✕
Journal of Obesity & Metabolic Syndrome

Search

Article

J Obes Metab Syndr 2023; 32(2): 121-129

Published online June 30, 2023 https://doi.org/10.7570/jomes23031

Copyright © Korean Society for the Study of Obesity.

Diagnosis of Obesity: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity

Ji-Hee Haam1, Bom Taeck Kim2, Eun Mi Kim3, Hyuktae Kwon4, Jee-Hyun Kang5, Jung Hwan Park6, Kyoung-Kon Kim7, Sang Youl Rhee8,9, Yang-Hyun Kim10,* , Ki Young Lee11,*

Author Affiliations

1Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam; 2Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon; 3Department of Dietetics, Kangbuk Samsung Hospital, Seoul; 4Department of Family Medicine, Seoul National University Hospital, Seoul; 5Department of Family Medicine, Konyang University College of Medicine, Daejeon; 6Department of Internal Medicine, Hanyang University College of Medicine, Seoul; 7Department of Family Medicine, Gachon University College of Medicine, Incheon; 8Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul; 9Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul; 10Department of Family Medicine, Korea University College of Medicine, Seoul; 11Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

Correspondence to:
Yang-Hyun Kim
https://orcid.org/0000-0003-3548-8758
Department of Family Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea
Tel: +82-2-920-5104
Fax: +82-2-928-8083
E-mail: 9754031@korea.ac.kr

Ki Young Lee
https://orcid.org/0000-0002-0333-7093
Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea
Tel: +82-32-458-2753
Fax: +82-32-460-2381
E-mail: kylee@gilhospital.com

Received: May 26, 2023; Reviewed : June 15, 2023; Accepted: June 16, 2023

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.

Abstract

Go to

The prevalence of obesity has consistently increased worldwide, and many obesity-related diseases are emerging as major health problems. Body mass index (BMI) is used to define obesity and is highly correlated with body fat mass. Moreover, obesity-related morbidities increase linearly with the increase in BMI. The Korean Society for the Study of Obesity defined overweight as a BMI ≥23 kg/m2 and obesity as a BMI ≥25 kg/m2, based on a significant increase in obesity-related diseases. A waist circumference of ≥90 cm in men and ≥85 cm in women are defined as abdominal obesity, which is also correlated with obesity-related diseases. These diagnostic criteria are the same as in the previous version; however, the updated guidelines put greater emphasis on the use of morbidity as the basis for obesity and abdominal obesity diagnoses. These new guidelines will help to identify and manage high-risk groups for obesity-related comorbidities among Korean adults.
Click here to check the Graphical Abstract.

Keywords: Diagnosis, Obesity, Abdominal obesity, Body mass index, Waist circumference, Comorbidity

INTRODUCTION

Go to

Obesity is a chronic disease characterized by excess body fat deposition and high body mass index (BMI), which is calculated by dividing weight (kg) by height squared (m2). According to the 2021 obesity fact sheet,1 the prevalence of obesity consistently increased over the previous 11 years. Consequently, many obesity-related diseases have emerged as health problems.2 The diagnosis of obesity is important because it serves as a criterion for starting treatment.

Herein, we intend to conduct a comprehensive review of the diagnostic section outlined in the 2022 Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity (KSSO).3

DEFINITION OF OBESITY

Go to

Diagnostic criteria for obesity in adults

BMI is used to define obesity because it is highly correlated with body fat in most populations and with obesity-related comorbidities such as diabetes mellitus, hypertension, and dyslipidemia.4-8 Therefore, it is recommended to measure the BMI every year to evaluate the risk of obesity and comorbid diseases.9

The World Health Organization (WHO) defines overweight as a BMI ≥25 kg/m2 and obesity as a BMI ≥30 kg/m2, regardless of race or sex.10 In Europe, the same definition of obesity is used to prevent confusion in health promotion, disease prevention, and management, despite the existence of a racially diverse population.11 However, Asian populations, including Koreans, have an increased risk of diabetes and cardiovascular diseases, even at a BMI ≤25 kg/m2; therefore, different BMI criteria for obesity are needed for different races.10,12 Based on the fact that Asians have higher morbidity and mortality even with lower BMI and waist circumference (WC), the WHO Asia-Pacific region defined BMI ≥23 kg/m2 as overweight and ≥25 kg/m2 as obese.12 Meanwhile, the WHO Expert Committee agreed that the WHO BMI cutoff points should remain as international classifications but identified additional points for taking public health action on the risks of obesity-related comorbidities. BMI ≥23 kg/m2 represents increased risk and BMI ≥27.5 kg/m2 represents high-risk.13 The American Association of Clinical Endocrinologists/American College of Endocrinology obesity guidelines in 2016 and the American Diabetes Association guidelines in 2022 defined a BMI ≥25 kg/m2 as overweight but recommended that Asians consider a BMI ≥23 kg/m2 as overweight.9,14 Moreover, there are diverse definitions of obesity among the Asian populations. In Japan, a BMI ≥23 kg/m2 is defined as overweight and a BMI ≥25 kg/m2 is defined as obesity,15 whereas in China, overweight is defined as a BMI ≥24 kg/m2 while obesity is defined as a BMI ≥28 kg/m2.16 The diagnostic criteria for obesity in each region/country are shown in Table 1.2,10,12,15-18

BMI and the risk of obesity-related comorbidities in Korean adults

The KSSO analyzed data from the National Health Insurance Corporation from 2009 to 2015 and reported the status of obesity and the risk of obesity-related comorbidities in Koreans in the 2017 obesity fact sheet, which showed that the risk of type 2 diabetes, hypertension, and dyslipidemia linearly increased as BMI increased from the range of 23 to 25 kg/m2.2 In addition, among young adults aged 20 to 39 who received health checkups from the National Health Insurance Corporation from 2009 until 2017, disease incidence was found to be significantly higher in the BMI range of 23 to 24.9 kg/m2 compared to normal weight, with a 2.4-fold increase in the risk of type 2 diabetes, a 1.2-fold increase in the risk of myocardial infarction, and a 1.2-fold increase in the risk of ischemic stroke. The risk of myocardial infarction, ischemic stroke, and type 2 diabetes increased 1.6-, 1.6-, and 6.5-fold respectively, in patients with a BMI range of 25 to 29.9 kg/m2 compared to normal weight individuals.19

Accordingly, the KSSO defined overweight as a BMI ≥23 kg/m2 and obesity as a BMI ≥25 kg/m2 based on a significant increase in obesity-related diseases. The diagnostic criteria for obesity are the same as those in the previous version, but the new guidelines further highlight the use of morbidity as the basis for diagnosis of obesity. The KSSO uses comorbidity, not mortality, as the diagnostic criterion for obesity.

The use of obesity-related comorbidities rather than mortality to define obesity is aimed at preventing obesity-related comorbidities, since their incidence increases linearly with increasing BMI in patients in their 20s to 60s.2,20-24 However, the relationship between BMI and mortality may differ depending on the characteristics of the study cohort such as age, comorbidities, smoking status, cause of death, and duration of follow-up.25-27 For example, among older adults with many comorbidities, there is a tendency to show a U-shaped or inverse J-shaped graph skewed to the right and the lowest mortality rate in overweight or obese ranges of BMI.28 In a large-scale cohort study of Koreans, nonsmoking men showed the lowest mortality rate for all causes at the overweight range (BMI 23.0 to 24.9 kg/m2), while smoking men showed the lowest mortality rate at the obesity range (BMI 25.0 to 27.9 kg/m2).29 However, in a study of Taiwanese subjects, mortality and cardiovascular disease incidence due to all causes increased significantly from a BMI of 25 kg/m2 upwards in the entire population and in nonsmokers.30 In 2016, the Global BMI Mortality Collaboration conducted a meta-analysis of 239 prospective studies that showed that all-cause mortality in East Asians increased significantly with a BMI ≥25 kg/m2.31 Thereby, when mortality is used as the cutoff for obesity diagnosis, it is highly variable and inconsistent; therefore, from the viewpoint of disease prevention, it is necessary to set the diagnosis of obesity at the point when obesity-related comorbidities increase. Moreover, because the criteria for diagnosing obesity in Korean adults are clinically aimed at screening and managing high-risk groups for obesity-related diseases, morbidities were used as the diagnostic criteria.

Stage of obesity in adults

The obesity stage in Korean adults was classified based on an increase in obesity-related comorbidities according to the BMI level. Overweight and obesity were defined as BMI ≥23 and ≥25 kg/m2, respectively (Table 2).2 The incidence of obesity-related comorbidities, such as type 2 diabetes, hypertension, and dyslipidemia, increases proportionally with an increase in BMI; however, the rate of increase slows and eventually levels off at a BMI of 35 to 37 kg/m2. Based on these results, the KSSO added a class III obesity to the existing classification, which previously only had two stages, defined as a BMI of 25 to 29.9 kg/m2 for class I obesity, a BMI of 30 to 34.9 kg/m2 for class II obesity, and a BMI ≥35 kg/m2 for class III obesity, instead of defining a BMI of 25 to 29.9 kg/m2 as class I obesity and a BMI ≥30 kg/m2 as class II obesity as was previously done (Table 2, Fig. 1).32

In Korea, the term “severe obesity” has been used arbitrarily with varying definitions, thereby causing confusion. Therefore, the KSSO officially defined class III obesity (BMI ≥35 kg/m2) as “severe obesity” starting from the 2018 KSSO guideline.32 Additionally, a BMI of 23 to 24.9 kg/m2 is defined as the “pre-obesity stage” (overweight or at-risk weight) because it implies the potential to progress to obesity if not managed carefully.32

Diagnostic criteria for abdominal obesity in adults

In Korea, the standard for abdominal obesity in adults is defined as a WC of ≥90 cm for men and ≥85 cm for women.33 Measuring the BMI alone for obesity has limitations in accurately reflecting body fat mass, especially in athletes or those with muscle loss. Thus, factors such as age, sex, race, body fluid status, and muscle mass should be considered when determining the degree of obesity.34,35 WC measurement also corrects errors in BMI in patients with low muscle mass, elderly individuals, and those with weight loss-inducing diseases.17,36,37 In addition, because abdominal obesity is a superior predictor of cardiovascular diseases and other obesity-related comorbidities than overall obesity, measuring WC in addition to BMI is recommended.38-41 In the long-term follow-up of the Coronary Artery Risk Development in Young Adults (CARDIA) study, using either one of the criteria, BMI ≥25 kg/m2, WC ≥94 cm for men, and ≥80 cm for women, predicted cardiovascular disease better than the BMI criterion alone.42 In addition, WC has been reported to be a strong predictor of mortality in all BMI ranges, showing a linear and positive correlation with mortality rates in various studies, including a Korean population study.43-50 In cases of abdominal obesity, independent of BMI, the incidences of metabolic syndrome, type 2 diabetes, hypertension, dyslipidemia, coronary artery disease, and cerebral artery disease increased. Therefore, when abdominal obesity is diagnosed, it is necessary to consider the increased risk of comorbidities more than when the risk classification is based on BMI alone (Table 2).

The discrimination point for diagnosing abdominal obesity varies by race and gender, and the KSSO recommends a diagnosis of abdominal obesity in Korean adults with a WC ≥90 cm for men and ≥85 cm for women, considering the risk of morbidity associated with increased WC and the prevalence of abdominal obesity. In this guideline, the cutoff point for abdominal obesity is the same as that in the previous version, but this guideline additionally emphasizes that the risk of morbidity should be considered for these criteria. Moreover, this guideline explains that WC is a better predictor of mortality because it shows a more linear positive correlation with mortality than BMI alone. In a Korean study by the KSSO, the WC at the point of occurrence of two or more metabolic syndrome risk factors suggested by the International Diabetes Federation, was used as the criterion for abdominal obesity.33 The diagnostic criteria for abdominal obesity in other regions and countries, including East Asian countries such as China and Japan, are summarized in Table 3.16,33,51-54

MEASUREMENT OF OBESITY AND ABDOMINAL OBESITY IN KOREANS

Go to

To obtain accurate BMI measurements, weight should be measured after an 8-hour fast and after voiding, with minimal clothing and no shoes. As the obesity stage increases, the daily weight variation also increases. Therefore, measurements should be taken under constant conditions at the same time each day. Height should be measured with the heel against the wall and feet 60° apart, with the head, buttocks, and heels against the wall, and the subject taking a deep breath. The weight was measured and recorded to the nearest 0.1 kg, while heights were measured and recorded to the nearest 0.1 cm.

When measuring WC, selecting a standardized anatomical location is crucial. To measure WC, individuals should stand with feet approximately 25 to 30 cm apart with weight evenly distributed and breathing comfortably. Measurements should be taken at the midpoint between the lowermost rib and the top of the iliac crest (WHO) or at the level of the iliac crest (National Institutes of Health) using a measuring tape. The tape should be loose enough to avoid applying pressure to the soft tissue, and measurements should be recorded to the nearest 0.1 cm. In severely obese women or in women after childbirth or menopause, subcutaneous fat may overlap with the waist and cause the measurement to be greater than the actual WC. In such cases, subcutaneous fat should be lifted and placed in an upright position.55

Other methods for measuring body fat, such as bioelectrical impedance analysis or dual-energy X-ray absorptiometry (DEXA) can be considered for diagnosing obesity. To evaluate abdominal obesity, abdominal computed tomography or magnetic resonance imaging may be used in addition to measuring WC. Traditionally, the American Endocrine Society has defined obesity as a body fat percentage of ≥25% in men and ≥35% in women.56 A study of Japanese individuals using DEXA to identify the discrimination point for body fat percentage that increases the risk of cardiovascular disease, also showed similar results (24% for men and 35% for women).57 In a study of Korean adults, even when the BMI was within the normal range, men with a body fat percentage ≥26% and women with a body fat percentage ≥36% can be considered obese with accompanying cardiovascular risk.58 However, large-scale studies in Korea have reported that BMI is more closely related to body fat mass than to body fat percentage,59 and evidence for the discrimination point of body fat percentage is currently lacking.60-63 Considering the current limitations in clinical use and cost, the use of BMI and WC to diagnose obesity should be prioritized.

CONCLUSION

Go to

BMI and WC cutoff points are important for predicting the risk of comorbidities. The Korean adult obesity diagnostic criteria were reasonably set at a BMI of ≥23 kg/m2 for overweight (pre-obesity) and ≥25 kg/m2 for obesity, considering the significant increase in obesity-related comorbidities in the high-risk groups for clinical management. In Korea, diagnosis of abdominal obesity is given for a WC ≥90 cm in men and ≥85 cm in women; this measurement is better correlated with cardiovascular disease and other obesity-related comorbidities than overall obesity, and measuring WC in addition to BMI is therefore recommended. Diagnostic criteria for obesity and abdominal obesity in Korean adults will help identify and manage high-risk groups for obesity-related comorbidities.

ACKNOWLEDGMENTS

Go to

Financial support was provided by the Korean Society for the Study of Obesity. However, financial support did not directly or indirectly influence the content or development of these guidelines.

AUTHOR CONTRIBUTIONS

Go to

Study concept and design: JHH and YHK; acquisition of data: BTK and EMK; analysis and interpretation of data: HK and JHK; drafting of the manuscript: JHH and YHK; critical revision of the manuscript: BTK, JHK, JHP, KKK, and SYR; and study supervision: YHK and KYL.

Figures

Go to
Fig. 1. The incidence rate of type 2 diabetes, hypertension, and dyslipidemia according to body mass index (BMI) level. Data derived from the National Health Insurance Service Health Checkup Data 2006 to 2015. Adapted from Seo et al.2

Tables

Go to

Diagnostic criteria of obesity by region/country (body mass index, kg/m2)

Region/Country Pre-obesity (overweight) Obesity Organization
International definition 25–29.9 ≥ 30 WHO10
The United States 25–29.9 ≥ 30 AHA/ACC/TOS17
Australia 25–29.9 ≥ 30 Australian Government National Health and Medical Research Council18
Asia-Pacific region 23–24.9 ≥ 25 WHO/IASO/IOTF. The Asia-Pacific perspective12
Korea 23–24.9 ≥ 25 Korean Society for the Study of Obesity2
Japan 23–24.9 ≥ 25 Japan Society for the Study of Obesity15
China 24–27.9 ≥ 28 Cooperative Meta-Analysis Group of the Working Group on Obesity in China16

WHO, World Health Organization; AHA, American Heart Association; ACC, American College of Cardiology; TOS, The Obesity Society; IASO, International Association for the Study of Obesity; IOTF, International Obesity Task Force.

Risk of comorbidity according to obesity and abdominal obesity

Classification* Body mass index (kg/m2) Risk of comorbidity according to abdominal obesity
< 90 cm (men)
< 85 cm (women)		 ≥ 90 cm (men)
≥ 85 cm (women)
Underweight < 18.5 Low Average
Normal 18.5–22.9 Average Increased
Pre-obese (overweight) 23–24.9 Increased Moderate
Class I obesity 25–29.9 High Severe
Class II obesity 30–34.9 Moderate Very severe
Class III obesity ≥ 35 Severe Very severe

Adapted from Seo et al.32

*Pre-obese may be defined as overweight or at-risk weight, and obese class III may be defined as extreme obesity.

The diagnostic criteria for abdominal obesity in other regions and countries (waist circumference, cm)

Region/Country Men Women Organization
Korea ≥ 90 ≥ 85 Korean Society for the Study of Obesity33
Europe ≥ 94 ≥ 80 IDF51
South Asia (China, Malaysia, India) ≥ 90 ≥ 80
China ≥ 90 ≥ 80
Japan ≥ 85 ≥ 90
Eastern Mediterranean and Middle East (Arab) ≥ 94 ≥ 80
Sub-Saharan Africa ≥ 94 ≥ 80
Ethnic South and Central America ≥ 90 ≥ 80
America ≥ 102 ≥ 88 AHA/NHLBI (Adult Treatment Panel III)52
Japan ≥ 85 ≥ 90 Japan Society for the Study of Obesity53
China ≥ 85 ≥ 80 Cooperative Meta-Analysis Group of the Working Group on Obesity in China16
Korea ≥ 90 ≥ 85 Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity (2020)54
Japan ≥ 85 ≥ 90
Jordan ≥ 98 ≥ 96
China ≥ 80 ≥ 80
Tunisia ≥ 85 ≥ 85
India ≥ 90 ≥ 80
Iran ≥ 89 ≥ 91

IDF, International Diabetes Federation; AHA, American Heart Association; NHLBI, National Heart Lung and Blood Institute; IAS, International Atherosclerosis Society; ICCR, International Chair on Cardiometabolic Risk.

References

Go to
  1. Yang YS, Han BD, Han K, Jung JH, Son JW; Taskforce Team of the Obesity Fact Sheet of the Korean Society for the Study of Obesity. Obesity fact sheet in Korea, 2021: trends in obesity prevalence and obesity-related comorbidity incidence stratified by age from 2009 to 2019. J Obes Metab Syndr 2022;31:169-77.
    Pubmed KoreaMed CrossRef
  2. Seo MH, Kim YH, Han K, Jung JH, Park YG, Lee SS, et al. Prevalence of obesity and incidence of obesity-related comorbidities in Koreans based on National Health Insurance Service Health Checkup Data 2006-2015. J Obes Metab Syndr 2018;27:46-52.
    Pubmed KoreaMed CrossRef
  3. 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
  4. Gray DS, Fujioka K. Use of relative weight and body mass index for the determination of adiposity. J Clin Epidemiol 1991;44:545-50.
    Pubmed CrossRef
  5. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;9:88.
    Pubmed KoreaMed CrossRef
  6. Heymsfield SB, Peterson CM, Thomas DM, Heo M, Schuna JM Jr, Hong S, et al. Scaling of adult body weight to height across sex and race/ethnic groups: relevance to BMI. Am J Clin Nutr 2014;100:1455-61.
    Pubmed KoreaMed CrossRef
  7. Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes (Lond) 2008;32:959-66.
    Pubmed KoreaMed CrossRef
  8. Strain GW, Zumoff B. The relationship of weight-height indices of obesity to body fat content. J Am Coll Nutr 1992;11:715-8.
    Pubmed CrossRef
  9. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract 2016;22 Suppl 3:1-203.
    Pubmed CrossRef
  10. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:1-253.
  11. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987-1003.
    Pubmed CrossRef
  12. World Health Organization. The Asia-Pacific perspective: redefining obesity and its treatment. WHO; 2000.
  13. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
    Pubmed CrossRef
  14. American Diabetes Association. Standards of medical care in diabetes-2022 abridged for primary care providers. Clin Diabetes 2022;40:10-38.
    Pubmed KoreaMed CrossRef
  15. Takahashi H, Mori M. Characteristics and significance of criteria for obesity disease in Japan 2011. Nihon Rinsho 2013;71:257-61.
  16. Zhou BF; Cooperative Meta-Analysis Group of the Working Group on Obesity in China. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci 2002;15:83-96.
  17. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the obesity society. J Am Coll Cardiol 2014;63(25 Pt B):2985-3023.
    KoreaMed CrossRef
  18. Australian Government, National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. NHMRC; 2013.
  19. Korean Society for the Study of Obesity. 2019 Obesity fact sheet. KOSSO; 2019.
  20. Abdullah A, Peeters A, de Courten M, Stoelwinder J. The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies. Diabetes Res Clin Pract 2010;89:309-19.
    Pubmed CrossRef
  21. Bays HE, Chapman RH, Grandy S; SHIELD Investigators' Group. The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys. Int J Clin Pract 2007;61:737-47.
    Pubmed KoreaMed CrossRef
  22. Rea TD, Heckbert SR, Kaplan RC, Psaty BM, Smith NL, Lemaitre RN, et al. Body mass index and the risk of recurrent coronary events following acute myocardial infarction. Am J Cardiol 2001;88:467-72.
    Pubmed CrossRef
  23. Schienkiewitz A, Schulze MB, Hoffmann K, Kroke A, Boeing H. Body mass index history and risk of type 2 diabetes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Am J Clin Nutr 2006;84:427-33.
    Pubmed CrossRef
  24. Strazzullo P, D'Elia L, Cairella G, Garbagnati F, Cappuccio FP, Scalfi L. Excess body weight and incidence of stroke: metaanalysis of prospective studies with 2 million participants. Stroke 2010;41:e418-26.
    Pubmed CrossRef
  25. Nam GE, Park HS. Perspective on diagnostic criteria for obesity and abdominal obesity in Korean adults. J Obes Metab Syndr 2018;27:134-42.
    Pubmed KoreaMed CrossRef
  26. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, et al; Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;373:1083-96.
    Pubmed CrossRef
  27. Tobias DK, Pan A, Jackson CL, O'Reilly EJ, Ding EL, Willett WC, et al. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med 2014;370:233-44.
    Pubmed KoreaMed CrossRef
  28. Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, et al. BMI and all cause mortality: systematic review and nonlinear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016;353:i2156.
    Pubmed KoreaMed CrossRef
  29. Jee SH, Sull JW, Park J, Lee SY, Ohrr H, Guallar E, et al. Bodymass index and mortality in Korean men and women. N Engl J Med 2006;355:779-87.
    Pubmed CrossRef
  30. Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr 2009;12:497-506.
    Pubmed CrossRef
  31. Di Angelantonio E, Bhupathiraju ShN, Wormser D, Gao P, Kaptoge S, et al; Global BMI Mortality Collaboration. Bodymass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016;388:776-86.
    Pubmed CrossRef
  32. Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, et al. 2018 Korean Society for the Study of Obesity guideline for the management of obesity in Korea. J Obes Metab Syndr 2019;28:40-5.
    Pubmed KoreaMed CrossRef
  33. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 2007;75:72-80.
    Pubmed CrossRef
  34. Bedogni G, Pietrobelli A, Heymsfield SB, Borghi A, Manzieri AM, Morini P, et al. Is body mass index a measure of adiposity in elderly women? Obes Res 2001;9:17-20.
    Pubmed CrossRef
  35. Frankenfield DC, Rowe WA, Cooney RN, Smith JS, Becker D. Limits of body mass index to detect obesity and predict body composition. Nutrition 2001;17:26-30.
    Pubmed CrossRef
  36. Lau DC; Obesity Canada Clinical Practice Guidelines Steering Committee and Expert Panel. Synopsis of the 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ 2007;176:1103-6.
    Pubmed KoreaMed CrossRef
  37. Moyer VA; U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;157:373-8.
    CrossRef
  38. Dimitriadis K, Tsioufis C, Mazaraki A, Liatakis I, Koutra E, Kordalis A, et al. Waist circumference compared with other obesity parameters as determinants of coronary artery disease in essential hypertension: a 6-year follow-up study. Hypertens Res 2016;39:475-9.
    Pubmed CrossRef
  39. Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, et al; Emerging Risk Factors Collaboration. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet 2011;377:1085-95.
    Pubmed CrossRef
  40. Seo DC, Choe S, Torabi MR. Is waist circumference ≥102/88cm better than body mass index ≥30 to predict hypertension and diabetes development regardless of gender, age group, and race/ethnicity? Meta-analysis. Prev Med 2017;97:100-8.
    Pubmed CrossRef
  41. van Dis I, Kromhout D, Geleijnse JM, Boer JM, Verschuren WM. Body mass index and waist circumference predict both 10-year nonfatal and fatal cardiovascular disease risk: study conducted in 20,000 Dutch men and women aged 20-65 years. Eur J Cardiovasc Prev Rehabil 2009;16:729-34.
    Pubmed CrossRef
  42. Reis JP, Allen N, Gunderson EP, Lee JM, Lewis CE, Loria CM, et al. Excess body mass index- and waist circumferenceyears and incident cardiovascular disease: the CARDIA study. Obesity (Silver Spring) 2015;23:879-85.
    Pubmed KoreaMed CrossRef
  43. Bigaard J, Tjønneland A, Thomsen BL, Overvad K, Heitmann BL, Sørensen TI. Waist circumference, BMI, smoking, and mortality in middle-aged men and women. Obes Res 2003;11:895-903.
    Pubmed CrossRef
  44. Cerhan JR, Moore SC, Jacobs EJ, Kitahara CM, Rosenberg PS, Adami HO, et al. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc 2014;89:335-45.
    Pubmed KoreaMed CrossRef
  45. Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk?: evidence from an individual-participant metaanalysis of 82 864 participants from nine cohort studies. Obes Rev 2011;12:680-7.
    Pubmed KoreaMed CrossRef
  46. Jacobs EJ, Newton CC, Wang Y, Patel AV, McCullough ML, Campbell PT, et al. Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med 2010;170:1293-301.
    Pubmed CrossRef
  47. Kim YH, Kim SM, Han KD, Jung JH, Lee SS, Oh SW, et al. Waist circumference and all-cause mortality independent of body mass index in Korean population from the National Health Insurance Health Checkup 2009-2015. J Clin Med 2019;8:72.
    Pubmed KoreaMed CrossRef
  48. Koster A, Leitzmann MF, Schatzkin A, Mouw T, Adams KF, van Eijk JT, et al. Waist circumference and mortality. Am J Epidemiol 2008;167:1465-75.
    Pubmed CrossRef
  49. Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation 2008;117:1658-67.
    Pubmed CrossRef
  50. Staiano AE, Reeder BA, Elliott S, Joffres MR, Pahwa P, Kirkland SA, et al. Body mass index versus waist circumference as predictors of mortality in Canadian adults. Int J Obes (Lond) 2012;36:1450-4.
    Pubmed KoreaMed CrossRef
  51. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome: a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006;23:469-80.
    Pubmed CrossRef
  52. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
    Pubmed CrossRef
  53. Examination Committee of Criteria for 'Obesity Disease' in Japan; Japan Society for the Study of Obesity. New criteria for 'obesity disease' in Japan. Circ J 2002;66:987-92.
    Pubmed CrossRef
  54. Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol 2020;16:177-89.
    Pubmed KoreaMed CrossRef
  55. National Institutes of Health. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. NIH; 2002.
  56. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995;854:1-452.
  57. Ito H, Nakasuga K, Ohshima A, Maruyama T, Kaji Y, Harada M, et al. Detection of cardiovascular risk factors by indices of obesity obtained from anthropometry and dual-energy X-ray absorptiometry in Japanese individuals. Int J Obes Relat Metab Disord 2003;27:232-7.
    Pubmed CrossRef
  58. Kim MK, Han K, Kwon HS, Song KH, Yim HW, Lee WC, et al. Normal weight obesity in Korean adults. Clin Endocrinol (Oxf) 2014;80:214-20.
    Pubmed CrossRef
  59. Kim SG, Ko Kd, Hwang IC, Suh HS, Kay S, Caterson I, et al. Relationship between indices of obesity obtained by anthropometry and dual-energy X-ray absorptiometry: the Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV and V, 2008-2011). Obes Res Clin Pract 2015;9:487-98.
    Pubmed CrossRef
  60. Kendler DL, Borges JL, Fielding RA, Itabashi A, Krueger D, Mulligan K, et al. The official positions of the international society for clinical densitometry: indications of use and reporting of DXA for body composition. J Clin Densitom 2013;16:496-507.
    Pubmed CrossRef
  61. Micklesfield LK, Goedecke JH, Punyanitya M, Wilson KE, Kelly TL. Dual-energy X-ray performs as well as clinical computed tomography for the measurement of visceral fat. Obesity (Silver Spring) 2012;20:1109-14.
    Pubmed KoreaMed CrossRef
  62. Pietiläinen KH, Kaye S, Karmi A, Suojanen L, Rissanen A, Virtanen KA. Agreement of bioelectrical impedance with dual-energy X-ray absorptiometry and MRI to estimate changes in body fat, skeletal muscle and visceral fat during a 12-month weight loss intervention. Br J Nutr 2013;109:1910-6.
    Pubmed CrossRef
  63. Sardinha LB, Lohman TG, Teixeira PJ, Guedes DP, Going SB. Comparison of air displacement plethysmography with dualenergy X-ray absorptiometry and 3 field methods for estimating body composition in middle-aged men. Am J Clin Nutr 1998;68:786-93.
    Pubmed CrossRef

Supplementary

Supplementary 1

Share this article on :

Related articles in Jomes

more