Risk and Treatment of Obesity
The prevalence of obesity among adults in Korea continues to increase.
1. Definition and standard of obesity
Obesity is most accurate to measure and evaluate the amount of fat in the body with more fat accumulated than normal. However, it is difficult to accurately measure the amount of fat in the body, so it is usually evaluated indirectly. The most commonly used method is to use a body mass index (BMI) and measure waist circumference.
1) Definition of obesity through body mass index
(1) Body mass index (BMI): Weight (kg) divided by the square of height (m2).
(e.g. Body mass index of a person with a height of 170 cm and a weight of 70 kg is 24.2 (=70 kg/(1.7 m)2).
(2) Obesity Criteria in Korea: The standard for adult obesity is 25 kg/㎡ or higher. Body mass index 25.0 to 29.9 kg/㎡ is classified into first-stage obesity, 30.0 to 34.9 kg/㎡ is classified into second-stage obesity, and 35.0 kg/㎡ or more is classified into third-stage obesity (high obesity).
2) Diagnostic Criteria for Abdominal Obesity
In Korea, abdominal obesity is diagnosed by measuring waist circumference. It is defined as abdominal obesity when the waist circumference is 90 cm for men and 85 cm for women. Measure the waist circumference with a tape measure while standing with both feet open 25 to 30 cm and exhaling comfortably. The location of the measurement is the midpoint between the lowest rib and the top of the pelvis at the side.
2. Domestic prevalence of obesity
1) Prevalence based on body mass index (BMI)
The prevalence of obesity among adults in Korea was 36.3% as of 2019, which has continued to increase over the past 11 years since 2009, especially for men.
2) Changes in the prevalence of abdominal obesity
The prevalence of abdominal obesity among adults in Korea is 23.9% as of 2019. It has increased steadily in both men and women over the last 11 years since 2009, especially in men.
health effects
· Obesity increases the risk of diabetes, dyslipidemia, dyslipidemia, asthma, cancer, and musculoskeletal disorders, and is also associated with various mental health-related diseases.
1. Obesity-related risks
The risk of obesity is often summarized in 5D: negative body image, disability, disability, disease, and death. Obesity is a "disease" that must be prevented and treated because it accompanies various complications and increases the resulting mortality rate.
2. Obesity and physical health
Obesity has a negative impact on overall health, including physical, mental, psychological, and social health. Obesity-related diseases continue to be revealed as research progresses.
1) type 2 diabetes
The more obese you are, the higher your risk of developing type 2 diabetes. The risk of type 2 diabetes increases by 20% for every 1 kg/㎡ increase in body mass index. If you become obese than your normal weight, your risk of developing type 2 diabetes increases by 5 to 13 times. Weight loss is not only effective in preventing type 2 diabetes, but also in managing diabetes in the pre-obese stage or obese.
2) dyslipidemia
Obese people are twice as likely to develop dyslipidemia as people with normal weight due to increased blood triglycerides, increased low density lipoprotein (LDL) cholesterol, and decreased high density lipoprotein (HDL) cholesterol. This increases the risk of cardiovascular disease. If you have dyslipidemia caused by obesity, your triglycerides increase on an empty stomach and after meals.
Losing weight by improving lifestyle habits in pre-obesity or obesity improves blood lipids. If you lose 3 kg of weight, neutral fat decreases by an average of 15 mg/dL, and if you lose 5 to 8 kg, low-density cholesterol decreases by 5 mg/dL and high-density cholesterol increases by 2 to 3 mg/dL. High-density cholesterol increased and triglycerides decreased compared to obese patients as pre-obesity or obese patients with type 2 diabetes lost 8% over a year and a total of 5.3% over four years. In particular, studies have shown that administration of weight control drugs together with lifestyle correction in adults has a lipid improvement effect at the same time as weight loss.
3) high blood pressure
As the obesity stage progresses, the risk of high blood pressure is 2.5 times and 4 times higher for men and women, respectively, than for people with normal weight. Patients with high blood pressure and obesity should reduce their blood pressure by reducing their weight to 5-15% of their total weight, and if necessary, even more. Obese patients with high blood pressure can consider obesity surgery as well as obesity drug treatment. If you lose 5% of your normal weight, systolic blood pressure decreases by 3 to 12 mmHg.
4) cardiovascular disease
Obesity not only increases the risk of coronary artery disease by 50%, but also increases the mortality rate from hypertension, heart failure, pulmonary embolism, stroke, dyslipidemia, and coronary artery disease in both men and women. Obese people have a 64% higher risk of ischemic stroke than people with normal weight. Excessive fat accumulation increases cardiac output and reduces systemic vascular resistance, eventually causing heart failure.
5) a cancer
Several studies have shown that weight gain is an important risk factor for cancer development. According to data over the past 25 years, about 14% of male cancer deaths and 20% of female cancer deaths from obesity. According to a 10-year follow-up study using data from the Korea Insurance Corporation of 780,000 Koreans, the risk of developing histologically confirmed colon cancer, liver cancer, biliary tract cancer, prostate cancer, kidney cancer, thyroid papilla cancer, small cell lung cancer, non-chicken lymphoma and melanoma increased as the body mass index increased.
In 2016, the International Agency for Research on Cancer (IARC) announced that 13 cancers were associated with obesity, including esophageal cancer, stomach cancer, colon and rectal cancer, liver cancer, gallbladder cancer, pancreatic cancer, breast cancer, endometrial cancer, ovarian cancer, kidney cancer, meningoma, thyroid cancer, and multiple myeloma. However, it is not yet clear how weight loss plays a role in cancer prevention, and further research is needed.
6) asthma
Obesity is an important risk factor for developing asthma. Asthma incidence is higher as the body mass index increases, doubling in children and 2.3 times in adults. Pre-obese or obese adults also have an increased number of asthma attacks. This is because obesity causes changes in respiratory system dynamics, airway resistance, breathing patterns, breathing exercises and gas exchange.
7) a musculoskeletal disorder
Obesity is associated with osteoarthritis, inflammatory arthritis, problems with the lumbar spine and other soft tissues, osteoporosis, walking, physical function, and disabilities. Obesity increases the physical force on the joints, causing osteoarthritis. If the body mass index is 30 kg/㎡ or higher, the incidence of knee osteoarthritis increases by four times, and the frequency of knee injuries increases.
8) a digestive system disease
Obesity is also associated with digestive problems. Non-alcoholic fatty liver disease is a disease that shows fat deposition in the liver without alcohol intake or accompanying causes and is related to obesity, type 2 diabetes, dyslipidemia, and metabolic syndrome. Patients with pre-obesity or obese non-alcoholic fatty liver disease are encouraged to reduce fat in the liver by improving their lifestyle, which combines diet and exercise therapy. In particular, in order to improve inflammation in the liver, you need to lose more than 7-10%. Also, obesity is associated with gastroesophageal reflux disease. Studies have shown that gastric acid reflux is more common in obese people than normal people. Therefore, it is recommended that obese people lose weight to treat gastroesophageal reflux disease.
How to do it - General ways to do it
• In order to treat obesity, you should check the degree of obesity and accompanying diseases, and set goals suitable for each individual.
• Obesity treatment methods include diet therapy, exercise therapy, medication, and surgical treatment, and it is also important to choose the right method for the individual.
1. Treatment of obesity
There is no simple way to solve obesity in the short term. Treatment methods for obesity include diet therapy, exercise therapy, behavioral therapy, and lifestyle correction, drug treatment, and surgical treatment. Although there are various causes of the outbreak and treatment methods vary depending on the individual's lifestyle and weight loss goals, basic lifestyle correction should take precedence to ensure safe weight loss and weight maintenance. If diet therapy and exercise therapy alone limit weight loss, the degree of obesity is severe, or the risk of obesity-related diseases is high, active treatment such as drug therapy and surgical treatment may be required.
2. Preparation and goal setting for obesity treatment
Before treating obesity, the body mass index and waist circumference are measured to evaluate the degree of obesity. Individual accompanying diseases (hypertension, dyslipidemia, diabetes, etc.) are identified, and stress and depressive symptoms are investigated to evaluate health risk before treatment. Obesity is rarely caused by endocrine diseases, so it is recommended to take appropriate tests after treatment.
Setting goals is important to treat obesity effectively. In general, it is ideal to 'lose 5-10% of your current weight and maintain your lost weight' over 6 months. When starting obesity treatment, it is important to set a weight loss goal according to the individual's health condition, so it is recommended to consult a doctor to set a realistic goal.
3. Choosing a method to treat obesity
1) Basics
To control your weight, you should improve your lifestyle, such as reduced food intake and increased activity. Behavioral therapy is recommended to last more than six months when losing weight, and behavioral therapy is recommended for more than a year to maintain the lost weight. There are differences in treatment methods depending on individual life patterns and weight loss goals, but safe weight loss and weight maintenance can be achieved only when diet, exercise therapy, and behavioral therapy are properly combined.
2) dietary therapy
Dietary control is essential in obesity treatment. Diet therapy limits energy intake, leading to energy deficiency in the body.
(1) The most commonly used method is to reduce your daily intake of calories by 500 kcal. For example, if you reduce your daily intake of calories by 500 kcal, such as reducing a bag of snacks every day or drinking cool water instead of cola, you can lose about 0.5 kg of weight a week.
(2) There are also low-calorie diet therapy (limited to 800 to 1,200 kcal per day) or ultra-low-calorie diet therapy (limited to 400 to 600 kcal per day), but caution should be taken as it can cause nutrient imbalances such as electrolytes and minerals.
(3) Record the type and amount of food you eat every day to understand the relationship between food intake and weight.
(4) When eating out, go hungry and eat slowly with calories and nutrients in mind.
5) Alcohol has 7 kcal of calories per gram and increases calorie intake through other foods. The higher the alcohol intake, the higher the calorie intake, so be careful.
(6) The right diet is to eat three regular meals a day as slowly as possible, and to cook and eat natural food rather than instant or fast food.
(7) Avoid eating snacks as much as possible, and avoid late-night snacks.
3) Exercise therapy
Exercise therapy is the basis of obesity treatment along with diet therapy, and exercise therapy is needed to reduce "body fat," a body tissue made of fat cells, and to maintain "restraint fat" by subtracting body fat from weight.
(1) For weight control, it is recommended to do regular exercises (arbitrary and muscular exercises) that can be enjoyed as part of your life.
(2) Aerobic exercise is recommended to be carried out twice a day for 30-60 minutes or 20-30 minutes at moderate intensity, and at least five times a week.
(3) Muscle training is recommended to perform 1 to 2 sets of 8 to 10 events with a weight that can be repeated 8 to 12 times and twice a week.
(4) Moderate intensity of physical activity is recommended for 200 to 300 minutes per week to maintain lost weight.
(5) When exercising, thoroughly warm up and clean up exercises, and take care not to get injured by exercise.
4) medication
Obesity treatment is first recommended for lifestyle changes such as diet therapy or exercise therapy, and if the body mass index is 25 kg/㎡ or higher, or if it is 23 kg/㎡ or higher and cardiovascular complications (hypertension, diabetes, dyslipidemia) or sleep apnea, Korea's Ministry of Food and Drug Safety recommends obesity treatment with a body mass index of 30 kg/㎡ or higher. All obesity drugs have side effects and taboos, so consult your doctor when using them. It should not be stopped suddenly, and if there is no sufficient weight loss effect of 3 to 5%, stop taking it.
(1) Drugs that can be used for a long time (more than one year)
- Orlistat: A drug that inhibits lipase, an enzyme that breaks down fat in ingested food, and blocks absorption of fat in the intestine, showing weight loss effects. In particular, it has the effect of improving lipids, improving blood sugar and insulin resistance, and preventing type 2 diabetes.
- Naltrexone – Bupropion: Bpropion inhibits the reabsorption of dopamine and norepinephrine, stimulates the appetite center, and reduces appetite.
- Liraglutide: Glucagon Like Peptide-1, GLP-1 analogs that increase satiety, induce weight loss, and improve blood sugar, blood pressure, and lipid.
- Phentermine/topiramate: Phentermine inhibits appetite by increasing the secretion of norepinephrine, and topiramate decreases weight by increasing energy consumption.
(2) Drugs that can be used for a short period of time (less than 12 weeks)
- Phentermine: Amphetamine stimulates the secretion of norepinephrine and inhibits appetite. Only short-term use is allowed in Korea, so you should be careful when using it.
- Pendimetrazine: Stimulates the secretion of norepinephrine and inhibits appetite. Only short-term use is allowed in Korea, so you should be careful when using it.
5) surgical treatment
According to the Obesity Association's medical guidelines, surgical treatment is considered if the body mass index is 35 kg/㎡ or higher (stage 3 obesity) or if the body mass index is 30 kg/㎡ or higher (stage 2 obesity) and patients with obesity-related diseases fail to lose weight due to non-surgical treatment. Surgical treatment is most effective in losing weight and maintaining lost weight, and is effective in curing or improving obesity-related diseases such as diabetes.
(1) Louwai gastric bypass surgery: intake restriction type + absorption restriction
(2) Gastric (retail) resection: intake restriction type
(3) Gastric band surgery: Intake restriction type
All three surgical procedures are safe and effective, but gastric bypass and gastric (retail) resection are more effective in weight loss than gastric band surgery. Gastric band surgery has fewer short-term complications than other surgeries, but it can cause long-term complications. For safe and effective surgical treatment, it is necessary to correct behavioral habits such as appropriate eating habits and changes in exercise habits before and after surgery.
How-to-Customized How-to-Do
• If high blood pressure patients lose weight, it can control blood pressure. In particular, high blood pressure patients with metabolic syndrome are recommended to lose weight and actively manage high blood pressure.
• If high-risk diabetic groups lose weight, they can reduce the incidence of diabetes, and adult obese patients can improve diabetes through weight loss.
• It is strongly recommended that patients with dyslipidemia maintain an appropriate weight. Studies have shown that weight loss improves dyslipidemia, such as low-density cholesterol.
• Weight loss lowers blood pressure, blood cholesterol, and blood sugar, which are risk factors for cardiovascular disease, thereby reducing cardiovascular disease occurrence and mortality.
• The health effects of weight loss in cancer survivors are well known in breast cancer and endometrial cancer, and recently, in gastric cancer patients, the incidence of cardiovascular disease has been reported to decrease.
1. High blood pressure and obesity
High blood pressure is closely related to weight, so losing weight also lowers blood pressure. According to the hypertension treatment guidelines published by the Korean Society of Hypertension in 2018, every time you lose 1 kg of weight, systolic blood pressure decreases 1.1 mmHg and diastolic blood pressure 0.9 mmHg.
When a hypertensive patient loses 10 kg, his blood pressure drops by about 10 mmHg. If hypertensive patients exceed the standard weight (height (m) x height (m) x BMI (male 22, female 21)) by more than 10%, losing as little as 5 kg will result in significant blood pressure reduction. In addition to high blood pressure, many patients with hypertension are accompanied by metabolic abnormalities such as obesity, dyslipidemia, and hyperglycemia.
2. Diabetes and Obesity
The Korean Diabetes Association Diabetes Treatment Guidelines (2021) recommend that obese high-risk diabetic groups lose and maintain their initial weight by more than 5% to prevent type 2 diabetes. Exercise and nutrition therapy at least 150 minutes a week of moderate intensity (fast walking with a little shortness of breath, cycling, etc.) are strongly recommended. In the U.S., "Type 2 Diabetes Treatment Guidelines for Obese Patients" also recommend losing more than 5% of weight for pre-obese or obese type 2 diabetics, and 5% to 15% of weight is recommended through lifestyle correction to reduce glycated hemoglobin.
In a study of adult obese patients with a body mass index of 25 kg/㎡ or higher among type 2 diabetes patients, weight loss by diet control had an effect of improving diabetes. Weight loss through obesity metabolic surgery is known to be more effective than medication. According to the guidelines for obesity metabolic surgery by the Korean Obesity Surgery Association in 2018, Asians to which Koreans belong may consider surgery for type 2 diabetes patients with a body mass index of 27.5 kg/㎡ or higher and poor blood sugar control.
3. Dyslipidemia and obesity
The guidelines for treating dyslipidemia (2018) of the Korean Society for Lipid Arteriosclerosis strongly recommend eating calories at a level that can maintain an appropriate weight. Studies show that low-density cholesterol and total cholesterol decreased when losing weight, and that losing 5-10% reduces triglycerides in the blood by more than 20%. As a result of collecting and analyzing studies conducted for more than two years on obese or pre-obese adults, losing 10 kg of weight lowered the total cholesterol by 8.9 mg/dL.
4. Cardiovascular Disease and Obesity
According to the 2018 guidelines for atrial fibrillation of the Korean Society of Arrhythmia, as a result of intensive weight loss of 10 to 15 kg in obese patients with atrial fibrillation, recurrence of atrial fibrillation decreased and symptoms improved compared to general management. Therefore, obese atrial fibrillation patients are recommended to lose weight to alleviate the degree of atrial fibrillation and symptoms. The Korean Stroke Society also recommends weight control for secondary prevention of stroke. Since weight gain is associated with an increase in stroke incidence, active weight loss is recommended for pre-obese or obese patients.
Obesity is certainly a risk factor for cardiovascular disease, but patients who have already confirmed cardiovascular disease show opposite results for obesity and obesity. Therefore, more active management is needed to prevent cardiovascular disease.
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