2017 obesity fact sheet - kosso.or.kr · 2017-10-10 · definition of obesity, abdominal obesity,...

2017ObesityFact Sheet

Welcome message

Dear Colleagues,

It is my great honor and pleasure to publish the ‘2017 Obesity Fact Sheet’

of the Korean Society for the Study of Obesity (KSSO).

The ‘2017 Obesity Fact Sheet’ is the 3rd edition, with the 1st Edition

published in 2015. It contains many contemporary aspects of obesity and

its related comorbidities in Koreans. Representative data sources provided

valuable information from the Korean National Health and Nutrition

Examination Survey (KNHANES) and from the National Health Insurance

Service (NHIS).

Data pertaining to over 10 million Korean adults were meticulously analyzed

and described, providing excellent information regarding the health status

of Koreans. We have designed this Fact Sheet to provide useful information

to both public and health care providers.

We encourage you to take this booklet to improve your knowledge and

clinical practice for Koreans. Additional information is anticipated in next

year’s Fact Sheet and we hope it will be of assistance to doctors, nurses,

nutritionists, physical educators, other health professionals, and to the

general public.

We would like to cordially thank Dr. Kyung-do Han, Prof. Yong-Gyu Park

and the team of statisticians who dedicated their knowledge, expertise

and time to assist in the publication of this booklet. We especially President of KSSO Kee-Hyoung Lee

Chairman, Board of Directors

Soon Jib Yoo

thank members of the NHIS for their active support of our work. This

booklet resulted from efforts of the NHIS-KSSO MOU Committee who

worked collectively and tirelessly to produce this booklet. I would like to

express my sincere appreciation to the Director of the NHIS-KSSO MOU

Committee, Won-Young Lee, and to the co-Director, Yang-Hyun Kim, for

their unwavering dedication and kindness.

I hope this booklet may be of assistance to health care providers and

general public. It is our intention that the information it provides be applied

to the promotion of Korean health. Obesity is an important cause of major

chronic metabolic diseases and cancers. Not only is KSSO an academic

organization but it has a role in policy-making, aiming to protect the health

of the general population. We hope this Fact Sheet provides a valuable

contribution to Korean national health policy formulation.

Best Regards,

2017Obesity Fact Sheet

Summary of 2017 Obesity Fact Sheet

• The prevalence of obesity and abdominal obesity increased since 2009

• The prevalence of obesity with abdominal obesity also increased especially in 20s, 30s, and 40s.

• As the socioeconomic status increased, the prevalence of obesity increased in men and the

prevalence of both obesity and abdominal obesity decreased in women.

• The one-person household had increased risk for obesity and abdominal obesity than more than

one-person households especially in young male adults (19-39 years).

• The incidence of type 2 diabetes mellitus, hypertension and dyslipidemia gradually increased as

the body mass index (BMI) and waist circumference increased, and even in subjects with more

than BMI 35 kg/m2

• The hazard ratio for myocardial infarction and ischemic stroke was higher in obesity stage I and

stage II than normal weight.

• The prevalence of irregular menstruation was higher in obese women than non-obese women in

all age groups.

• BMI was strongly associated with increased incidence of breast cancer among postmenopausal

women, whereas it was inversely associated with incidence of breast cancer among

premenopausal women.

• Maternal complications, such as eclampsia, and high-risk pregnancies, increased as the BMI of

women increased.

Source of data

• The percentages and the total number of people over the age of 20 were determined using the

National Health Checkup Database from 2006 through to 2015 and derived from the National

Health Insurance Service (NHIS).

• Korean National Health and Nutrition Examination Survey (KNHANES) data 2010-2015 from the

Korea Centers for Disease Control & Prevention were also used to analyze the prevalence of

women’s health and obesity-related socioeconomic status.

• People over the age of 20 were included.

Data presentation

• Data were presented according to age and sex standardization, using the 2010 Census of the

Korean population.

• Obesity Prevalence= [(Patients who were obese, based on a body mass index of ≥ 25 kg/m2) /

(total number of individuals from the National Health Checkup)] X 100 (%).

• Regarding socioeconomic variables, the level of education were divided into four groups:

elementary school, middle school, high school, and university or higher. Income levels were

divided into quartiles, ranging from Quartile 1 (the lowest) to Quartile 4 (the highest).

Data source of 2017 Obesity Fact Sheet


Definition of Obesity, Abdominal obesity, Class I and Class II obesity • Obesity was defined as a body mass index (BMI, weight in kilograms divided by the square of height in meters) ≥ 25.0 kg/m2 in

adults, in accordance with the Asia-Pacific criteria of the WHO guidelines (WHO, 2000). • Abdominal obesity was defined as a waist circumference (WC) ≥ 90 cm in men and ≥ 85 cm in women, according to the definition

of the KSSO.• Class I obesity was defined as 25 ≤ BMI < 30 kg/m2 and Class II obesity was defined as a BMI ≥ 30.0 kg/m2.

01 Obesity trend


The prevalence of obesity and abdominal obesity The prevalence of obesity steadily increased from 29.7% in 2009 to 32.4% in 2015 and the prevalence of abdominal obesity also steadily increased from 18.4% in 2009 to 20.8% in 2015.

Data derived from the NHIS data set: 2009-2015Data was presented by age and sex standardization using the 2010 Census Korean population.The definition of obesity is a BMI ≥ 25kg/m2 and that of abdominal obesity is a WC ≥ 90cm in men and ≥ 85cm in women.

50

40

30

20

102009 2010 2011 2012 2013 2014 2015

(%)

35.6

29.7

23.9 23.3 23.7 23.4 23.7 23.7 24.5

29.7 30.2 30.2 30.6 31.132.4

36.3 37.0

40.7

37.938.8

37.3

Total Men Women Total Men Women

Obesity

30

25

20

15

10

(%)

2009 2010 2011 2012 2013 2014 2015

20.6 20.821.3 21.4

22.222.8

24.6

18.4

16.3 15.8 16.0 15.916.4 16.4

17.318.2 18.6 18.6

Abdominal Obesity

19.3 19.6

20.8

17.5

16.5

25

20

15

10

5

(%)

The prevalence of obesity with abdominal obesity The prevalence of obesity with abdominal obesity increased steadily from 15.1% in 2009 to 17.7% in 2015, and this phenomenon was especially observed in individuals in their second, third and fourth decades.

Data derived from the NHIS data set: 2009-2015Data was presented by age and sex standardization using the 2010 Census Korean population.

Total Men Women

2009 2010 2011 2012 2013 2014 2015 2009 2010 2011 2012 2013 2014 2015

17.7

15.1

12.7 12.3 12.6 12.5 13.0 13.013.7

15.1 15.6 15.516.2

17.718.018.6 18.6

19.5

21.9

20.2

Obesity with abdominal obesity Obesity with abdominal obesity30

25

20

15

10

5

(%)

17.717.9

23.9

23.7

18.6

14.4

14.2

8.0

14.314.9 15.1

15.7 16.2

18.2

14.1

15.5 15.3 17.1 17.3

18.7

23.8

24.1 24.1 24.0 24.0 24.625.7

23.3 22.9 22.8 22.923.8

17.818.9

20.519.0

18.2

17.818.017.1

8.28.9 9.0

10.010.6

11.5

16.917.8

20s 30s 40s 50s 60s 70s 80s

Age group

The prevalence of obesity, by age group, between 2014 and 2015• The prevalence of obesity increased steadily among those aged between 20 and 60 years, but decreased from 70 years of age, in total. • In men, the prevalence increased until 30–40 years of age, but decreased from 40–50 years of age. • In women, the prevalence increased to the mid-70 years of age, and decreased from the mid-70 years of age.

Data derived from the NHIS data set: 2014-2015Data was presented by age and sex standardization using the 2010 Census Korean population.The definition of obesity is a BMI ≥ 25kg/m2.

Obesity50

40

30

20

10

0

(%)

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80- (years)

26.8

18.7

24.2

32.635.7

32.9 34.5 34.3 35.938.1

38.5 37.3

33.9

26.729.6

38.241.040.3

37.731.9

28.225.3

21.217.3

14.411.112.4

35.5

43.145.3 44.4 43.2

41.0 39.9 38.6

36.532.8

28.522.4

Total Men Women

The prevalence of abdominal obesity, by age group, between 2014 and 2015• The prevalence of abdominal obesity increased steadily from 20–30 years of age to 70–80 years of age, but decreased from 80–90 years of

age, in total. • Before 60–70 years of age, the prevalence of abdominal obesity was higher in men than in women, but after 60–70 years of age, the

prevalence of abdominal obesity in women was higher than in men.

Data derived from the NHIS data set: 2014-2015Data was presented by age and sex standardization using the 2010 Census Korean population.The definition of abdominal obesity is a WC ≥ 90cm in men and ≥ 85cm in women.

12.1

6.26.3

9.210.5 11.9

13.616.8

21.5

28.4

33.4

37.639.1

35.3

31.634.733.931.3

28.1

23.720.418.918.3

20.118.6

12.7

8.8

18.3

24.0 25.1 24.5 24.0 24.425.9

27.729.1 29.5 29.1

26.1

45

40

35

30

25

20

15

10

5

0

(%)Abdominal Obesity

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80- (years)

Total Men Women

02 Obesity and socioeconomic status


Obesity and socioeconomic status• In men, as education and income levels increased, the prevalence of obesity increased. However, no similar trend was found in abdominal

obesity.• In women, as education and income level increased, both the prevalence of obesity and abdominal obesity decreased.

Data derived from the KNHANES 6th data set: 2013-2015

0 0

45 45(%) (%)

25 25

35 35

15 15

40 40

20 20

30 30

10 10

5 5

Obesity and education level Obesity and income level

elementary:≤ 6 Q1middle:7-9 Q2high:10-12 Q3university:>13 Q4

40.7

36.0

27.9

25.4

18.4

35.5

23.3

14.6

27.0 27.9 25.4

26.7

22.925.1

24.526.2

31.7

35.1

22.0

17.1

12.7

34.3

36.9

40.0

38.1

30.9

36.7 41.7

37.4

27.9

15.7

9.8

Obesity Abdominal obesity


Men

Women

The prevalence of obesity and abdominal obesity in one-person household versus more than one-person householdsIn both men and women, the prevalence of obesity and abdominal obesity was higher in one-person household than in more than one-person households, and this trend was more prominent among women.


0 0

1010

20

20

30

3040

4050(%) (%)

Men (total) Women (total)

Obesity ObesityAbdominal obesity Abdominal obesity

39.5

29.5

33.732.2

37.6

24.9

25.4

19.1

More than one-person householdsOne-person household More than one-person householdsOne-person household

The prevalence of obesity and abdominal obesity in one-person household versus more than one-person households, among the young adult group (aged 19-39 years)• In men, the prevalence of obesity and abdominal obesity was higher in one-person households than in more than one-person households.• In women, however, the prevalence of obesity and abdominal obesity was lower in one-person households than in more than one-person

households.


0 0

105

20

10

30

1540

2050

Men Women

Obesity ObesityAbdominal obesity Abdominal obesity

44.5

31.9

6.9

15.9

21.2

16.7

11.9

(%) (%)

More than one-person householdsOne-person householdMore than one-person householdsOne-person household

37.6

03 Obesity and comorbidities


The definition of T2DM, hypertension, dyslipidemia, MI, and ischemic stroke

T2DM, Type 2 diabetes mellitus; MI, myocardial infarction; CT, computed tomography, and MRI, magnetic resonance imaging

Hypertension

1) ICD-code: I10~13, and I15 &2) Hypertension medication- Mean F/U duration: 5.2 years

T2DM 1) ICD-code: E11~14 &2) T2DM medication- Mean F/U duration: 5.3 years

Dyslipidemia 1) ICD-code: E78 &2) Dyslipidemia medication- Mean F/U duration: 5.0 years

MI

1) ICD-code: I21,22 &2) Events-related hospitalization- Mean F/U duration: 5.4 years

Ischemic Stroke

1) ICD-code: I63,64 &2) Events-related hospitalization &3) Claim for CT or MRI - Mean F/U duration: 5.4 years

60.0

50.0

40.0

30.0

20.0

10.0

0.0

(per 1,000)

The incidence rate of T2DM, hypertension and dyslipidemia, according to BMI level 2009–2015• Incident T2DM, hypertension and dyslipidemia

increased gradually from the lowest level of BMI. • Even in individuals with a BMI more than 35 kg/m2,

the incidence of morbidity still increased.• Individuals who did health checkup during 2009-

2012 were included and followed up to 2015.

Data derived from the NHIS data set: 2009-2015

5.1

1.9

1.6

5.1

1.5

5.4

9.7

1.6

6.0

11.6

1.9

14.3

2.8

9.1

20.4

2.2

<17 17 18 19 20 21 22

T2DM Hypertension Dyslipidemia

7.3 8.

2

17.3

6.8 7.9

3.5

10.5

23.3

4.3

11.3

26.0

5.2

13.7

6.3

15.6

31.0 33

.50

8.8

19.7

35.9

10.6

22.2

12.4

24.9

41.0

14.2

42.3

30.5

44.0

19.1

33.1

21.4

48.6

23.9

50.3

41.0

51.4

29.4

42.4

51.4

30.8

43.1

32.7

42.5

31.1

44.7

48.8

23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ≥40

Age, sex-adjusted rates by BMI per 1kg/m²

BMI (kg/m2)

28.5

7.6

17.5

38.3

27.3

16.5

46.5

36.7 38

.9

27.5

48.4

56.5

• Incident T2DM, hypertension and dyslipidemia increased gradually from the lowest level of WC.

• People who did health checkup during 2009-2012 were included and followed up to 2015.


0.0

T2DM

10.0

20.0

30.0

40.0

50.0

60.0

The incidence rate of T2DM, hypertension and dyslipidemia, according to WC 2009–2015

M<

65, W

<60

M<

70, W

<65

M<

75, W

<70

M<

80, W

<75

M<

85, W

<80

M<

90, W

<85

M<

95, W

<90

M<

100,

W<

95

M<

105,

W<

100

M<

110,

W<

105

M≥1

10, W

≥105

(per 1,000)

3.9 3.9 4.75.9

7.69.7

12.2

15.3

18.8

22.8

28.5

Hypertension Dyslipidemia

M<

65, W

<60

M<

65, W

<60

M<

70, W

<65

M<

70, W

<65

M<

75, W

<70

M<

75, W

<70

M<

80, W

<75

M<

80, W

<75

M<

85, W

<80

M<

85, W

<80

M<

90, W

<85

M<

90, W

<85

M<

95, W

<90

M<

95, W

<90

M<

100,

W<

95

M<

100,

W<

95

M<

105,

W<

100

M<

105,

W<

100

M<

110,

W<

105

M<

110,

W<

105

M≥1

10, W

≥105

M≥1

10, W

≥105

Age, sex-adjusted rates by BMI per 1kg/m²

10.4 9.5 10.112.5

15.9

19.8

23.5

27.2

30.834.0

36.6

11.013.1

16.3

20.3

25.1

30.6

36.7

42.9

56.4

38.4

49.0

The HR for T2DM, hypertension, dyslipidemia, MI, and ischemic stroke, according to combined BMI and WCHR for each morbidities was higher in individuals with abdominal obesity than individuals without abdominal obesity after adjustment with age and sex.

Age and sex were adjusted. People who did health checkup during 2009-2012 were included and followed up to 2015. HR, hazard ratio

No abdominal obesity Abdominal obesity

BMI (kg/m2)


T2DM 8

6

7

3

4

5

0

1

2

<18.5 18.5-23 23-25 25-30 ≥ 30

1.094

HR

0.762

1.665

2.499

4.807

1

1.778

2.434

3.638

7.170

No abdominal obesity Abdominal obesity

<18.5 18.5-23 23-25 25-30 ≥ 30

1

1.451

1.936

2.992

1.373

2.328

<18.5 18.5-23 23-25 25-30 ≥ 30

BMI (kg/m2)

0 0

11

2

23

4 3

DyslipidemiaHypertension

0.514

1.495

2.251

1

0.575

1.185

1.635

2.076

2.712

BMI (kg/m2)

HR HR

3.796

1.674

0.6811.009

<18.5 18.5-23 23-25 25-30 ≥ 30

BMI (kg/m2)

<18.5 18.5-23 23-25 25-30 ≥ 30

BMI (kg/m2)

0 0

0.6

0.3

1

1.2

0.9

2 1.5

MI Ischemic stroke

1.2031.004 1 1.015

1.238

1 1.05

1.603

1.666

1.719 1.3161.223 1.241

1.384 1.283

1.668

1.337

HR HR

1.439

1.0611.079

1.824

The HR for MI and ischemic stroke• The HR for incident MI was 24.6% higher in the class I obesity group and 64.4% higher in the class II obesity group than in the normal

weight group (BMI 18.5-25 kg/m2), after adjustment for age and sex, with a mean FU period of 5.4 years. • The HR for incident stroke was 15.2% higher in the class I obesity group and 41.2% higher in the class II obesity group than in the normal

weight group (BMI 18.5-25 kg/m2), after adjustment for age and sex, with a mean FU period of 5.4 years.

Age and sex were adjusted. People who did health checkup during 2009-2012 were included and followed up to 2015. Data derived from the NHIS data set: 2009-2015.

* Reference group

MI1.8 1.8

1.187

0.987 1.01.042

1.412

1.0

1.246

1.6441.6 1.6

1.4 1.4

1.2 1.2

1 1

0.8 0.8

0.6 0.6

0.4 0.4

0.2 0.2

<18.5 <18.518.5-23 18.5-2323-25 23-2525-30 25-30≥ 30 ≥ 30

0 0

Ischemic stroke

BMI (kg/m2) BMI (kg/m2)

HR HR

1.077* *1.152

04 Obesity and women


The prevalence of obesity and abdominal obesity in women, according to age group • The prevalence of obesity and abdominal obesity

in women increased, according to age group. • At the age of 50, the prevalence of abdominal

obesity was higher than the prevalence of obesity.


50(%)

40

30

20

10

0

20-24 25-29 30-34 35-39

12.4

6.2 6.3

9.210.5

11.1

14.4

17.3

40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80- (years)


11.9

13.6

16.8

21.5

28.4

33.437.6

39.1

35.3

21.2

25.3

28.2

31.9

37.7

40.3 41.0

38.2

29.6

<15 15-19 20-24 25-29 30-34 35-39 40-44 45-49

Irregular menstruation

The diagnosis of irregular menstruation in based on self-questionnaire.Data derived from the KNHANES 5th 2010-2012

35(%)

30

25

20

15

10

5

0

Non-obesity Obesity

Irregular menstruation by age

15.3

19.8

13.1

11.0

6.86.1

15.517.0

12.312.3

19.7

22.8

33.3

22.5

6.85.8

(years)

Prevalence of irregular menstruation was higher in the obesity group than in the non-obese group in all age groups.

BMI and breast cancer riskBMI was associated with increased incidence of breast cancer among postmenopausal women, whereas it was inversely associated with incidence of breast cancer among premenopausal women.

Menopausal status was determined at the age of 50 years, which as assumed to represent the usual age at menopause among Korean women.Breast cancer was definded as ICD-C50 and a registration for intractable and rare diseases.People who did health checkup during 2006-2012 were included and followed to 2015. Data derived from the NHIS data set: 2006-2015

* Reference group

0.6

0.8

1

1.2

1.4

Breast cancer

<18.5 18.5-23 23-25 25-30 ≥ 30

Premenopausal Postmenopausal

BMI (kg/m2)

HR

0.779

1

1.0691.152

1.325

0.9720.941

0.914

1

0.952

*

Prepregnancy weight and maternal complication

Age-adjusted dataEclampsia was defined as ICD O11, 14.0, 14.1, 14.9, 15.0, 15.1, 15.2, and 15.9.High risk pregnancies was defined as ICD-Z 35.8 and 35.9.The event within 280 before delivery was included during 2007-2015.Data derived from the NHIS data set: 2006-2015

The maternal complications such as eclampsia and high-risk pregnancies increased as the BMI of women increased.

* Reference group

Eclampsia High-risk pregnancies

8 2

6 1.5

4 1

2 0.5

0<18.5 <18.518.5-23 18.5-2323-25 23-2525-30 25-3030-35 30-35≥ 35 ≥ 35

0*

*

BMI (kg/m2) BMI (kg/m2)

HR HR

0.729

0.982 1 1.0491.130

1.307

1.597

11.513

2.341

4.035

7.054

2017 Obesity Fact Sheet Task Force Team

Director Won-Young Lee Sungkyunkwan University

Secretary Yang-Hyun Kim Korea University

Member

Hyuk-Sang Kwon The Catholic University of Korea

Se Eun Park Sungkyunkwan University

Mi Hae Seo Soonchunhyang University

Jang Won Son The Catholic University of Korea

Seung-Hyun Yoo National Health Insurance Service

Seong-Su Lee The Catholic University of Korea

Chan-Hee Jung Soonchunhyang University

Kyungdo Han The Catholic University of Korea

Byungduck Han Sahmyook Medical Center

Publisher Soon Jib Yoo, Chairman, Board of Directors

Editor Won-Young Lee, Director, Committee of NHIS MOU

Published by Korean Society for The Study of Obesity

Design Inkwon&Partners

Printed by Sejong C&P

www.kosso.or.kr/eng/

Korean Society for the Study of Obesity Board

President Kee-Hyoung Lee Korea University Pediatrics

Vice-presidentKwan-Woo Lee Ajou University Endocrinology

Kyu-Rae Lee Gachon University Family Medicine

Chairman, Board of Directors Soon Jib Yoo The Catholic University of Korea Endocrinology

Director, General Affairs Hyuk-Sang Kwon The Catholic University of Korea Endocrinology

Director, Committee of Scientific Affairs Cheol-Young Park Sungkyunkwan University Endocrinology

Director, Committee of Publication Soo Lim Seoul National University Endocrinology

Director, Committee of Training Sang Yeoup Lee Pusan National University Family Medicine

Director, Committee of Research Min-Seon Kim University of Ulsan Endocrinology

Director, Committee of Public Relation Jae-Heon Kang Inje University Family Medicine

Director, Committee of Education Sang Woo Oh Dongguk University Family Medicine

Director, Committee of Planning Sung Rae Kim The Catholic University of Korea Endocrinology

Director, Committee of Policy Dae Jung Kim Ajou University Endocrinology

Director, Committee of Finance Kiyoung Lee Gachon University Endocrinology

Director, Committee of International Liaison Kyoung Kon Kim Gachon University Family Medicine

Director, Committee of Health Insurance and Legislation Seon Mee Kim Korea University Family Medicine

Director, Committee of Metabolic Syndrome Kyung Mook Choi Korea University Endocrinology

Director, Committee of Clinical Guideline Sung Soo Kim Chungnam National University Family Medicine

Director, Committee of Food and Nutrition Eun Mi Kim Kangbuk Samsung Hospital Nutrition

Director, Committee of Behavior Therapy Hye Jung Shin National Medical Center Pediatrics

Director, Committee of Childhood and Adolescent Obesity Sochung Chung Konkuk University Pediatrics

Director, Committee of Bariatric Surgery Joo-Ho Lee Ewha Womans University Surgery

Director, Committee of Information Chong Hwa Kim Sejong Hospital Endocrinology

Director, Committee of External Cooperation Keun-Sang Yum The Catholic University of Korea Family Medicine

Director, Committee of Exercise Yun-A Shin Dankook University Sports Science

Director, Committee of Clinics Youn Hui Cho Cho's Clinic Internal Medicine

Director, Committee of NHIS MOU Won-Young Lee Sungkyunkwan University Endocrinology

Director, Committee of Audit Chang Beom Lee Hanyang University Endocrinology

Director Without PortfolioDoo-Man Kim Hallym University Endocrinology

SeungJoon Oh Kyung Hee University Endocrinology

This study was supported by a grant from the Korean Health Technology and Research and Development project, Ministry of Health and Welfare, Re public of Korea (HC16C2285)

2017 Obesity Fact Sheet www.kosso.or.kr/eng/

2017 obesity fact sheet - kosso.or.kr · 2017-10-10 · definition of obesity, abdominal obesity,...

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