Glycemic status, insulin resistance, and mortality from lung cancer among individuals with and without diabetes.

BACKGROUND: The effects of glycemic status and insulin resistance on lung cancer remain unclear. We investigated the associations between both glycemic status and insulin resistance, and lung cancer mortality, in a young and middle-aged population with and without diabetes. METHODS: This cohort study involved individuals who participated in routine health examinations. Lung cancer mortality was identified using national death records. Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% CIs for lung cancer mortality risk. RESULTS: Among 666,888 individuals (mean age 39.9 ± 10.9 years) followed for 8.3 years (interquartile range, 4.6-12.7), 602 lung cancer deaths occurred. Among individuals without diabetes, the multivariable-adjusted HRs (95% CI) for lung cancer mortality comparing hemoglobin A1c categories (5.7-5.9, 6.0-6.4, and ≥ 6.5% or 39-41, 42-46, and ≥ 48 mmol/mol, respectively) with the reference (< 5.7% or < 39 mmol/mol) were 1.39 (1.13-1.71), 1.72 (1.33-2.20), and 2.22 (1.56-3.17), respectively. Lung cancer mortality was associated with fasting blood glucose categories in a dose-response manner (P for trend = 0.001) and with previously diagnosed diabetes. Insulin resistance (HOMA-IR ≥ 2.5) in individuals without diabetes was also associated with lung cancer mortality (multivariable-adjusted HR, 1.41; 95% CI, 1.13-1.75). These associations remained after adjusting for changing status in glucose, hemoglobin A1c, insulin resistance, smoking status, and other confounders during follow-up as time-varying covariates. CONCLUSIONS: Glycemic status within both diabetes and prediabetes ranges and insulin resistance were independently associated with an increased risk of lung cancer mortality.

Analysis of public perception of national obesity management policy.

PURPOSE: This study aimed to provide essential data necessary for shaping future obesity policy directions and strengthening the effectiveness of such measures. METHODS: A literature review and expert meetings were conducted to identify policy objectives that should be included in the comprehensive national obesity management plan. Based on these objectives, a questionnaire was developed, and a survey was conducted nationwide through an online panel targeting citizens aged 15-69. RESULTS: When analyzing the appropriateness of promoting national obesity policies, 38.6% of respondents answered "not appropriate," while only 8.4% answered "appropriate." We also assessed the importance of the four key areas of the national obesity management policy, with 36.9% considering "improvement of lifestyle to prevent obesity" as the most important. Additionally, we analyzed the significance of specific tasks. "Strengthening child and adolescent obesity prevention and management," "enhancing group meal nutrition and hygiene," "strengthening the operation of community-based obesity and exercise clinics," and "advancing an integrated information platform for nutrition, dietary patterns, and physical activity" emerged as pivotal tasks within their respective areas. CONCLUSION: The primary tasks identified as top priorities by the public in this study regarding national obesity policy initiatives can be incorporated into future obesity management strategies. Our approach has the potential to enhance the efficacy of these policies by aligning future obesity policy trajectories with public demands and expectations.

Association between body fat and bone mineral density in Korean adults: a cohort study.

Although obesity was once considered protective against osteoporosis, various factors influence the relationship between fat and bone mineral density (BMD). To establish the importance of healthy body composition in decelerating declines in BMD, we conducted a study to compare the association between body fat composition and BMD in Korean adults. Using data collected from the Kangbuk Samsung Health Study from 2012 to 2019, this cohort study compared the incidence of decreased BMD among the following four groups: normal BMI and normal adiposity (NBMI-NA), normal BMI and high adiposity (NBMI-HA), overweight, and obesity. Decreased BMD was defined as a Z-score ≤ - 2.0 in premenopausal women and men < 50 years of age or a T-score < - 1.0 in postmenopausal women and men ≥ 50 years of age. Individuals who were diagnosed with osteoporosis or compression fracture after their second visit were categorized as having decreased BMD. The incidence rate of decreased BMD in the NBMI-NA group was 3.37, and that in the NBMI-HA group was 4.81, which was the highest among all groups. After adjusting for confounding factors, NBMI-HA led to a significantly greater risk of decreased BMD compared to NBMI-NA (HR 1.47; 95% CI 1.09-1.99). Even with a normal BMI, a high BFP was associated with an increased risk of decreased BMD. Therefore, healthy body composition management, not simply BMI, is important in preventing decreased BMD.

Association of Uncontrolled Hypertension or Diabetes Mellitus With Major Adverse Cardiovascular Events and Mortality in South Korea: Population-Based Cohort Study.

BACKGROUND: Managing hypertension (HT) and diabetes mellitus (DM) is crucial to preventing cardiovascular diseases. Few studies have investigated the incidence and risk of cardiovascular diseases or mortality in uncontrolled HT or DM in the Asian population. Epidemiological studies of cardiovascular disease should be conducted with continuous consideration of the changing disease risk profiles, lifestyles, and socioeconomic status over time. OBJECTIVE: We aimed to examine the association of uncontrolled HT or DM with the incidence of cardiovascular events or deaths from any cause. METHODS: This population-based retrospective study was conducted using data from the Korean National Health Insurance Service-National Health Screening Cohort, including patients aged 40-79 years who participated in national screening from 2002 to 2003 and were followed up until 2015. The health screening period from 2002 to 2013 was stratified into 6 index periods in 2-year cycles, and the follow-up period from 2004 to 2015 was stratified accordingly into 6 subsequent 2-year periods. The incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death from any cause were estimated according to HT or DM control status. Extended Cox models with time-dependent variables updated every 2 years, including sociodemographic characteristics, blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence, were used. RESULTS: Among the total cohort of 440,249 patients, 155,765 (35.38%) were in the uncontrolled HT or DM group. More than 60% of the patients with HT or DM who were prescribed medications did not achieve the target BP or FBG. The incidence of MACE was 10.8-15.5 and 9.6-13.3 per 1000 person-years in the uncontrolled DM and uncontrolled HT groups, respectively, and increased with age. In the uncontrolled HT and DM group, the incidence of MACE was high (15.2-17.5 per 1000 person-years) at a relatively young age and showed no age-related trend. Adjusted HR for MACE were 1.28 (95% CI 1.23-1.32) for the uncontrolled DM group, 1.32 (95% CI 1.29-1.35) for the uncontrolled HT group, and 1.54 (95% CI 1.47-1.60) for the uncontrolled HT and DM group. Adjusted HR for death from any cause were 1.05 (95% CI 1.01-1.10) for the uncontrolled DM group, 1.13 (95% CI 1.10-1.16) for the uncontrolled HT group, and 1.17 (95% CI 1.12-1.23) for the uncontrolled HT and DM group. CONCLUSIONS: This up-to-date evidence of cardiovascular epidemiology in South Korea serves as the basis for planning public health policies to prevent cardiovascular diseases. The high uncontrolled rates of HT or DM, regardless of medication prescription, have led us to suggest the need for a novel system for effective BP or glycemic control, such as a community-wide management program using mobile health technology.

The association between cotinine-measured smoking intensity and sleep quality.

INTRODUCTION: Cigarette smoking is suggested to be associated with sleep problems. This study evaluated the quantitative association between urinary cotinine-verified smoking intensity and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI). METHODS: This was a cross-sectional study of 189970 participants from the Kangbuk Samsung Health Study recruited between 2016 and 2018. Logistic regression analysis adjusted for covariates was performed to estimate the association between urinary cotinine levels assessed by quartiles and poor sleep quality, defined as global PSQI score >5. RESULTS: The odds ratios (OR) and 95% confidence intervals (CI) for poor sleep quality comparing the highest urinary cotinine quartile to non-smokers were: 1.23 (95% CI: 1.16-1.30) for overall, 1.19 (95% CI: 1.12-1.26) for males, and 1.55 (95% CI: 1.29-1.87) for females. Among self-reported never smokers, cotinineverified smokers had higher odds for decreased sleep quality compared to cotinineverified never smokers with OR of 1.26 (95% CI: 1.08-1.46). CONCLUSIONS: Elevated urinary cotinine levels were associated with poor sleep quality in relatively young and middle-aged South Korean adults. Higher odds for poor sleep quality among cotinine-verified smokers who self-reported as never smokers also demonstrate the value of quantitative measurement of urinary cotinine. Prospective studies are warranted to clarify the cause-effect relationship between smoking and sleep quality.

Fasting ketonuria is inversely associated with coronary artery calcification in non-diabetic individuals.

BACKGROUND AND AIMS: Increased levels of ketone bodies, an alternative fuel when glucose availability is low, may exert beneficial effects on cardiovascular disease (CVD) risk factors. Whether increased ketone bodies are associated with coronary artery calcium (CAC), a recognized and strong cardiovascular risk factor, remains unknown. We investigated the association of fasting ketonuria with CAC and its progression. METHODS: Cross-sectional and longitudinal studies were conducted in adults without diabetes or CVD. Subjects underwent routine health examinations including cardiac computed tomography estimations of CAC scores. Logistic regression models were performed to compute the odds ratios (ORs), 95% confidence intervals (CIs), for prevalent CAC scores >0 according to fasting ketonuria categories (0, 1, and ≥2). Linear mixed models with random intercepts and random slopes were used to estimate CAC progression. RESULTS: Of 144,346 subjects, 12.3% had CAC scores >0 at baseline. Overall, higher fasting ketonuria was associated with decreased prevalence of coronary calcification than no ketonuria. Multivariable-adjusted ORs (95% CIs) for prevalent CAC by comparing ketonuria categories 1 and ≥2 with no ketonuria, were 0.94 (0.84-1.06) and 0.82 (0.71-0.95), respectively. The associations did not differ according to clinically relevant subgroups. Ketonuria was associated with lower CAC progression over time; the multivariable adjusted ratio of progression rates comparing ketonuria ≥2 versus no ketonuria was 0.976 (0.965-0.995). CONCLUSIONS: We found an inverse association between fasting ketonuria and subclinical coronary atherosclerosis, in both prevalence and progression. The potentially protective role of increased ketone body formation in CVD requires further investigation.

Long or Irregular Menstrual Cycles and Risk of Prevalent and Incident Nonalcoholic Fatty Liver Disease.

CONTEXT: The association of menstrual cycle length and irregularity with the risk of non-alcoholic fatty liver disease (NAFLD) is unknown. OBJECTIVE: We examined this association in large cross-sectional and cohort studies. METHODS: The cross-sectional study included 72 092 women younger than 40 years who underwent routine health examinations; the longitudinal analysis included the subset of 51 118 women without NAFLD at baseline. Long or irregular cycles were defined as menstrual cycles of 40 days or longer or too irregular to estimate. Abdominal ultrasonography was performed to identify NAFLD. Multivariable Cox proportional hazard regression analyses were performed to estimate hazard ratios (HRs) and 95% CIs for incident NAFLD according to menstrual cycle regularity and length, with 26- to 30-day cycles as the reference. RESULTS: At baseline, 27.7% had long or irregular menstrual cycles and 7.1% had prevalent NAFLD. Long or irregular menstrual cycles were positively associated with prevalent NAFLD. During a median follow-up of 4.4 years, incident NAFLD occurred in 8.9% of women. After adjustment for age, body mass index, insulin resistance, and other confounders, the multivariable-adjusted HR for NAFLD comparing long or irregular menstrual cycles to the reference group was 1.22 (95% CI, 1.14-1.31); this association strengthened in the time-dependent analysis with an HR of 1.49 (95% CI, 1.38-1.60). CONCLUSION: Long or irregular menstrual cycles were associated with increased risk of both prevalent and incident NAFLD in young, premenopausal women. Women with long or irregular menstrual cycles may benefit from lifestyle modification advice to reduce the risk of NAFLD and associated cardiometabolic diseases.

Weight Change and the Development of Nonalcoholic Fatty Liver Disease in Metabolically Healthy Overweight Individuals.

INTRODUCTION: The study sought to investigate the effect of weight change on hepatic steatosis (HS) incidence with or without liver fibrosis in metabolically healthy overweight or obese individuals. METHODS: A cohort of 14,779 metabolically healthy men and women who were overweight or obese (body mass index ≥23 kg/m2) and free from HS and an intermediate or high probability of fibrosis at baseline were followed for a median of 5.2 years. Metabolic health was defined as freedom from the components of metabolic syndrome and a homeostatic model assessment of insulin resistance <2.5. Weight changes were calculated as differences from baseline at the next subsequent visit. The outcome was HS incidence, with or without liver fibrosis, as assessed by liver ultrasound and 2 noninvasive fibrosis scores. RESULTS: During 76,794.6 person-years of follow-up, 3539 cases of HS incidence were identified. The multivariable adjusted hazard ratios (95% confidence intervals) for HS incidence by weight change group, <-5.0%, -5.0%-1.0%, 1.0%-5.0%, and >5.0%, relative to the no weight change group (-0.9% to 0.9%) were 0.52 (0.44-0.60), 0.83 (0.75-0.92), 1.21 (1.10-1.33), and 1.51 (1.36-1.69), respectively. Clinically relevant weight loss of >5% was also associated with a lowered risk of HS with intermediate or high probability of advanced fibrosis. In mediation analyses, associations remained significant, although adjustment for metabolic risk factors was attenuating. DISCUSSION: Clinically relevant weight loss was associated with a reduced risk of developing nonalcoholic fatty liver disease with or without intermediate or high probability of advanced fibrosis in metabolically healthy overweight or obese individuals.

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.

Depression and increased risk of non-alcoholic fatty liver disease in individuals with obesity.

Abstract. AIMS: The longitudinal relationship between depression and the risk of non-alcoholic fatty liver disease is uncertain. We examined: (a) the association between depressive symptoms and incident hepatic steatosis (HS), both with and without liver fibrosis; and (b) the influence of obesity on this association. METHODS: A cohort of 142 005 Korean adults with neither HS nor excessive alcohol consumption at baseline were followed for up to 8.9 years. The validated Center for Epidemiologic Studies-Depression score (CES-D) was assessed at baseline, and subjects were categorised as non-depressed (a CES-D < 8, reference) or depression (CES-D ⩾ 16). HS was diagnosed by ultrasonography. Liver fibrosis was assessed by the fibrosis-4 index (FIB-4). Parametric proportional hazards models were used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS: During a median follow-up of 4.0 years, 27 810 people with incident HS and 134 with incident HS plus high FIB-4 were identified. Compared with the non-depressed category, the aHR (95% CIs) for incident HS was 1.24 (1.15-1.34) for CES-D ⩾ 16 among obese individuals, and 1.00 (0.95-1.05) for CES-D ⩾ 16 among non-obese individuals (p for interaction with obesity <0.001). The aHR (95% CIs) for developing HS plus high FIB-4 was 3.41 (1.33-8.74) for CES-D ⩾ 16 among obese individuals, and 1.22 (0.60-2.47) for CES-D ⩾ 16 among non-obese individuals (p for interaction = 0.201). CONCLUSIONS: Depression was associated with an increased risk of incident HS and HS plus high probability of advanced fibrosis, especially among obese individuals.

Patient motivation to lose weight: Importance of healthcare professional support, goals and self-efficacy.

BACKGROUND: People with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight. METHODS: PwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight. RESULTS: Data from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86-2.88]), comfort in talking to their HCP about weight (1.46 [1.24-1.72), agreement that it is easy to lose weight (1.73 [1.30-2.31]), and a goal of reducing risks from excess weight (1.45 [1.22-1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41-0.58]). PwO who reported being motivated to lose weight were more likely to exercise ≥5 times a week versus <1 time a week (2.77 [2.09-3.68]) than those who reported they were not motivated. CONCLUSIONS: Positive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management. CLINICAL TRIAL REGISTRATION: NCT03584191.

Low-level alcohol consumption and cancer mortality.

The effect of light-to-moderate alcohol consumption on cancer risk remains controversial. We examined the association between low-level alcohol consumption and cancer mortality. A cohort study included 331,984 Korean adults free of cancer at baseline who underwent a comprehensive health checkup examination. Participants were categorized into never drinkers, former drinkers, and current drinkers who were further divided into light, moderate, heavy, and very heavy drinkers. Vital status and cancer-related deaths were ascertained through links to national death records. During 1,633,906 person-years of follow-up (median 5.3 years interquartile range 3.8-6.2), 374 cancer-related deaths were identified (cancer-cause mortality rate of 23 per 105 person-years). When former and never drinkers were classified as non-drinkers, the light drinkers had a lowest risk of cancer mortality compared with non-drinkers and other current drinkers (J-shaped); however, with consideration of lifetime abstinence history, current drinking was positively associated with cancer mortality in a dose-dependent manner. When changes in alcohol drinking status and confounders during follow-up were updated as time-varying covariates and never drinkers were used as the reference, the multivariable-adjusted hazard ratios (HRs) (95% confidence intervals, CIs) for cancer mortality among current light, moderate, heavy, and very heavy drinkers were 1.58 (1.03-2.43), 2.28 (1.41-3.70), 2.34 (1.42-3.85), and 2.97 (1.80-4.90), respectively, and the highest risk of cancer mortality was observed in former drinkers, who had an HR (95% CI) of 3.86 (2.38-6.28). Alcohol consumption was significantly and positively associated with an increased risk of cancer mortality in a dose-dependent manner, beginning with light drinkers.

The 3Ds - Discussion, diagnosis and direction: Elements for effective obesity care by healthcare professionals.

BACKGROUND: The care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). METHODS: An online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. RESULTS: Data from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43-1.76] and 2.16 [1.94-2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39-1.69] and 1.15 [1.04-1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21-1.53]) and schedule follow-up appointments (1.21 [1.06-1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74-0.92]) or schedule follow-up appointments (0.69 [0.62-0.78]). CONCLUSION: Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. CLINICAL TRIAL REGISTRATION: NCT03584191.

Depressive symptoms and risk of liver-related mortality in individuals with hepatitis B virus infection: a cohort study.

The impact of depression on the risk of liver-related mortality in individuals with hepatitis B virus (HBV) infection remains unclear. We examined the association between depression, HBV infection, and liver-related mortality. A total of 342,998 Korean adults who underwent health examinations were followed for up to 7.8 years. Depressive symptoms were defined as a Center for Epidemiologic Studies-Depression score ≥ 16. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). During 1,836,508 person-years of follow-up, 74 liver-related deaths and 54 liver cancer deaths were identified (liver-related mortality rate of 4.0 per 105 person-years and liver cancer mortality rate of 2.9 per 105 person-years). Subjects with depressive symptoms had an increased risk of liver-related mortality with a corresponding multivariable aHR of 2.00 (95% CI 1.10-3.63) compared to those without depressive symptoms. This association was more evident in HBsAg-positive participants with a corresponding multivariable aHR of 4.22 (95% CI 1.81-9.88) than HBsAg-negative participants (P for interaction by HBsAg positivity = 0.036). A similar pattern was observed in relation to liver cancer mortality. In this large cohort, depressive symptoms were associated with an increased risk of liver-related mortality, with a stronger association in HBsAg-positive individuals.

Efficacy and Safety of Combined Extracts of Cornus officinalis and Ribes fasciculatum for Body Fat Reduction in Overweight Women.

Obesity is a medical condition that presents excessive fat accumulation with high risk of serious chronic diseases. The aim of this clinical trial is to investigate the anti-obesity effects of Cornus officinalis (CO) and Ribes fasciculatum (RF) on body fat reduction in Korean overweight women. A total of 147 overweight female participants enrolled in double-blinded clinical trial for 12 weeks and 76 participants completed the clinical study. Participants were treated with four CO and RF mixture (COEC; 400 mg per tablet) or four placebo tablets once a day. Obesity associated parameters (body weight, body mass index (BMI), waist circumference, waist-to-hip ratio, body fat percentage and body fat mass) and safety assessment were analyzed. After 12 weeks of COEC treatment, primary outcomes such as body fat percentage (0.76% vs. 0.01%; p = 0.022) and mass (1.1 kg vs. 0.5 kg; p = 0.049) were significantly decreased. In addition, the results were statistically significant between the COEC and placebo groups, strongly indicated that COEC had anti-obesity effects on overweight women. Secondary outcomes-including body weight, waist and hip circumference, waist-to-hip ratio, body mass index and computed tomography measurement of visceral fat area, subcutaneous fat area, total abdominal fat area and visceral-to-subcutaneous fat ratio-were reduced in COEC-treated group, but no statistical differences were found between the COEC and placebo groups. The safety assessment did not differ between the two groups. These results suggest that treatment of COEC extract reduces body fat percentage and mass in Korean overweight women, indicating it as a protective functional agent for obesity.

Perceptions, Attitudes, Behaviors, and Barriers to Effective Obesity Care in South Korea: Results from the ACTION-IO Study.

Background: The prevalence of obesity is increasing in South Korea. We aimed to identify the perceptions, attitudes, behaviors, and barriers to effective obesity care in South Korea. Methods: The Awareness, Care, and Treatment In Obesity maNagement-an International Observation (ACTION-IO) study was a cross-sectional survey conducted in 11 countries. Respondents were people with obesity (PwO; body mass index ≥25 kg/m2 in South Korea from self-reported height/weight) and healthcare professionals (HCPs) primarily involved in direct care with PwO. Results: The survey was completed by 1,500 PwO and 200 HCPs in South Korea. PwO (78%) and HCPs (81%) agreed that obesity is a chronic disease, but more PwO (84%) believed that obesity has an extreme impact on their overall health compared with HCPs (65%). Most PwO felt completely responsible for their own weight loss (81%), and 78% reported at least one serious weight loss attempt in the past. In contrast, HCPs reported that, on average, only 35% of their patients with obesity had made a serious attempt at losing weight. Only 31% of PwO had discussed weight with their HCP in the past 5 years; of those, 78% appreciated that HCPs initiated these conversations. Short appointment times restricted weight loss discussions for 70% of HCPs, and 29% of HCPs expressed complete comfort with such conversations. Conclusion: South Korean PwO are motivated to lose weight and have expressed interest in HCPs being more active in their weight management. Further nationwide efforts may be required to lower the barriers to education about obesity and effective weight loss discussion and management.

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.

Corrigendum: 2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea.

[This corrects the article on p. 40 in vol. 28, PMID: 31089578.].

2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea.

Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m2. Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m2 and for Korean patients with BMI ≥30 kg/m2 who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.