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
2017Obesity 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
2017Obesity Fact Sheet
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
2017Obesity Fact Sheet
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
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.
Data derived from the KNHANES 6th data set: 2013-2015
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.
Data derived from the KNHANES 6th data set: 2013-2015
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
2017Obesity Fact Sheet
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.
Data derived from the NHIS data set: 2009-2015
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)
Data derived from the NHIS data set: 2009-2015
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
2017Obesity Fact Sheet
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.
Data derived from the NHIS data set: 2014-2015
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)
Obesity Abdominal obesity
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/