Current status and treatment of obesity in Korea

Over the last decade, the male obesity rate in Korea has surged from 36.3% in 2012 to 46.3% in 2021. The proportion of overweight and obese students among elementary, middle, and high school students increased from 22.9% in 2016 to 30.8% in 2021.Current Concepts: Various methods, such as body mass index, waist circumference measurement, and impedance body fat analysis, are used to diagnose obesity. Obesity treatment is needed to establish an individualized treatment plan based on the cause of obesity, and behavioral changes should be induced through dietary therapy and exercise. Drug therapy should be considered in patients who could not lose weight despite non-pharmacological therapies for over 3 months and have one or more cardiovascular risk factors. Behavioral therapy is the core of obesity treatment because of its application as a programmed treatment for weight control and an approach to changing behaviors related to food intake and physical activity. If non-drug treatment does not lead to weight loss, drug therapy should be considered. Along with drug treatment, dietary therapy, exercise, and behavioral therapy are essential. In severely obese patients, surgical intervention can be considered for weight loss, the maintenance of reduced weight, and improvement of obesity-related comorbidities, including type 2 diabetes.Discussion and Conclusion: To successfully treat obesity, a combination of dietary plans, exercise programs, and drug therapy are required according to an accurate assessment of the cause and degree of obesity.

Bariatric surgery versus medical therapy in Korean obese patients: prospective multicenter nonrandomized controlled trial (KOBESS trial)

Purpose@#The aim of this study was to show that bariatric surgery (BS) is more effective than medical therapy (MT) in Asian obese patients. @*Methods@#In this prospective, multicenter, nonrandomized, controlled trial, obese patients with body mass index of ≥35 kg/m2 or 30.0–34.9 kg/m2 with obesity-related comorbidities were assigned to undergo BS, such as laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass, or MT. Patients who underwent BS were evaluated 4, 12, 24, and 48 weeks after surgery, whereas patients who received MT were monitored at a hospital every 6 weeks for 1 year. At each visit, weight, waist and hip circumference, and blood pressure were measured, and patients underwent physical examination and laboratory testing. Health-related quality of life (HQOL) was investigated using Euro QOL-5 Dimension, Impact of Weight on Quality of Life questionnaire-Lite and Obesity-related Problems scale. @*Results@#The study included 264 patients from 13 institutions; of these, 64 underwent BS and 200 received MT. Of the patients who underwent BS, 6.3% experienced early complications. Relative weight changes from baseline to 48 weeks were significantly greater in the BS than in the MT group (26.9% vs. 2.1%, P < 0.001), as were the rates of remission of diabetes (47.8% vs. 16.7%, P = 0.014), hypertension (60.0% vs. 26.1%, P < 0.001), and dyslipidemia (63.2% vs. 22.0%, P < 0.001). HQOL was better in the BS than in the MT group at 48 weeks. @*Conclusion@#BS was safe and effective in Korean obese patients, with greater weight reduction, remission of comorbidities, and quality of life improvement than MT.

Effects of a mobile healthcare service provided by public health centers on practicing of health behaviors and health risk factors

BACKGROUND/OBJECTIVES: This study evaluated whether a mobile health (mHealth) application can instigate healthy behavioral changes and improvements in metabolic disorders in individuals with metabolic abnormalities. SUBJECTS/METHODS: Participants were divided into an mHealth intervention group (IG), which used a mobile app for 24 weeks, and a conventional IG. All mobile apps featured activity monitors, with blood pressure and glucose monitors, and body-composition measuring devices. The two groups were compared after 24 weeks in terms of health-behavior practice rate and changes in the proportion of people with health risks, and health behaviors performed by the IG that contributed to reductions in more than one health risk factor were analyzed using multiple logistic regression. RESULTS: Preference for low-sodium diet, reading nutritional facts, having breakfast, and performing moderate physical activity significantly increased in the mHealth IG. Furthermore, the mHealth IG showed a significant increase of eight items in the mini-dietary assessment; particularly, the items “I eat at least two types of vegetables of various colors at every meal” and “I consume dairies, such as milk, yogurt, and cheese, every day.” The proportion of people with health risks, with the exception of fasting glucose, significantly decreased in the mHealth IG, while only the proportion of people with at-risk triglycerides and waist circumference of females significantly decreased in the control group. Finally, compared to those who did not show improvements of health risks, those who showed improvements of health risks in the mHealth IG had an odds ratio of 1.61 for moderate to vigorous physical activity, 1.65 for “I do not add more salt or soy sauce in my food,” and 1.77 for “I remove fat in my meat before eating.” CONCLUSIONS: The findings suggest that the additional use of a community-based mHealth service through a mobile application is effective for improving health behaviors and lowering metabolic risks in Koreans.

The Differences in Obesity Rates According to Status of Co-Residence with Their Parents in Korean Adolescents: The Implication of the Gender of Single Parent Living with Adolescents

BACKGROUND: Many studies have reported that adolescents living with single parent have a high risk of obesity. However, those studies did not explore the implication of the gender of single parent living with adolescents. This study investigated the differences in obesity rates according to status of co-residence with their parents in Korean adolescents. The family living with single parent was classified into the family living with single father and the family living with single mother. METHODS: This cross-sectional study involved 59,602 adolescents who participated in the 2017 Korea Youth Risk Behavior Web-based Survey. The data on height, weight, status of co-residence with parents, and the other variables were obtained through online questionnaires. RESULTS: In male adolescents, the family living with single mother was related to a high proportion of obesity (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.09–1.40) and overweight (OR 1.17, 95% CI 1.03–1.34). However, in female adolescents, the family living with single father was related to a high proportion of obesity (OR 1.49, 95% CI 1.23–1.82). In addition, female adolescents living with neither parent were more likely to be obese (OR 1.47, 95% CI 1.13–1.91) and overweight (OR 1.31, 95% CI 1.00–1.70). CONCLUSIONS: This study showed a risk of obesity in adolescents living with single parent differs according to the gender of single parent living with adolescents. Not adolescents living with a same-gender parent, but those living with an opposite-gender parent have a high risk of obesity.

The Distribution of Weight Status according to Familial Socioeconomic Status in Korean Adolescents: The Twelfth Korea Youth Risk Behavior Web-based Survey, 2016

BACKGROUND: The influence of socioeconomic status (SES) on weight status varies depending on the countries' levels of social and economic development. There are many studies on a risk of adolescent obesity according to familial SES in Korea. However, it is not clarified what effects familial SES has on a risk of underweight in Korean adolescents. This study investigated the distribution of weight status including obesity and underweight according to familial SES in Korean adolescents. METHODS: This cross-sectional study involved 63,741 adolescents who participated in the 2016 Korea Youth Risk Behavior Wed-based Survey. The data on height, weight, familial SES, current smoking status, current alcohol intake, physical activity, breakfast skipping, perceived stress, depressive mood, and living with family were obtained through online questionnaires. The assessment of familial SES was based on perceived household economic status and parental education level. RESULTS: In boys, low household economic status was related to a high proportion of obesity (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04–1.25) and underweight (OR 1.31, 95% CI 1.14–1.51). Girls with low household economic status were more likely to be obese (OR 1.81, 95% CI 1.61–2.03) and overweight (OR 1.41, 95% CI 1.23–1.60) but, although not statistically significant, less likely to be underweight (OR 0.88, 95% CI 0.75–1.04). CONCLUSIONS: This study showed that adolescents with low familial SES were at a high risk of obesity and underweight. A risk of underweight was increased in boys with low familial SES but in girls with high familial SES.

The Distribution of Weight Status according to Familial Socioeconomic Status in Korean Adolescents: The Twelfth Korea Youth Risk Behavior Web-based Survey, 2016

BACKGROUND@#The influence of socioeconomic status (SES) on weight status varies depending on the countries' levels of social and economic development. There are many studies on a risk of adolescent obesity according to familial SES in Korea. However, it is not clarified what effects familial SES has on a risk of underweight in Korean adolescents. This study investigated the distribution of weight status including obesity and underweight according to familial SES in Korean adolescents.@*METHODS@#This cross-sectional study involved 63,741 adolescents who participated in the 2016 Korea Youth Risk Behavior Wed-based Survey. The data on height, weight, familial SES, current smoking status, current alcohol intake, physical activity, breakfast skipping, perceived stress, depressive mood, and living with family were obtained through online questionnaires. The assessment of familial SES was based on perceived household economic status and parental education level.@*RESULTS@#In boys, low household economic status was related to a high proportion of obesity (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04–1.25) and underweight (OR 1.31, 95% CI 1.14–1.51). Girls with low household economic status were more likely to be obese (OR 1.81, 95% CI 1.61–2.03) and overweight (OR 1.41, 95% CI 1.23–1.60) but, although not statistically significant, less likely to be underweight (OR 0.88, 95% CI 0.75–1.04).@*CONCLUSIONS@#This study showed that adolescents with low familial SES were at a high risk of obesity and underweight. A risk of underweight was increased in boys with low familial SES but in girls with high familial SES.

The Differences in Obesity Rates According to Status of Co-Residence with Their Parents in Korean Adolescents: The Implication of the Gender of Single Parent Living with Adolescents

BACKGROUND@#Many studies have reported that adolescents living with single parent have a high risk of obesity. However, those studies did not explore the implication of the gender of single parent living with adolescents. This study investigated the differences in obesity rates according to status of co-residence with their parents in Korean adolescents. The family living with single parent was classified into the family living with single father and the family living with single mother.@*METHODS@#This cross-sectional study involved 59,602 adolescents who participated in the 2017 Korea Youth Risk Behavior Web-based Survey. The data on height, weight, status of co-residence with parents, and the other variables were obtained through online questionnaires.@*RESULTS@#In male adolescents, the family living with single mother was related to a high proportion of obesity (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.09–1.40) and overweight (OR 1.17, 95% CI 1.03–1.34). However, in female adolescents, the family living with single father was related to a high proportion of obesity (OR 1.49, 95% CI 1.23–1.82). In addition, female adolescents living with neither parent were more likely to be obese (OR 1.47, 95% CI 1.13–1.91) and overweight (OR 1.31, 95% CI 1.00–1.70).@*CONCLUSIONS@#This study showed a risk of obesity in adolescents living with single parent differs according to the gender of single parent living with adolescents. Not adolescents living with a same-gender parent, but those living with an opposite-gender parent have a high risk of obesity.

Effectiveness and safety of low-carbohydrate diets

With the recent assertions made by certain Korean media that low-carbohydrate, high-fat diets are panaceas for weight reduction and health improvement, such diets have been in the public spotlight. Medical and nutrition professionals have claimed that the inordinate popularity of low-carbohydrate, high-fat diets may pose a significant threat to public health. The aim of this review was to explore the latest evidence on the effectiveness and safety of low-carbohydrate diets. Recent clinical trials have shown that low-carbohydrate diets result in favorable changes in body weight and biochemical cardiovascular risk factors. However, the safety of low-carbohydrate diets remains inconclusive in the long term. Although the latest guidelines for the management of obesity recommend obese adults to use low-carbohydrate diets as an alternative dietary approach to achieve weight loss depending on each patient's dietary habits and medical status, such diets cannot currently be recommended as a strategy for health promotion among the general population due to long-term safety concerns. The results of cohort studies in Japan that have shown moderate diets lower in carbohydrates to be associated with decreased risks of cardiovascular mortality, total mortality, and type 2 diabetes in Japanese women, suggest that a low-glycemic load diet might be an optimal dietary approach for Korean obese adults with insulin resistance.

Effectiveness and safety of low-carbohydrate diets

With the recent assertions made by certain Korean media that low-carbohydrate, high-fat diets are panaceas for weight reduction and health improvement, such diets have been in the public spotlight. Medical and nutrition professionals have claimed that the inordinate popularity of low-carbohydrate, high-fat diets may pose a significant threat to public health. The aim of this review was to explore the latest evidence on the effectiveness and safety of low-carbohydrate diets. Recent clinical trials have shown that low-carbohydrate diets result in favorable changes in body weight and biochemical cardiovascular risk factors. However, the safety of low-carbohydrate diets remains inconclusive in the long term. Although the latest guidelines for the management of obesity recommend obese adults to use low-carbohydrate diets as an alternative dietary approach to achieve weight loss depending on each patient's dietary habits and medical status, such diets cannot currently be recommended as a strategy for health promotion among the general population due to long-term safety concerns. The results of cohort studies in Japan that have shown moderate diets lower in carbohydrates to be associated with decreased risks of cardiovascular mortality, total mortality, and type 2 diabetes in Japanese women, suggest that a low-glycemic load diet might be an optimal dietary approach for Korean obese adults with insulin resistance.

The Relationship between Smoking and Unhealthy Weight Control Behaviors among Korean Adolescents: The Tenth Korea Youth Risk Behavior Web-Based Survey, 2014 / 가정의학회지

BACKGROUND: Adolescent smoking is positively related to weight control attempts, especially by unhealthy methods. The co-occurrence of smoking and unhealthy weight control behaviors may cause serious health problems in adolescents. This study examined the relationship of smoking with unhealthy weight control behaviors among Korean adolescents. METHODS: This cross-sectional study involved 31,090 students of grades 7 to 12, who had tried to reduce or maintain their weight during the 30 days prior to The Tenth Korea Youth Risk Behavior Web-based Survey, 2014. Data on height, weight, weight control methods, smoking, alcohol intake, living with one's family, and perceived economic status were obtained through self-report questionnaires. ‘Unhealthy weight control behaviors’ were subcategorized into ‘extreme weight control behaviors’ and ‘less extreme weight control behaviors.’ RESULTS: The smoking rates were 13.3%±0.4% in boys and 3.8%±0.2% in girls. Current smokers were more likely to engage in extreme weight control behaviors (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.09 to 2.00 in boys, and OR, 2.05; 95% CI, 1.59 to 2.65 in girls) and less extreme weight control behaviors (OR, 1.23; 95% CI, 1.07 to 1.40 in boys, and OR, 1.47; 95% CI, 1.22 to 1.76 in girls) compared to non-smokers among both boys and girls. CONCLUSION: Current smoking is independently related to a high likelihood of engaging in unhealthy weight control behaviors among Korean adolescents. This relationship is stronger for girls than for boys. Extreme weight control behaviors have a stronger relationship with current smoking than less extreme weight control behaviors.

Snack Consumption Patterns and Its Nutritional Significance in Korean Elderly Population: from the 2013-2014 Korea National Health and Nutrition Examination Survey

BACKGROUND: This study aims to evaluate the importance of snacks to a balanced diet by assessing snack consumption patterns and factors associated with eating snacks of Korean elders of 60 years or more. METHODS: This analysis is based on participants from the 2013-2014 Korea National Health and Nutrition Examination Survey. Meal or snack consumption was based on a 24 hours recall data, and the adequacy of each nutrient intake was based on the Dietary Reference Intakes by the Korea Nutrition Society. The cutoff for snack consumption valued as meaningful was more than 200 kcal/day of snack energy intake. RESULTS: Korean male elders of age 60 years or more are consuming 333.6±11.1 kcal of snack and 271.7±7.4 kcal for females. When consumed together with meals, snack consumption increased the adequacy of all nutrients intake, except sodium. Based on energy contribution, male Korean elders are consuming snack food group in order of beverage and alcohols, grains, and fruits, while for females the order was grains, fruits, and dairy. Older age (men and women), joblessness (men), and chronic disease (women) were positively associated with having snack of 200 kcal or more per day, whereas ‘living with a partner (men)’, alcohol intake frequency of more than twice per week (men), and ‘doing regular aerobic physical activity (women)’ showed negative association. CONCLUSIONS: Snack consumption of Korean elders contributed to more adequate nutritional status, but improvement of food groups is needed because they were mainly concentrated on grains.

Development of tailored nutrition information messages based on the transtheoretical model for smartphone application of an obesity prevention and management program for elementary-school students

BACKGROUND/OBJECTIVES: Easy access to intervention and support for certain behaviors is important for obesity prevention and management. The available technology such as smartphone applications can be used for intervention regarding healthy food choices for obesity prevention and management in elementary-school students. The transtheoretical model (TTM) is comprised of stages and processes of change and can be adopted to tailored education for behavioral change. This study aims to develop TTM-based nutrition contents for mobile applications intended to change eating behaviors related to weight gain in young children. SUBJECTS/METHODS: A synthesized algorithm for tailored nutrition messages was developed according to the intake status of six food groups (vegetables, fruits, sugar-sweetened beverages, fast food and instant food, snacks, and late-night snacks), decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. The messages in this study were developed from December 2014 to April 2015. After the validity evaluation of the contents through expert consultation, tailored nutrition information messages and educational contents were developed based on the TTM. RESULTS: Based on the TTM, stages of subjects are determined by their current intake status, decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. Three versions of tailored nutrition messages at each TTM stage were developed so as to not send the same messages for three weeks at most, and visual materials such as figures and tables were developed to provide additional nutritional information. Finally, 3,276 tailored nutrition messages and 60 nutrition contents for applications were developed. CONCLUSIONS: Smartphone applications may be an innovative medium to deliver interventions for eating behavior changes directly to individuals with favorable cost-effectiveness. In addition, using the TTM for tailored nutrition education for healthy eating is an effective approach.

The Mediating Role of Parental Support in the Relationship between Life Stress and Suicidal Ideation among Middle School Students / 가정의학회지

BACKGROUND: Youth suicide is increasingly being recognized as a major social problem in South Korea. In this study, we aimed to explore the effects of parental support on the relationship between life stress and suicidal ideation among middle-school students. METHODS: This study analyzed data from a cross-sectional study on mental health conducted by the South Korea National Youth Policy Institute between May and July of 2013. Questionnaire responses from 3,007 middle-school students regarding stress factors, thoughts of suicide during the past year, and parental support were analyzed in terms of 3 subscale elements: emotional, academic, and financial support. RESULTS: Among the participants, 234 male students (7.8%) and 476 female students (15.8%) reported experiencing suicidal ideation in the past year. Life stress significantly influenced suicidal ideation (P<0.001), and parental support and all of the subscale elements had a significant influence on decreasing suicidal ideation. As shown in model 1, life stress increased suicidal ideation (adjusted odds ratio [aOR], 1.318; P<0.001), and, in model 2, the effect of life stress on suicidal ideation decreased with parental support (aOR, 1.238; P<0.001). CONCLUSION: Parental support was independently related to a decrease in suicidal ideation, and life stress was independently related to an increase in suicidal ideation. Parental support buffered the relationship between life stress and suicidal ideation.

Influenza Vaccination Status in Korean Adult Population in Relation with Socioeconomic and Medical Factors

BACKGROUND: Influenza causes morbidity and mortality, resulting in the medical and socioeconomic costs. We aimed to analyse whether socioeconomic and medical factors may affect influenza vaccination status divided into 2 groups; one aged 19 to 64 years old and the other aged 65 or over who are eligible for free vaccination. METHODS: The study included 1,412 individuals aged 19 and over who responded to influenza vaccination survey, based on 2013 National Health and Nutrition Examination Survey. Related factors were categorized into socioeconomic factors and medical factors. Univariate analyses were conducted to examine the correlations between vaccination rate and each variables. Multivariate analysis was obtained after adjusting variables which were statistcally significant. RESULTS: Influenza vaccination rate was significantly different in the population aged 19 to 64 (24.9%) and the population aged 65 or over (80.5%). In the former population, high vaccination rate was associated with healthcare usage (odds ratio [OR]=1.37, 95% confidence interval [CI]=1.03-1.83), underlying chronic diseases (OR=2.21, 95% CI=1.43-3.40), and public assistance recipient households (OR=2.21, 95% CI=1.03-4.78), while low vaccination rate was correlated with no use of medical check up (OR=0.70, 95% CI=0.52-0.94) and heavy alcoholics (OR=0.41, 95% CI=0.24-0.70). In the latter population aged 65 or over, high vaccination rate was associated with healthcare usage (OR=1.82, 95% CI=1.28-2.59), and underlying malignancies (OR=4.79, 95% CI=1.07-21.54), whereas low vaccination rate was associated with public assistance recipient households (OR=0.33, 95% CI=0.14-0.76), and no use of medical check up (OR=0.37, 95% CI=0.19-0.73). CONCLUSIONS: In the population below 65 years old, vaccination rate would be expected to rise by the recommendation of medical care providers and expanding the coverage of free vaccination. In elderly, individualized care for those who have less access to medical care and high susceptibility is highly recommended.

Acceptability and Feasibility of a Smartphone Application for 5th, 6th Grade Elementary Students to Prevent Childhood Obesity; a Qualitative Study

BACKGROUND: This study aimed to describe the acceptability and feasibility of the “HAPPY ME”, a smartphone application (app) for guiding healthy eating habits and physical activities to prevent childhood obesity, through in-depth interviews of 5th and 6th grade students of an elementary school. METHODS: A total of 25 students were recruited from grades 5 and 6 of an elementary school in Gimpo. They were asked to participate in in-depth interviews about expectations regarding the “HAPPY ME”, smartphone usage behaviors, perceptions and attitudes towards health, and satisfaction with the “HAPPY ME”, before and after the 4-week trial of the “HAPPY ME”. RESULTS: Study participants reported a high level of satisfaction regarding gamification elements such as awarding points as rewards for completing missions and using closed social networking services with friends. They also reported that their eating habits had improved after the 4-week trial. However, some students felt that the app was complicated to use and recommended that it should have prompts as notifications. CONCLUSIONS: This study showed that the “HAPPY ME” is acceptable and feasible for use with children. However, the app needs to be modified based on the results of this study.

Development of a Smartphone Application for 4th-6th Grade Elementary Students Aimed to Prevent Childhood Obesity

BACKGROUND: There is high interest in a new approach to improve children's lifestyle habits in order to prevent childhood obesity. A smartphone application (app) is a new technology platform that can be used to prevent childhood obesity. METHODS: The key messages for healthy eating habits and physical activities were selected by experts in nutrition, physical activity, and psychology and were adjusted for use in elementary school students. Gamification techniques were used to increase app user engagement. A total of 249 students in grades 4-6 were asked to rate their satisfaction for the app after 4 weeks of use. RESULTS: The main menu of "HAPPY ME" was composed of user profile, "EVERYDAY QUEST," exercise diary, diet diary, settings, and notifications. The app users were asked to complete 6-9 daily missions regarding healthy eating habits and physical activities through "EVERYDAY QUEST." The mean satisfaction scores for each variable were distributed from 3.6 to 4.0 points, and most of the students responded that they would continue to use the app (4.0 points). CONCLUSION: We developed a smartphone app (HAPPY ME) for 4th-6th grade elementary students aimed to provide educational information about healthy eating habits and physical activities in order to prevent childhood.

Weight Control Methods Related to Cotinine-Verified Smoking among Korean Adult Women: Korea National Health and Nutrition Examination Survey, 2008-2011 / 가정의학회지

BACKGROUND: Korean women are known to have a very low smoking rate. However, the actual smoking rate among Korean women is higher than 10% and may continue to increase gradually. In addition, some Korean women use extreme weight control methods that have potentially harmful effects. This study was conducted to elucidate weight control methods related to cotinine-verified smoking among Korean adult women. METHODS: This cross-sectional study involved 4,189 women aged > or =19 years who had attempted weight control during the past 1 year from the Korea National Health and Nutrition Examination Survey, 2008-2011. Smoking status was assessed using both self-report questionnaires and assays of urinary cotinine, and weight control methods were investigated using self-report questionnaires. RESULTS: The smoking rate based on the measurement of urinary cotinine was 12.4% +/- 0.8% among Korean women. Cotinine-verified smokers were more likely to attempt fasting (odds ratio, 2.19; 95% confidence intervals, 1.03 to 4.67), taking prescription diet-pills (odds ratio, 2.37; 95% confidence intervals, 1.47 to 3.82), and taking nonprescription diet-pills (odds ratio, 3.46; 95% confidence intervals, 1.71 to 6.98), and were less likely to attempt eating less food or modifying dietary patterns (odds ratio, 0.71; 95% confidence intervals, 0.51 to 0.99) compared to non-smokers. CONCLUSION: Korean adult women's smoking is independently related to a high likelihood of using weight control methods with potentially harmful effects, such as fasting and taking diet-pills, and a low likelihood of choosing weight control methods, including dietary modification, that require constant effort for a prolonged time.

Development of a Smartphone Application Prototype for Child Obesity Prevention: Rationale and Study Design of Acceptability and Feasibility Tests

BACKGROUND: There have been many efforts to rectify lifestyles that contribute to obesity using a variety of methodologies in heterogeneous settings, but effective and sustainable interventions that are suitable for children are still needed. We developed a smartphone application called "HAPPY ME" for guiding health behavior decisions, which employs gamification and self-monitoring strategies. The aim of this paper is to outline the rationale and methods for the development and feasibility test of "HAPPY ME". METHODS: The study consisted of two phases: 1) description of theory-based conceptual framework and rationales for smartphone application development and 2) outline of a pre- and post-test design in 4th-6th grade of healthy elementary school students for 4 weeks. The students will be delivered missions or messages on a daily basis, which is to stretch the knowledge and skills for action. They will simultaneously be engaged in self-monitoring their eating and physical activities to clear daily quests. To measure acceptability and feasibility we will monitor usability, compliance, and satisfaction for a 4-week study period and evaluate the intervention effects on self-efficacy, readiness, and intention to engage in healthy behavior. CONCLUSIONS: The results of the feasibility study will show whether the smartphone application "HAPPY ME" for children is acceptable, as well as if it is usable and feasible for self-directed health management. The results will provide preliminary evidence of the effectiveness of smartphone application-supported child behavioral modification for child obesity prevention and management.

Clinical Characteristics and Metabolic Health Status of Obese Korean Children and Adolescents / 가정의학회지

BACKGROUND: This study aimed to determine the prevalence of metabolically healthy and unhealthy obesity (MHO and MUO, respectively) and examine the demographic, anthropometric, and lifestyle predictors of metabolic health status in Korean children and adolescents. METHODS: This study was based on data collected from the Korean Children-Adolescent Study in 2010. A total of 1,700 children (846 boys and 854 girls) were included in the primary cohort and classified into metabolically healthy and unhealthy groups according to factors related to the metabolic syndrome. Demographic and biochemical features were evaluated in study participants. Logistic regression estimated the odds ratios of having more fat mass among MUO compared with MHO children after adjusting for confounding factors. RESULTS: Mean body mass index was higher in the MUO group than in the MHO group (24.83 vs. 23.02 kg/m2, respectively). The proportion of obese participants was also higher in the MUO group (59.4%) than in the MHO group (20.7%). MHO children were more likely to have parents with better socioeconomic status and a higher fruit and vegetable intake compared with MUO children. Higher fat mass and percent fat was associated with MUO according to multiple logistic regression analysis. CONCLUSION: Fat mass and percent fat are associated with metabolically healthy phenotypes of obesity among children and adolescents.

2014 Clinical Practice Guidelines for Overweight and Obesity in Korea

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index > or =25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.