Journal of Obesity & Metabolic Syndrome

Search

Article

March, 2024 | Vol.33 No.1

J Obes Metab Syndr 2024; 33(1): 1-10

Published online March 30, 2024 https://doi.org/10.7570/jomes23074

Copyright © Korean Society for the Study of Obesity.

Weight Management Health Note, a Mobile Health Platform for Obesity Management Developed by the Korean Society for the Study of Obesity

Yujung Lee1, Hyunji Sang1,2, Sunyoung Kim2,3, Doo Ah Choi4, Sang Youl Rhee1,2,* , on Behalf of the Committee of IT-Convergence Treatment of Metabolic Syndrome of the Korean Society for the Study of Obesity

1Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul; Departments of 2Endocrinology and Metabolism, 3Family Medicine, College of Medicine, Kyung Hee University, Seoul; 4Huray Positive, Inc., Seoul, Korea

Correspondence to:
Sang Youl Rhee
https://orcid.org/0000-0003-0119-5818
Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
Tel: +82-2-958-8200
Fax: +82-2-968-1848
E-mail: rheesy@khu.ac.kr

Received: October 27, 2023; Reviewed : December 18, 2023; Accepted: January 12, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Weight Management Health Note application, developed by the Korean Society for the Study of Obesity (KSSO), was designed to assist individuals in weight management and enhance overall well-being. The Committee of IT-Convergence Treatment of Metabolic Syndrome of the KSSO designed this application. Committee members reviewed and supervised the application’s underlying driving algorithms and scientific rationale. A healthcare-specific application developer subsequently finalized the application. This application encompasses a myriad of features, including a comprehensive food diary, an exercise tracker, and tailor-made lifestyle recommendations aligned with individual needs and aspirations. Moreover, it facilitates connections within a community of like-minded individuals endeavoring to manage their weight, fostering mutual support and motivation. Importantly, the application is rich in evidence-based health content curated by the KSSO, ensuring users access accurate information for effective obesity management. Looking ahead, the KSSO is committed to orchestrating diverse academic research endeavors linked to this application and refining its functionalities through continuous feedback from users. The KSSO aspires for this application to serve as a valuable resource for individuals striving to manage their health and enhance their quality of life.

Keywords: Obesity, Mobile applications, Telemedicine, Weight loss, Weight reduction programs, Healthcare, Korea

Information and communication technology (ICT)-based digital health is an important tool for addressing diverse medical challenges. Numerous attempts have been made to integrate digital health into medical fields. For example, in diabetes management, leveraging digital health has shown promise in pre-clinical and remote clinical trials.1 A digital approach can enhance patient education, advance blood glucose monitoring and adherence, and facilitate the assessment and management of complications, engaging healthcare professionals directly.1 Prior studies have underscored the potential advantages of digital health, exemplified by the positive impact and considerable satisfaction derived from using Diabetes Notepad, a mobile application designed for enhancing diabetes self-care.2

Moreover, amid heightened health awareness due to the coronavirus disease-2019 (COVID-19) pandemic, there has been a surge in efforts to incorporate ICT-based technologies into healthcare functions.3 South Korea’s remarkable surge in medical application downloads during the pandemic highlights its steadfast commitment to integrating digital health into everyday medical practices.4

According to the Obesity Statistics by the Numbers (2023) publication of the Korean Society for the Study of Obesity (KSSO), the prevalence of obesity in Korea has risen persistently over the past decade, particularly the number of individuals classified as obese class 2 and 3. In 2021, 49.8% of men and 27.8% of women were classified as obese with a body mass index (BMI) of 25 kg/m2 or more.5 The World Health Organization (WHO) considers obesity an epidemic that poses a significant threat to public health.6 However, due to the rampant prevalence of the disease, misleading information about obesity has proliferated on the internet. To counteract this, the KSSO is currently disseminating authoritative information on obesity through the Clinical Practice Guidelines for Obesity.7

Traditional weight loss methods have focused on reducing calorie intake below expenditure, employing calorie restriction, and increasing physical activity.8 This trend has propelled the evolution of mobile health (mHealth) applications centered on monitoring food intake and exercise. Smartphone applications for weight loss are simple-to-use, convenient tools that allow individuals to manage their health in addition to enabling continuous monitoring of calorie intake, physical activity, and weight at any time of the day, facilitating a more detailed and sustained management approach compared to conventional methods.9 Aligning with this trend, the KSSO launched the Weight Management Obesity Note application in November 2022, marking the initial phase of nationwide obesity management.

Obesity predominantly stems from an individual’s lifestyle behaviors, encompassing diet, activity levels, and stress management. Therefore, cognitive-behavioral therapy directed at behavior modification stands as the cornerstone of obesity treatment. Comprehensive lifestyle interventions target three main areas: controlling food intake, increasing physical activity, and employing behavioral therapy techniques. These strategies have long proven efficacious in enhancing compliance with prescribed meal and activity regimens, culminating in superior outcomes for obesity treatment.10 Standard lifestyle interventions include maintaining a daily diary of food intake and physical activity, conducting weekly weight checks, following structured curricula akin to those in diabetes prevention programs, and receiving regular feedback from physicians. These elements are integral parts of the KSSO mHealth application.10

The objective of obesity treatment transcends mere weight loss; treatment aims to curtail the diseases stemming from obesity and foster better overall health. Earlier studies, outlined in Table 1, have targeted a 5% to 10% reduction in baseline weight, a range recognized to offer substantial clinical benefits.10 For instance, shedding 5% to 10% of total body weight within 6 months significantly reduces morbidity, disability, and mortality linked to obesity-related diseases, and notably enhances quality of life. In individuals with smaller weight losses of 3% to 5%, improvements in risk factors associated with cardiovascular diseases such as high blood pressure, type 2 diabetes mellitus, and dyslipidemia have been reported.11 These parameters, pivotal for healthcare, underscore the importance of tracking user data.

Created by the IT-Convergence Metabolic Syndrome Treatment Committee of the KSSO, Weight Management Health Note aims to assist individuals in weight management and overall health enhancement. The application offers life-tracking tools such as a food diary, exercise tracker, and weight monitor, coupled with tailor-made lifestyle recommendations based on individual preferences and goals. Users have the autonomy to personalize commitments and share them while being rewarded with badges and receiving weekly progress reports for motivation and guidance. Access to an abundance of evidence-based health content ensures users access accurate obesity management insights. The overall flowchart of the application is depicted in Fig. 1.

Getting started

Upon initial application launch, users provide sign-up information and complete a detailed questionnaire. Based on their responses, the application formulates specific lifestyle improvement objectives aligned with user data. This 14-question survey meticulously evaluates water intake, dietary habits, drinking patterns, and daily physical activity, juxtaposing them with pre-entered information to create a personalized management plan.

The five core functions of the application: weight, eating, exercise, sleep, and drinking

Weight Management Health Note revolves around weight management, concentrating on regulating dietary intake, exercise, sleep patterns, and alcohol consumption. Fig. 2 showcases the application’s primary screens and functionalities, thoroughly evaluated in Table 2 within the KSSO’s clinical practice guidelines. For instance, under question-and-answer 5–2, the application advises users to “evaluate alcohol consumption during behavioral therapy for weight loss and maintenance.” Moreover, as presented in chapters 8, 9, 10, and 13, users in different circumstances are suggested to focus on different types of interventions. Binge eating and weight maintenance are also considered in the application. Weight Management Health Note considerations correspond well with those outlined in clinical practice guidelines. Once users input their data, the application generates an intuitive graphical representation depicting changes over time. The application evaluates and records several aspects pivotal to health management. First, it examines weight metrics, encompassing the latest measurements and deviations from the target weight, allow tracking of progress and goal attainment. Second, it employs BMI to assess obesity. Third, it meticulously tracks food intake, detailing total calorie consumption and the balance of nutrients—carbohydrates, proteins, and fats—over the preceding 2 months. Fourth, it captures exercise data, encompassing overall calorie expenditure, diverse exercise types undertaken, and their respective durations. Furthermore, it scrutinizes sleep patterns, recording the average daily duration of sleep and instances of disruptions. Lastly, it monitors drinking habits, analyzing the frequency and quantity of weekly alcohol intake.

These functionalities align with the five core features identified through lifestyle missions that were established based on an initial survey. Users can engage with distinct categories displayed in Fig. 3. The application offers the flexibility to log various meal types—breakfast, lunch, dinner, or snacks—by specifying date, time, food choices from a list with adjustable portions, and automated nutritional data capture, including the option to add a photo. Exercise inputs allow users to input exercise type, duration, and steps tracked automatically by the user’s phone. Caloric expenditure from exercises is automatically calculated based on predefined values. The recent application version 1.0.3 leverages the smartphone’s pedometer for automatic activity tracking. Sleep data entry includes bedtime, wake-up times, and the selection of sleep disorder symptoms (insomnia, narcolepsy, snoring, restless legs, sleep apnea, or others). Users can also log their drinking habits, specifying the type, duration, units, and quantity of alcohol consumed in glasses. The system then intuitively evaluates these inputs, offering ratings like ‘good,’ ‘recommended,’ or ‘poor’ to reflect activity levels.

In the remaining meal-related categories, whether the user had breakfast and whether a heavy meal was consumed are automatically logged alongside meal entry. However, other meal-related aspects like eating speed, fasting, broth intake, instant meal frequency, vegetable intake, and fruit intake require manual input from the user. Additionally, users can manually select the frequency of weight measurements: once a day, at least once a week, or once or twice a month.

On the mission screen, users view the “remaining calories,” representing unconsumed calories for the day. This feature subtracts the user’s eaten calories and recalculates burnt calories through exercise from the recommended intake based on the user’s body information.

Reports and rewards

Weekly reports detail user-entered answers, cumulative physical activity, and drinking habits. The reward system grants badges upon completing sleep challenges (7 to 8 hours per day), exercise challenges (100 to 300 minutes per week), refraining from daily alcohol consumption, and achieving specific nutrition goals, such as avoiding overeating or excessive fasting.

Resolutions and health information

Users can create resolutions, select the commitment’s background color, and compose a 40-character commitment within the application. The resulting commitment can be saved as an image and shared on social media. Health information encompasses nine categories, covering obesity facts, treatment, various exercises, and a question-and-answer section through categorized subtopics and video-supported tips. Note that the health information category is current inactive (January 2024).

Google Play Store alone hosted 54,546 mHealth applications by the third quarter of 2022.12 Weight Management Health Note stands out due to the extensive expertise incorporated within the application by KSSO’s expertise encompassing knowledge across multiple medical disciplines. This application is a promising primary tool for chronic disease treatment and essential ICT-based medical aid tool that can benefit the wider public. While previous studies have underscored the efficiency of ICT interventions for obesity (Table 1)10-15, further clinical trials are crucial to substantiate its effectiveness, ensuring its viability beyond theoretical foundations. The fusion of professionalism and ICT elements within Weight Management Health Note could potentially make this application the most effective application currently available for self-management of obesity and related diseases.

The authors would like to thank Former Chairman Ki-jin Kim, President Chang-Beom Lee, and all executives of the Korean Society for the Study of Obesity. In addition, the corresponding author would like to express thanks to Professors Emeriti Young Seol Kim and Young Kil Choi from Kyung Hee University for their exceptional teaching and inspiration.

Study concept and design: SK, DAC, and SYR; acquisition of data: DAC and SYR; analysis and interpretation of data: YL and HS; drafting of the manuscript: YL, HS, and SK; critical revision of the manuscript: SYR; and study supervision: SYR.

Fig. 1. General content and flowchart of the Weight Management Health Note application. This figure offers an overview of the user’s journey through the Weight Management Health Note application, outlining key stages from registration to acquisition of personalized health information and self-care. The process begins with the user’s initial registration within the Weight Management Health Note application. After signing up, users are prompted to complete an “initial survey.“ This survey serves as the foundation for understanding the user’s lifestyle, allowing the application to establish daily routine goals based on the assessment. These lifestyle goals form the basis for “lifestyle management missions“ tailored to the user’s specific needs and circumstances. Users actively engage with the application by completing sub-missions within their chosen categories. The categories are broadly divided into five categories: “Drinking,“ which encompasses weekly amount and frequency of consumption of alcoholic beverages; “Meal,“ where users focus on recent food intake, nutritional ratio, and total calorie intake; “Weight,“ with missions related to obesity assessment, weight change, and recent weight tracking; “Sleep,“ involving missions related to sleep disorders, average sleep duration, and daily sleep duration; and “Exercise,“ in which users specify exercise types and durations, as well as monitor total calorie consumption. As users accumulate data and experience within the application, they gain access to weekly reports. These reports offer valuable insights, such as weight comparisons and record frequency, enhancing the user’s understanding of their personalized health information.
Fig. 2. Overview of the application screen and functionalities available within the application. The primary section is dedicated to weight management. Here, users can consistently monitor their weight and body mass index (BMI) with variations over time. On the secondary tab, users encounter missions related to daily calorie management. These missions guide users toward aligning their calorie intake with recommended values, facilitating a healthier lifestyle. Third screen introduces missions designed to promote calorie-conscious behaviors and encourage physical activity. Within the Meal search, users can search for specific meals and access valuable information about their nutritional value, including the percentage of essential nutrients contained in each food item. Meal input tab is a comprehensive tool that allows users to input detailed meal information. Users can specify meal types, record the date and time of consumption, list individual food items consumed, and attach pictures for reference. Lastly, the Meal analysis offers users the ability to analyze their meal-related data. This includes a graphical representation of total calorie intake, numerical values of average intake, and a count of instances where overeating has occurred.
Fig. 3. Visual representation of the categorized missions in the application. The first category, ‘Meal,’ encompasses a variety of missions that center around crucial aspects of nutrition and eating habits. These missions include recommendations for daily calorie intake, encouraging breakfast consumption, managing overeating, regulating eating speed, avoiding excessive fasting, promoting the intake of soups, making mindful choices regarding fast food, and emphasizing the importance of vegetables and fruits in one’s diet. Missions related to the ‘Exercise’ pillar encourage users to maintain recommended levels of calorie expenditure through exercise and an active lifestyle. For drinking, the missions keep track of intake of alcoholic beverages, measuring consumption in terms of glasses. ‘Weight’ measurement missions guide users on assessing their weight, monitoring variations, and achieving weight-related goals. Records are also kept of users’ sleeping habits.

Current evidence regarding mHealth interventions

No. of individuals in intervention group Intervention type Duration Methods Results Etc. Reference
763 Vida Health program 4 months of intensive active coaching, 8 months of maintenance coaching Coaching via live video, phone, and text message 3.23% ↓ in TBW at 4 months of coaching
9.46% ↓ in TBW in the total intervention group
28.6% of intervention participants achieved a weight loss of 5% or more of TBW
Improved blood pressure 10
91 Daily self-monitoring 6 months (1) Cellular-connected scales for daily weighing
(2) Web-based graph of weight trends over time
(3) Weekly tailored feedback via e-mail on selfweighing frequency and weight loss progress
(4) 22 weekly lessons on behavioral weight control via e-mail
4.41% ↓ in TBW (3 months)
6.55% ↓ in TBW (6 months)
Intervention group self-weighed more days/week (6.1± 1.1 vs. 1.1± 1.5)
Consumed fewer calories/day compared to the control group: 1,509 (range, 1,291–1,728) vs. 1,856 (range, 1,637–2,074)
11
23,682 Noom Coach 6 months Tracks dietary intake, physical activity, and body weight
Reports trends in body weight changes, calorie intake, and nutritional summaries to provide customized feedback
Users of the 5% reduction group consumed significantly lower amounts of calories for breakfast, lunch, and dinner; burned higher amounts of calories from exercise; entered more data (body weight, exercise, and meals) Users who frequently entered body weight data achieved the 5% body weight reduction about 3 days faster (62 days: 95% CI, 47.95–50.06) than users who entered body weight data less frequently (65 days: 95% CI, 51.91–54.09)
Users who frequently entered their exercise data achieved the 5% body weight reduction 6 days earlier (60 days: 95% CI, 46.87–49.13) than users in the low data entry group (66 days: 95% CI, 51.90–54.10)
Users who frequently entered meal (breakfast, lunch, and dinner) data achieving the 5% body weight reduction 7 days faster than the group who did not enter data frequently
12
35,921 Noom Coach 0–26 weeks (initial) 27–76 weeks (long-term) Tracks dietary intake, physical activity, and body weight
Reports trends in body weight changes, calorie intake, and nutritional summaries provides customized feedback
Factors contributing to weight loss: (positive) gender, baseline BMI, and weight input frequency (negative) age, breakfast input frequency, breakfast calories, lunch calories, and dinner calories Dinner input frequency to be the strongest factor in losing 10% body weight over 26 weeks
Weight input frequency, along with lunch and dinner intake calories, has been shown to lower the likelihood of yo-yo
13
1,439 “My Chart in My Hand” 18 months mPHR application, checks hospital records and manages health information
(1) Self-monitoring function: manually input blood glucose levels, blood pressure levels, weight, and height; provides indexes (body mass index, 10-year cardiovascular disease risk, and metabolic syndrome risk)
(2) Chart function: allows access to medical records, disease management, and allergy history
(3) Medication function: medication schedules and information about medicines
(4) Appointments and assessment of waiting status
Average duration of use: 25.62 weeks
Application use declines overt time
Self-monitoring function frequently and regularly reduces the probability of abandoning the application
14
8,353 Noom Coach 12 months Tracks dietary intake, physical activity, and body weight
Reports trends in body weight changes, calorie intake, and nutritional summaries and provides customized feedback
Users who frequently monitored their lunch, dinner, body weight, evening snack, and exercise exhibited significant weight loss over time
No significant differences in body weight changes between users who used the free version (log and track diet, exercise, and weight) versus paid version (customized diet planning, one-on-one coaching, social support, weight recording logs, and food and exercise tracking) of the application (β= −0.2; P=0.19)
Users in OECD countries consumed more calories than those in low-income countries for 12 months
No statistically significant differences between users from low-income and OECD countries in body weight was observed over the 12-month period
15

TBW, total body weight; CI, confidence interval; BMI, body mass index; mPHR, mobile personal health records; OECD, Organization for Economic Co-operation and Development.

Chapters in clinical practice guidelines for obesity by KSSO 2022 relevant to the Weight Management Health Note application7

Question Recommendation
1. Diagnosis of obesity
Q1-1 Is measuring BMI in adults an appropriate way to evaluate the risk of obesity-related comorbidities? R1-1-1 It is recommended to measure BMI at least once a year in all adults (I, B).
R1-1-2 Considering the risk of obesity-related comorbidities, the criterion for adult obesity in Korea is a BMI of 25 kg/m2 or higher (IIa, B).
Q1-2 Does dividing obesity into grades help evaluate the risk of obesity-related diseases in adults? R1-2 Obesity is divided into class 1 obesity (BMI 25.0−29.9 kg/m2), class 2 obesity (BMI 30.0−34.9 kg/m2), and class 3 obesity (severe obesity, BMI 35.0 kg/m2 or higher) in Korea, considering the risk of obesity-related comorbidities (IIa, B).
Q1-3 Does measuring WC in addition to BMI help evaluate the risk of obesity-related comorbidities in adults? R1-3 The criteria for determining abdominal obesity by measuring WC are 90 cm or more for men and 85 cm or more for women in Korea (IIa, B).
2. Pre-treatment evaluation of obesity
Q2-1 Is it necessary to confirm the cause of obesity in adults before treatment? R2-1 Before starting treatment, consider conducting a medical interview and performing screening tests for genetic diseases, endocrinologic diseases, and medications that may cause obesity (IIa, B).
Q2-2 Is it necessary to confirm the presence of obesity-related comorbidities before treating adult patients with obesity? R2-2 Because obesity increases the risk of hypertension, type 2 diabetes, dyslipidemia, gout, arthritis, cardiovascular disease, and cancer and increases mortality rate, a medical interview and screening test for these diseases is recommended (I, A).
Q2-3 What should the weight loss goal for adults with obesity be before treatment? R2-3 It is recommended to set a primary goal of losing 5%−10% of initial body weight within 6 months (I, A).
3. Diet therapy
Q3-1 How much should energy intake be restricted for weight loss in overweight or obese adults? R3-1-1 It is recommended to individualize the amount of energy restriction for weight loss in obese or overweight adults based on personal characteristics and medical conditions (I, A).
R3-1-2 Very low energy diets should only be performed under supervision of trained professionals under limited circumstances and should be implemented along with intensive lifestyle interventions (I, A).
Q3-2 Do differences in macronutrient content in nutritional approaches affect the efficacy of weight loss and improvement of metabolic markers in adults with obesity? R3-2-1 While diverse types of diets (low energy, low carbohydrate, low-fat, high protein, etc.) can be chosen, it is recommended to use a diet that is nutritionally appropriate and achieves an energy deficit, emphasizing healthy eating habits (I, A).
R3-2-2 It is recommended to individualize the composition of macronutrients (carbohydrates, fats, proteins) based on personal characteristics and medical conditions (I, A).
4. Exercise therapy
Q4-1 How should the decision of exercise participation be made before exercise therapy in adults with obesity? R4-1 If there are symptoms of cardiovascular, metabolic, or renal diseases or if there are no symptoms but there is a history of cardiovascular, metabolic, or renal diseases and regular exercise is not performed, exercise should be started after consulting a doctor. In other cases, low to moderate intensity exercise without prior medical permission is appropriate (I, A).
Q4-2 What is the amount and method of exercise that can help lose weight in adults with obesity? R4-2 For weight loss, it is recommended to perform aerobic exercise for at least 150 minutes per week, 3−5 times a week and resistance exercise using large muscle groups, 2−3 times a week (I, A).
Q4-3 What is the difference in weight loss effect between the combination of aerobic and resistance exercise versus aerobic exercise alone in adults with obesity? R4-3 Exercise that combines aerobic exercise and resistance exercise is more effective for weight loss than either aerobic exercise alone or resistance exercise alone. Therefore, it is recommended to perform a combination of both aerobic and resistance exercise for weight loss (I, A).
Q4-4 What is the difference in weight loss effect between exercise alone and exercise performed in combination with diet therapy in adults with obesity? R4-4 For effective weight loss, it is recommended to combine exercise with diet therapy (I, A).
5. Behavioral therapy
Q5-1 Are comprehensive lifestyle interventions that incorporate behavioral therapy techniques more effective for weight loss and its maintenance in adults with obesity than typical treatments (e.g., providing advice and educational materials)? R5-1-1 For weight loss, comprehensive lifestyle improvements such as reducing energy intake and increasing physical activity based on behavioral therapy are recommended (I, A).
R5-1-2 For effective weight loss, it is recommended that a trained therapist conduct face-to-face behavioral therapy for at least 6 months (I, A).
R5-1-3 For effective maintenance of weight loss, it is recommended that a trained therapist conduct behavioral therapy for at least 1 year (I, A).
R5-1-4 If 2.5% weight loss is not achieved within 1 month of behavioral therapy, consider reinforcing the lifestyle interventions based on behavioral therapy (IIa, B).
Q5-2 What measures are necessary for weight loss and its maintenance in adults with obesity who drink alcohol? R5-2 It is recommended to evaluate alcohol consumption during behavioral therapy for weight loss and its maintenance (I, A).
Q5-3 What treatment is needed to reduce weight gain when trying to quit smoking during obesity treatment? R5-3 When attempting to quit smoking during obesity treatment, consider using smoking cessation medications in conjunction with behavioral therapy to prevent weight gain (IIa, B).
8. Obesity in the elderly
Q8-3 What should be considered for effective and safe obesity treatment in the elderly? R8-3-1 In managing obesity in the elderly, it may be necessary to evaluate osteoporosis and sarcopenia (IIb, B).
R8-3-2 For treatment of obesity in the elderly, it is recommended to prioritize a low energy diet rich in protein and to increase physical activity (I, A).
R8-3-3 When treating obesity in the elderly, pharmacotherapy and surgical treatments may be considered with caution, taking into account the presence of accompanying diseases and medications to ensure patient safety (IIb, B).
9. Obesity in children and adolescents
Q9-2 What are the treatment goals and principles for obesity in children and adolescents? R9-2 Treatment of obesity in children and adolescents is recommended to maintain appropriate weight while supplying the energy and nutrients necessary for normal growth and to habituate a healthy lifestyle (I, A).
Q9-3 What are safe and effective treatment strategies for obesity in children and adolescents? R9-3-1 Comprehensive lifestyle modifications including diet, exercise, and behavioral therapy are recommended for treatment of obesity in children and adolescents (I, A).
R9-3-2 In cases where weight gain and obesity-related comorbidities are sustained even with intensive diet, exercise, and behavioral therapy, obesity pharmacotherapy by an experienced specialist should be considered (IIa, B).
R9-3-3 In cases where weight gain and obesity-related comorbidities are sustained even with intensive multidisciplinary treatment and pharmacotherapy for obesity, surgical therapy may be considered in limited cases, only after completion of growth and puberty (IIb, C).
10. Obesity in women
Q10-2 What are the appropriate lifestyle habits for weight management during pregnancy and after delivery in women with obesity? R10-2-1 In pregnant women with obesity, a balanced diet and regular physical activity should be considered for appropriate rather than excessive weight gain during pregnancy (IIa, B).
R10-2-2 Active lifestyle interventions, such as modification of diet and an increase in physical activity, are recommended for weight management after delivery in women with obesity (I, A).
11. Obesity in patients with mental illness
Q11-1 Is it necessary to conduct screening tests for obesity and metabolic diseases in patients with severe mental illness for proper management? R11-1 It is recommended to conduct screening tests for obesity and metabolic diseases in patients with severe mental illness who are taking medications related to weight gain for prevention and management of metabolic diseases (I, B).
Q11-2 For patients with obesity and severe mental illness, is it effective and mentally safe to implement comprehensive lifestyle interventions, obesity pharmacotherapy, and bariatric surgery? R11-2 For weight loss in patients with obesity and severe mental illness, comprehensive lifestyle interventions are recommended (I, A).
Q11-3 Is distinguishing whether a patient with obesity also has binge eating disorder useful in predicting the effectiveness of obesity treatment? R11-3 Because patients with obesity in conjunction with binge eating disorder may experience less weight loss in response to typical obesity treatments, the presence of binge eating disorder should be considered when treating obesity (IIa, C).
Q11-4 What kind of obesity treatment is effective at inducing weight loss and improving symptoms of obstructive sleep apnea in patients with obesity and obstructive sleep apnea? R11-4 Comprehensive lifestyle interventions for weight loss are recommended for patients with obesity and obstructive sleep apnea (I, A).
12. Weight maintenance after weight loss
Q12-1 Are there different long-term outcomes for obesity-related comorbidities in adults with obesity who have successfully maintained weight loss compared to those who have not? R12-1 It is recommended to maintain weight loss for more than 1 year to prevent and manage obesity-related comorbidities (I, A).
Q12-2 What treatment is effective for long-term weight management and outcomes in adults with obesity? R12-2-1 It is recommended to use a combination of diet, exercise, and cognitive-behavioral therapy for weight maintenance after weight loss (I, A).
R12-2-2 The use of anti-obesity medications that are approved for long-term use may also be considered (IIb, B).
Q12-3 Is additional obesity pharmacotherapy helpful for long-term weight management in patients with morbid obesity who have regained weight after bariatric/metabolic surgery? R12-3 In patients who have regained weight after bariatric/metabolic surgery, the use of anti-obesity medications in conjunction with lifestyle modifications may be considered (IIb, B).
13. Metabolic syndrome
Q13-1 What are the diagnostic criteria for metabolic syndrome in Korean adults? R13-1 In Korea, adults are diagnosed with metabolic syndrome if they meet three or more of the following criteria (A).
(1) Abdominal obesity (WC ≥ 90 cm in men and ≥ 85 cm in women)
(2) Elevated blood pressure (≥ 130/85 mmHg or use of hypertension medications)
(3) Elevated fasting blood sugar (≥ 100 mg/dL or use of diabetes medications)
(4) Elevated triglycerides (≥ 150 mg/dL or use of lipid-lowering drugs)
(5) Low HDL cholesterol (< 40 mg/dL in men and < 50 mg/dL in women or use of lipid-lowering drugs)
Q13-2 What are effective interventions for treating and managing metabolic syndrome in adults? R13-2 To treat and manage metabolic syndrome, lifestyle modifications and, if necessary, drug interventions for individual components are recommended (I, A).
14. Obesity treatment using ICT-based interventions
Q14-1 Can information and communication technology-based methods be used to modify lifestyle to manage obesity and metabolic syndrome? R14-1 ICT-based interventions should be considered for managing obesity and metabolic syndrome (IIa, B).
Q14-2 Are ICT-based interventions effective at inducing weight loss and maintenance compared to conventional treatment in adults with obesity? R14-2 ICT-based interventions may be considered as part of a comprehensive strategy for weight loss (IIb, B).

KSSO, Korean Society for the Study of Obesity; BMI, body mass index; WC, waist circumference; HDL, high-density lipoprotein; ICT, information and communication technology.

  1. Rhee SY, Kim C, Shin DW, Steinhubl SR. Present and future of digital health in diabetes and metabolic disease. Diabetes Metab J 2020;44:819-27.
    Pubmed KoreaMed CrossRef
  2. Kim YJ, Rhee SY, Byun JK, Park SY, Hong SM, Chin SO, et al. A smartphone application significantly improved diabetes self-care activities with high user satisfaction. Diabetes Metab J 2015;39:207-17.
    Pubmed KoreaMed CrossRef
  3. Birkmeyer S, Wirtz BW, Langer PF. Determinants of mHealth success: an empirical investigation of the user perspective. Int J Inf Manage 2021;59:102351.
    Pubmed KoreaMed CrossRef
  4. Stewart C. Growth in the number of medical apps downloaded during the COVID-19 pandemic by country in 2020 [Internet]. Statista; 2020 [cited 2024 Jan 27]. Available from: https://www.statista.com/statistics/1181413/medical-app-downloads-growth-during-covid-pandemic-by-country.
  5. Korean Society for the Study of Obesity Big Data Center. Obesity in numbers [Internet]. Korean Society for the Study of Obesity; 2023 [cited 2024 Jan 30]. Available from: https://general.kosso.or.kr/html/?pmode=BBBS0001300004&page=1&smode=view&seq=1388&searchValue=&searchTitle=strTitle.
  6. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. WHO; 2000.
  7. Kim KK, Haam JH, Kim BT, Kim EM, Park JH, Rhee SY, et al. Evaluation and treatment of obesity and its comorbidities: 2022 update of clinical practice guidelines for obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2023;32:1-24.
    Pubmed KoreaMed CrossRef
  8. Hutchesson MJ, Rollo ME, Krukowski R, Ells L, Harvey J, Morgan PJ, et al. eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis. Obes Rev 2015;16:376-92.
    Pubmed CrossRef
  9. Burke LE, Styn MA, Sereika SM, Conroy MB, Ye L, Glanz K, et al. Using mHealth technology to enhance self-monitoring for weight loss: a randomized trial. Am J Prev Med 2012;43:20-6.
    Pubmed KoreaMed CrossRef
  10. Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, et al. The science of obesity management: an endocrine society scientific statement. Endocr Rev 2018;39:79-132.
    Pubmed KoreaMed CrossRef
  11. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. European guidelines for obesity management in adults. Obes Facts 2015;8:402-24.
    Pubmed KoreaMed CrossRef
  12. Ceci L. Number of mHealth apps available in the Google Play store from 1st quarter 2015 to 3rd quarter 2022 [Internet]. Statista; 2020 [cited 2024 Jan 27]. Available from: https://www.statista.com/statistics/779919/health-apps-available-google-play-worldwide.
  13. Chin SO, Keum C, Woo J, Park J, Choi HJ, Woo JT, et al. Successful weight reduction and maintenance by using a smartphone application in those with overweight and obesity. Sci Rep 2016;6:34563.
    Pubmed KoreaMed CrossRef
  14. Lee K, Kwon H, Lee B, Lee G, Lee JH, Park YR, et al. Effect of self-monitoring on long-term patient engagement with mobile health applications. PLoS One 2018;13:e0201166.
    Pubmed KoreaMed CrossRef
  15. Han M, Rhee SY. Effect of adherence to smartphone app use on the long-term effectiveness of weight loss in developing and OECD countries: retrospective cohort study. JMIR Mhealth Uhealth 2021;9:e13496.
    Pubmed KoreaMed CrossRef