kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.3.174 kjhp-16-174 Original Article Diagnosis of Severe Obesity in Korean Children and Adolescents JungJi-Hye 1 ChoYoung-Gyu 2 Institute for Clinical Nutrition, Inje University, Seoul, Korea Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea Corresponding author: Young-Gyu Cho, MD Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea Tel: +82-2-2272-0908, Fax: +82-2-2268-0971 E-mail: jacobel@hanmail.net 01 2016 20 01 2016 16 3 174 179 09062016 28082016 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Backgroud

Although the obesity prevalence in Korean children and adolescents has stabilized since early 2000s, it is noted that severe obesity is increasing. However, no diagnostic criteria to define severe obesity in Korean children and adolescents has not been recommended yet.

 Methods

We established two kinds of diagnostic criteria of severe obesity with the 2007 Korean National Growth Charts; 1) body mass index (BMI) criteria 1: BMI≥120% of 95th percentile or 30 kg/m2, whichever is lower, 2) BMI criteria 2: ≥99th percentile. We examined the prevalence of severe obesity among children and adolescents who participated in the Fifth Korea National Health and Nutrition Examination Survey, 2010–2012 based on BMI criteria 1 and 2 as well as percentage-weight-for-height (PWH).

 Results

We presented the age- and sex-specific BMI cut-offs of BMI criteria 1 and 2. The prevalence of severe obesity was 1.6% and 1.7% based on BMI criteria 1 and 2, respectively. The prevalence of severe obesity based on PWH was 0.8%, which was lower than the prevalences based on BMI criteria 1 and 2.

 Conclusions

Our diagnostic criteria of severe obesity can be utilized in the epidemiological surveys and researches before the recommendation of the formal diagnostic criteria.

 Child Adolescent Obesity Body mass index Prevalence References Bahk J Khang YH Trends in measures of childhood obesity in Korea from 1998 to 2012 J Epidemiol 201626 4 199207 Ministry of Education The results of school health examinatio n sample survey [Internet] Sejong Ministry of Education 2016 [Accessed April 15, 2016]. Available from: http://www.moe.go.kr/web/100026/ko/board/view.do?bbsId=294&pageSize= 10&currentPage=3&encodeYn=Y&boardSeq=62361&mode= view. Skinner AC Perrin EM Moss LA Skelton JA Cardiometabolic risks and severity of obesity in children and young adults N Engl J Med 2015373 14 130717 Barlow SE Expert Committee Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report Pediatrics 2007120 Suppl 4 S16492 Kelly AS Barlow SE Rao G Inge TH Hayman LL Steinberger J Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association Circulation 2013128 15 1689712 Centers for Disease Control and Prevention 2007 Korean children and adolescents national growth chart: commentary [Internet] Cheongju Centers for Disease Control and Prevention 2007 [Accessed April 15, 2016]. Available from: http://www.cdc.go.kr/CDC/notice/CdcKrInfo0201.jsp?menuIds=HOME0 01-MNU1154-MNU0004-MNU1889&cid=1235. International Obesity Task Force The Asia-Pacific perspective: redefinining obesity and its treatment Sydney Health Communications Australia Pty Ltd 2000 Flegal KM Wei R Ogden CL Freedman DS Johnson CL Curtin LR Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts Am J Clin Nutr 200990 5 131420 Skinner AC Skelton JA Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012 JAMA Pediatr 2014168 6 5616 Li L Pérez A Wu LT Ranjit N Brown HS Kelder SH Cardiometabolic risk factors among severely obese children and adolescents in the United States, 1999–2012 Child Obes 201612 1 129 Chung S Management of severe obesity in children and adolescents J Korean Soc Pediatr Endocrinol 201015 2 8592 Cole TJ Lobstein T Extended international (IOTF) body mass index cutoffs for thinness, overweight and obesity Pediatr Obes 20127 4 28494 Seo JY Cho YG Kang JH Hur YI Park HA Kim KW New diagnostic criteria for obesity and overweight in Korean children and adolescents using 2007 Korean National Growth Charts Obes Res Clin Pract 20137 3 e1829 Oh SW Diagnostic criteria for childhood obesity Korean J Obes 200817 4 18890 Figures and Tables

The proportion of mild, moderate and severe obesity in Korean children and adolescents according to three set of different diagnostic criteria.

Age- and sex-specific BMI cut-offs to define severe obesity in Korean children and adolescents

Age BMI cut-offs 1a BMI cut-offs 2b
Boys Girls Boys Girls
2 22.98 22.73 20.18 20.15
2.5 22.41 22.18 19.78 19.68
3 22.08 21.83 19.67 19.43
3.5 21.95 21.65 19.82 19.39
4 22.00 21.64 20.18 19.52
4.5 22.20 21.76 20.67 19.78
5 22.53 21.99 21.24 20.16
5.5 22.97 22.33 21.86 20.63
6 23.50 22.75 22.51 21.17
6.5 24.11 23.23 23.20 21.76
7 25.12 24.06 24.29 22.70
8 26.55 25.27 25.78 24.01
9 28.01 26.51 27.25 25.31
10 29.38 27.70 28.62 26.50
11 30.00 (30.60)c 28.79 29.81 27.54
12 30.00 (31.63)c 29.72 30.79 28.37
13 30.00 (32.42)c 30.00 (30.46)c 31.52 28.99
14 30.00 (32.98)c 30.00 (31.00)c 31.99 29.37
15 30.00 (33.32)c 30.00 (31.34)c 32.23 29.54
16 30.00 (33.46)c 30.00 (31.49)c 32.24 29.54
17 30.00 (33.47)c 30.00 (31.49)c 32.08 29.42
18 30.00 (33.41)c 30.00 (31.39)c 31.80 29.26

Abbreviation: BMI, body mass index.

120% of 95th BMI percentile or a BMI of 30 kg/m

whichever is lower.

99th BMI percentile.

Values in parentheses are 120% of 95th BMI percentile.

Trends in age-standardized prevalence (standard error) of severe obesity in Korean children and adolescents aged 7–18 years

  2001 2005 2007–2009 2010–2012 P for trend
Total          
BMI criteria 1a 1.2 (0.3) 1.9 (0.4) 1.4 (0.2) 1.6 (0.3) 0.681
BMI criteria 2b 1.0 (0.2) 1.2 (0.3) 1.3 (0.2) 1.4 (0.2) 0.417
PWH criteriac 0.8 (0.2) 0.6 (0.2) 0.9 (0.2) 0.9 (0.2) 0.629
Boys          
BMI criteria 1a 1.9 (0.5) 2.3 (0.7) 1.9 (0.4) 1.9 (0.4) 0.625
BMI criteria 2b 1.3 (0.4) 0.7 (0.4) 1.3 (0.3) 1.1 (0.3) 0.691
PWH criteriac 1.2 (0.4) 0.5 (0.2) 1.1 (0.3) 0.9 (0.3) 0.570
Girls          
BMI criteria 1a 0.4 (0.2) 1.4 (0.5) 0.9 (0.2) 1.2 (0.3) 0.143
BMI criteria 2b 0.8 (0.3) 1.8 (0.6) 1.3 (0.3) 1.8 (0.4) 0.127
PWH criteriac 0.3 (0.2) 0.7 (0.3) 0.6 (0.2) 1.0 (0.3) 0.090

Abbreviations: BMI, body mass index; PWH, percentage-weight-for-height.

BMI≥120% of 95th percentile or 30 kg/m

whichever is lower.

Moderate obesity: BMI≥95th percentile or 25 kg/m

whichever is lower to <99th percentile, Severe obesity: ≥99th percentile.

PWH≥150%.

Age- and sex-specific BMI cut-offs to define very severe obesity in Korean children and adolescents

Age BMI cut-offsa
Boys Girls
2 26.81 26.52
2.5 26.14 25.87
3 25.76 25.46
3.5 25.61 25.26
4 25.67 25.24
4.5 25.90 25.38
5 26.29 25.66
5.5 26.80 26.05
6 27.42 26.54
6.5 28.13 27.11
7 29.30 28.07
8 30.98 29.48
9 32.67 30.92
10 34.28 32.32
11 35.00 (35.70)b 33.59
12 35.00 (36.90)b 34.67
13 35.00 (37.83)b 35.00 (35.54)b
14 35.00 (38.48)b 35.00 (36.17)b
15 35.00 (38.87)b 35.00 (36.56)b
16 35.00 (39.04)b 35.00 (36.74)b
17 35.00 (39.05)b 35.00 (36.74)b
18 35.00 (38.98)b 35.00 (36.62)b

Abbreviation: BMI, body mass index.

140% of 95th BMI percentile or a BMI of 35 kg/m

whichever is lower.

Values in parentheses are 140% of 95th BMI percentile.