Korean Journal of Health Promotion

Jung and Cho: Diagnosis of Severe Obesity in Korean Children and Adolescents

Original Article

Published online: January 20, 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.3.174

Diagnosis of Severe Obesity in Korean Children and Adolescents

¹Institute for Clinical Nutrition, Inje University, Seoul, Korea

²Department 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

Received June 09, 2016 Accepted August 28, 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.

ABSTRACT

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.

Key words: Child; Adolescent; Obesity; Body mass index; Prevalence

Figure 1.

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

Table 1.

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

Age	BMI cut-offs 1^a		BMI cut-offs 2^b
Age	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.

^a120% of 95th BMI percentile or a BMI of 30 kg/m

²whichever is lower.

^b99th BMI percentile.

^cValues in parentheses are 120% of 95th BMI percentile.

Table 2.

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 1^a	1.2 (0.3)	1.9 (0.4)	1.4 (0.2)	1.6 (0.3)	0.681
BMI criteria 2^b	1.0 (0.2)	1.2 (0.3)	1.3 (0.2)	1.4 (0.2)	0.417
PWH criteria^c	0.8 (0.2)	0.6 (0.2)	0.9 (0.2)	0.9 (0.2)	0.629
Boys
BMI criteria 1^a	1.9 (0.5)	2.3 (0.7)	1.9 (0.4)	1.9 (0.4)	0.625
BMI criteria 2^b	1.3 (0.4)	0.7 (0.4)	1.3 (0.3)	1.1 (0.3)	0.691
PWH criteria^c	1.2 (0.4)	0.5 (0.2)	1.1 (0.3)	0.9 (0.3)	0.570
Girls
BMI criteria 1^a	0.4 (0.2)	1.4 (0.5)	0.9 (0.2)	1.2 (0.3)	0.143
BMI criteria 2^b	0.8 (0.3)	1.8 (0.6)	1.3 (0.3)	1.8 (0.4)	0.127
PWH criteria^c	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.

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

²whichever is lower.

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

²whichever is lower to <99th percentile, Severe obesity: ≥99th percentile.

^cPWH≥150%.

Table 3.

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

Age	BMI cut-offs^a
Age	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.

^a140% of 95th BMI percentile or a BMI of 35 kg/m

²whichever is lower.

^bValues in parentheses are 140% of 95th BMI percentile.

REFERENCES

REFERENCES: References

1. Bahk J, Khang YH. Trends in measures of childhood obesity in Korea from 1998 to 2012. J Epidemiol 2016;26(4):199-207.
[Article] [PubMed] [PMC]

2. 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..

3. Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med 2015;373(14):1307-17.
[Article] [PubMed]

4. Barlow SE. Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):S164-92.
[Article] [PubMed]

5. Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013;128(15):1689-712.
[Article] [PubMed]

6. 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..

7. International Obesity Task Force. The Asia-Pacific perspective: redefinining obesity and its treatment. Sydney: Health Communications Australia Pty Ltd; 2000.

8. 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 2009;90(5):1314-20.
[Article] [PubMed]

9. Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012. JAMA Pediatr 2014;168(6):561-6.
[Article] [PubMed]

10. 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 2016;12(1):12-9.
[Article] [PubMed]

11. Chung S. Management of severe obesity in children and adolescents. J Korean Soc Pediatr Endocrinol 2010;15(2):85-92.

12. Cole TJ, Lobstein T. Extended international (IOTF) body mass index cutoffs for thinness, overweight and obesity. Pediatr Obes 2012;7(4):284-94.
[PubMed]

13. Seo JY, Cho YG, Kang JH, Hur YI, Park HA, Kim KW, et al. New diagnostic criteria for obesity and overweight in Korean children and adolescents using 2007 Korean National Growth Charts. Obes Res Clin Pract 2013;7(3):e182-9.
[Article] [PubMed]

14. Oh SW. Diagnostic criteria for childhood obesity. Korean J Obes 2008;17(4):188-90.

Diagnosis of Severe Obesity in Korean Children and Adolescents

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Table 1.

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Table 3.

References