity treatment vary based on patient subtype. Therefore, our findings suggest that CBT or BT should be selectively recommended as a treatment strategy for different obesity subtypes.

Dietary Capsaicin Reduces Obesity-induced Insulin Resistance and Hepatic Steatosis in Obese Mice Fed a High-fat Diet

Kang, J. H.,Tsuyoshi, G.,Han, I. S.,Kawada, T.,Kim, Y. M.,Yu, R. NAASO The Obesity Society 2010 Obesity Vol.18 No.4

Visceral fat thickness is associated with carotid atherosclerosis in peritoneal dialysis patients.

Lee, Mi Jung,Shin, Dong Ho,Kim, Seung Jun,Oh, Hyung Jung,Yoo, Dong Eun,Kim, Jwa-Kyung,Park, Jung Tak,Han, Seung Hyeok,Kang, Shin-Wook,Choi, Kyu Hun,Yoo, Tae-Hyun NAASO, the Obesity Society 2012 Obesity Vol.20 No.6

<P>Visceral fat has been known to associate with atherosclerosis, inflammation, and insulin resistance. However, the influence of visceral fat on cardiovascular disease (CVD) in peritoneal dialysis (PD) patients has never been elucidated. We investigated whether visceral fat thickness (VFT) has a predictive role in carotid atherosclerosis determined by carotid intima-media thickness (cIMT) in PD patients. A cross-sectional study was undertaken in 88 prevalent PD patients. BMI and waist circumference (WC) were measured as anthropometric indexes of obesity. VFT and subcutaneous fat thickness (SFT) were determined by sonographic measurement of abdominal fat. Carotid atherosclerosis was defined as increased cIMT (>1.0 mm) or presence of plaque. Thirty-two (36.3%) patients had carotid atherosclerosis. Patients with carotid atherosclerosis showed significantly higher VFT, BMI, and WC. In univariate logistic analysis, BMI, WC, and VFT except SFT were significant risk factors of carotid atherosclerosis. However, multivariate analysis revealed VFT was an independent factor associated with carotid atherosclerosis after adjusting for demographic, biochemical parameters, and anthropometric indexes (per 1 mm increase, odds ratio (OR) = 2.294, 95% confidence interval: 1.048-5.021, P = 0.038). When the patients were divided into three groups according to VFT, log high sensitivity C-reactive protein (hs-CRP), and homeostasis model assessment-insulin resistance (HOMA(IR)) were both higher in the third tertile compared to other tertiles. In conclusion, VFT, not SFT, is independently associated with carotid atherosclerosis in PD patients. Therefore sonographic measurement of VFT could be useful to stratify the risk of cardiovascular disease in PD patients.</P>

Association of variations in TPH1 and HTR2B with gestational weight gain and measures of obesity.

Kwak, Soo Heon,Park, Byoung Lae,Kim, Hail,German, Michael S,Go, Min Jin,Jung, Hye Seung,Koo, Bo Kyong,Cho, Young Min,Choi, Sung Hee,Cho, Yoon Shin,Shin, Hyoung Doo,Jang, Hak C,Park, Kyong Soo NAASO, the Obesity Society 2012 Obesity Vol.20 No.1

<P>Serotonin is involved in appetite regulation and energy homeostasis. Recently, it has been reported that 5-hydroxytryptamine receptor 2B (Htr2b) and tryptophan hydroxylase 1 (Tph1) play major role in β-cell proliferation in mouse during pregnancy. We investigated the genetic association of HTR2B and TPH1 with risk of gestational diabetes mellitus (GDM) and measures of obesity, in 869 Korean GDM women and carefully selected 632 nondiabetic control subjects. Six single-nucleotide polymorphisms (SNPs) in HTR2B and ten SNPs in TPH1 were selected for genotyping according to their tagging status. Genetic variants in HTR2B and TPH1 were not associated with the risk of GDM. In GDM women, SNPs of TPH1 were significantly associated with weight gain during pregnancy. In nondiabetic controls, SNPs of TPH1 were associated with waist circumference and BMI. We also found that a variant of TPH1 (rs623580) was associated with BMI in a genome-wide association study comprised of 8,842 subjects. Although genetic variants in HTR2B and TPH1 were not associated with risk of GDM, we found significant association of these variants with measures of obesity. However, further replication studies in a different population are required to confirm our findings.</P>

Effects of Functional Food Components in Reducing Obesity-induced Inflammation and Metabolic Diseases

Kang, Ji-Hye,Yu, Rina Korean Society for the Study of Obesity 2012 The Korean journal of obesity Vol.21 No.3

Data Analytic Process of a Nationwide Population-Based Study on Obesity Using the National Health Information Database Presented by the National Health Insurance Service 2006–2015

Kim, Yang-Hyun,Han, Kyungdo,Son, Jang-Won,Lee, Seong-Su,Oh, Sang Woo,Kwon, Hyuk-Sang,Shin, Soon-Ae,Kim, Yeon-Yong,Lee, Won-Young,Yoo, Soon Jib Korean Society for the Study of Obesity 2017 Journal of obesity & metabolic syndrome Vol.26 No.1

<P><B>Background</B></P><P>In Korea, the prevalence of obesity has steadily increased, and the socioeconomic burden of obesity has increased along with it. In 2015, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Society for the Study of Obesity (KSSO), providing limited open access to its databases so that the status of obesity and obesity management could be investigated.</P><P><B>Methods</B></P><P>Using NHIS databases, we analyzed nationwide population-based studies for obesity using the definition of obesity (body mass index ≥25 kg/m<SUP>2</SUP>) in subjects over the age of 20. Age and sex standardization were used for all data.</P><P><B>Results</B></P><P>The KSSO released the ‘Obesity Fact Sheet 2016’ using the 2006–2015 NHIS Health Checkup database. The prevalence of obesity steadily increased from 28.7% in 2006 to 32.4% in 2015, and the prevalence of abdominal obesity also steadily increased from 18.4% in 2009 to 20.8% in 2015. The prevalence of class II obesity steadily increased from 2006 to 2015, such that the total prevalence was 4.8% in 2015 (5.6% in men and 4.0% in women). The highest prevalence of obesity was found in Jeju Island, while the lowest prevalence was found in Daegu City. The highest prevalence of abdominal obesity was also found in Jeju Island, while the lowest prevalence was found in Gwangju City.</P><P><B>Conclusion</B></P><P>Based on the Obesity Fact Sheet 2016, a strategy for reducing the prevalence of obesity is needed, especially in Korean men.</P>

The impact of obesity on subclinical coronary atherosclerosis according to the risk of cardiovascular disease

Lee, S. Y.,Chang, H. J.,Sung, J.,Kim, K. J.,Shin, S.,Cho, I. J.,Shim, C. Y.,Hong, G. R.,Chung, N. NAASO The Obesity Society 2014 Obesity Vol.22 No.7

Objective: To evaluate whether the association of obesity with coronary atherosclerosis depends on the risk of cardiovascular disease (CVD). Methods: A total of 1,406 asymptomatic Korean adults underwent both cardiac and abdominal multislice computed tomography (MSCT) as part of a routine health check-up. Obesity was measured using body mass index (BMI), waist circumference (WC), and MSCT-derived area/ratio of visceral and subcutaneous fat. The burden of CVD risk was assessed by the Framingham risk equation. Results: In the low-risk group for CVD, obesity measurements ( standardized odds ratio, 95% confidence interval) of BMI (1.406, 1.197-1.652), WC (1.707, 1.434-2.032), visceral fat area (1.700, 1.438-2.009), and visceral-to-subcutaneous fat ratio (1.620, 1.379-1.903) were associated with the presence of coronary calcification after adjusting for traditional CVD risks. But in the moderate-to-high risk group, the associations were attenuated. For additional adjustments of obesity measurements, in the low-risk group, WC (1.717, 1.172-2.514) and visceral-to-subcutaneous fat ratio (1.400, 1.029-1.904) were independent determinants of coronary calcification. Conclusions: Obesity is differentially associated with subclinical coronary atherosclerosis, according to the burden of CVD risk. In low-risk adults, the relative distribution of abdominal fat, as well as whole body fat, is important to coronary atherosclerosis.