Table 2.
Recommendations for the management of obesity
| Recommendation | Category of evidence and strength of recommendation | |
|---|---|---|
| Evaluation before obesity treatment | ||
| 1. | The definition for obesity in adults is BMI ≥ 25 kg/m2. Abdominal obesity is detected by measuring the waist circumference and is defined as ≥ 90 cm and ≥ 85 cm for adult men and women, respectively. | B, Class IIa |
| 2. | Obesity is classified into primary obesity, commonly known as simple obesity, and secondary obesity, which can be caused by genetics, endocrine diseases, and drugs. | B |
| 3. | Obesity increases the risk of type 2 diabetes, hypertension, dyslipidemia, coronary artery disease and metabolic syndrome, and increases total mortality, cancer mortality, and cardiovascular mortality. | A |
| 4. | It is recommended that treatment is determined through sufficient discussion between the patient and physician about the benefits and risks associated with weight loss. While recommending treatments for obesity to patients, doctors must ensure that patients are ready to participate in weight loss. | C, Class I |
| 5. | It is recommended to lose 5%–10% of body weight within 6 months after starting treatment as the primary goal of weight loss. | A, Class I |
| Nutrition therapy in obesity management | ||
| 6. | In order to lose weight, it is recommended that energy intake should be reduced, and the degree of energy restriction should be individualized according to individual characteristics and medical conditions. | A, Class I |
| 7. | Various dietary methods (low calorie diet, low carb diet, low fat diet, high protein diet) can be selected, but energy intake can be reduced, and nutritionally appropriate methods are recommended. | A, Class I |
| 8. | It is recommended to individualize the composition of macronutrients (carbohydrates, fats, proteins) according to individual characteristics and medical conditions. | C, Class I |
| 9. | Very-low calorie diet should be implemented only in limited circumstances, and intensive interventions are recommended to be carried out to improve lifestyles along with medical monitoring. | A, Class I |
| Physical activity in obesity management | ||
| 10. | It is recommended to assess participation in physical activity and conduct health status evaluation before physical activity. In patients with symptoms of cardiovascular, metabolic, or kidney disease, it is recommended to start physical activity after consulting the patient’s doctor. Otherwise, low to moderate intensity of physical activity is recommended initially. | A, Class I |
| 11. | For weight loss, it is recommended to perform aerobic exercise for at least 150 minutes per week or 3–5 times a week. Additional resistance training 2–4 times a week using large muscle groups should be considered to lose weight. | A, Class I A, Class IIa |
| 12. | Physical activity alone does not have a great effect on weight loss, so we recommend physical activity combined with nutrition therapy. | A, Class I |
| 13. | For weight loss, a combination of aerobic exercise and resistance exercise should be considered because it is more effective than aerobic exercise alone and resistance exercise alone. There is no significant difference between high-intensity exercise and moderate-intensity exercise in terms of weight loss effect. | A, Class IIa |
| Behavior therapy in obesity management | ||
| 14. | For weight loss, it is recommended to improve lifestyle through interventions such as reducing food intake and increasing physical activity. | A, Class I |
| 15. | For effective weight loss, it is recommended that a trained therapist performs behavior therapy for more than 6 months. | A, Class I |
| 16. | For effective weight maintenance, it is recommended that a trained therapist performs behavioral therapy for at least 1 year. | A, Class I |
| 17. | It is recommended that obese people be suspected to have eating disorders if they are observed with excessive weight or body type in self-assessment, various weight control behaviors to offset the effects of binge eating, or binge eating. | A, Class I |
| 18. | In the case of behavioral therapy for weight loss, smoking cessation counseling should be performed. | B, Class IIa |
| 19. | In the case of behavioral therapy for weight loss, we recommend alcohol counseling. | A, Class I |
| 20. | For the treatment of sleep apnea, it is recommended to lose weight through behavioral therapy. | A, Class I |
| Pharmacotherapy in obesity management | ||
| 21. | The basic treatments for obesity include nutrition therapy, physical activity, and behavior therapy, and we recommend pharmacotherapy as an additional treatment alongside comprehensive lifestyle intervention. | A, Class I |
| 22. | In cases of failure to lose weight through lifestyle intervention in patients with BMI ≥ 25 kg/m2, pharmacotherapy should be considered. | B, Class IIa |
| 23. | For long-term weight management, it is recommended that drugs approved based on the large-scaled clinical trials should be used. | B, Class I |
| 24. | It is recommended that the pharmacotherapy be changed or discontinued if weight loss is not greater than 5% within 3 months of pharmacotherapy. | A, Class I |
| Bariatric surgery | ||
| 25. | Bariatric surgery should be considered to maintain weight loss and for weight loss in patients with severe obesity and to improve accompanying diseases related to obesity, including type 2 diabetes. | A, Class IIa |
| 26. | Bariatric surgery should be considered in patients with failure to lose weight despite optimal medical and behavioral management in whom with BMI ≥ 35 kg/m2 or BMI ≥ 30 kg/m2 and obesity-related comorbidities. | B, Class IIa |
| 27. | Bariatric surgery should be considered in patients with type 2 diabetes with BMI ≥ 27.5 kg/m2 or poorly controlled blood glucose despite optimal medical management. | B, Class IIa |
| 28. | Sleeve gastrectomy, Roux-en-Y gastric bypass surgery, adjustable gastric band surgery, and biliopancreatic diversion surgery are standard procedures with established effectiveness and safety. | A, Class I |
| 29. | Before surgery, it is recommended to obtain past medical and psychosocial history and perform physical examination and diagnostic test to evaluate the safety of the surgery. | A, Class I |
| 30. | Preoperative micronutrient examination is required, and follow-up examination is recommended according to the schedule after the surgery | A, Class I |
| 31. | Multidisciplinary treatment should be considered before and after surgery to increase the treatment effectiveness and safety. | C, Class IIa |
| Obesity in children and adolescents | ||
| 32. | It is recommended to prevent and treat childhood and adolescent obesity because they often develop into adult obesity and can cause accompanying diseases. | A, Class I |
| 33. | Treatment for childhood and adolescent obesity is recommended to provide the energy and nutrients needed for normal growth and main- tain appropriate weight with proper lifestyle modifications. | A, Class I |
| 34. | When diagnosing obesity in children and adolescents over the age of 2, BMI percentiles by sex and age are based on the 2017 Child and Adolescent Growth Chart. BMI ≥ the 85th percentile is defined as pre-obesity, and ≥ the 95th percentile is defined as obesity. | A, Class I |
| 35. | Individualized risk assessment should be considered in children and adolescents with pre-obesity or obesity. | B, Class IIa |
| 36. | For the treatment of obesity in children and adolescents, comprehensive lifestyle interventions including nutrition therapy, physical activity, and behavior therapy are recommended. | A, Class I |
| 37. | When comprehensive lifestyle interventions including nutrition therapy, physical activity, and behavior therapy fail to result in appropriate weight loss and comorbidities are not controlled, pharmacotherapy by an experienced specialist should be considered. | B, Class IIa |
| Obesity in the elderly | ||
| 38. | For diagnosis of obesity in the elderly, it is recommended to evaluate waist circumference along with BMI. | A, Class I |
| 39. | Weight loss in the elderly should be considered when the benefits of weight loss are greater than the status. | B, Class IIa |
| 40. | In the treatment of obesity in the elderly, a protein-rich low-calorie diet and increased physical activity are recommended. | A, Class I |
| 41. | In the treatment of obesity in the elderly, pharmacotherapy and surgical treatment may be considered with regard to individual comorbidities, other medications, and safety | B, Class IIb |
| Metabolic syndrome | ||
| 42. | As the severity of obesity increases, the incidence of metabolic syndrome increases. | A |
| 43. | The clinical significance of metabolic syndrome can predict the occurrence of diabetes and cardiovascular disease, and increases morbidity and mortality caused by cardiovascular disease | A |
| 44. | Diagnosis of metabolic syndrome in adults in Korea requires ≥ 3 of the five following criteria: waist circumference ≥ 90 cm (men) or ≥ 85 cm (women), blood pressure ≥ 130/85 mmHg or taking anti-hypertensive medication, fasting blood glucose ≥ 100 mg/dL or taking anti-diabetic medication, triglycerides ≥ 150 mg/dL, HDL cholesterol < 40 mg/dL (men), or 50 mg/dL (women), or taking anti-dyslipidemia medication. | D |
| 45. | For the treatment of metabolic syndrome, lifestyle intervention and treatment of each component should be considered. | A, Class IIa |
BMI, body mass index; HDL, high-density lipoprotein.