Active treatment needed for childhood·adolescent obesity

One in three children and adolescents in Korea is obese

Traditional diet-based therapies have clear limitations, calling for a paradigm shift in treatment.

With interest in obesity management becoming higher than ever with the introduction of Mounjaro and Wegovy, attention is also gathering to neglected areas.

 

In particular, the rising prevalence of childhood obesity and the limited treatment options have raised the need for improved treatment environments.

 

Globally, obesity has become the most common nutritional disorder among children, leading to physical problems such as growth hormone deficiency, precocious puberty, and polycystic ovary syndrome, as well as psychosocial issues including low self-esteem, depression, and anxiety.

 

Since children and adolescents are continuously growing in height and weight, obesity is diagnosed using body mass index (BMI) percentiles based on sex and age.

 

According to the Korean Society for the Study of Obesity’s Clinical Practice Guidelines (2022, 8th edition), children aged two years and older should be assessed using the 2017 growth chart: BMI at or above the 85th percentile is considered overweight, and at or above the 95th percentile is considered obese.

 

◆Childhood and adolescent obesity is on a continuous rise...Korea is also at risk The problem is the sharp increase in the childhood and adolescent obesity population.

 

According to a pooled analysis by the World Health Organization (WHO) and Imperial College London, the number of obese children and adolescents has increased by more than tenfold over the past 40 years.

 

By analyzing BMI and obesity prevalence trends from height and weight measurements in populations aged 5 and older across 200 countries between 1975 and 2016, the prevalence of childhood obesity rose from less than 1% in 1975 to 6% among girls and 8% among boys in 2016.

 

This indicates a steady global rise in both the number and proportion of children affected by obesity, with particularly sharp increases in regions such as the Middle East and North Africa, South Asia, East Asia, and high-income English-speaking countries.

 

Prevalence of Pediatric and Adolescent Obesity in Korea

In line with global trends, obesity prevalence among Korean children and adolescents has also been on the rise.

 

According to the “2021 National Health Statistics” published by the Korea Disease Control and Prevention Agency, obesity prevalence among boys aged 6–18 increased to 19.5% in the 8th survey period from 11.1% in the 5th (a 1.76-fold increase), while among girls it rose to 12.7% from 9.2%, which is a 1.38-fold increase.

 

Also, a sample survey of elementary, middle, and high school students released by the Ministry of Education in April showed that 29.3% of students fell into the overweight or obese category last year—which is roughly one in three.

 

◆Academic community aligns with clinical guidelines...recommends drug therapy Given this situation, clinical guidelines for childhood and adolescent obesity are also evolving.

 

Notably, the necessity for more direct treatment approaches, including previously conservative drug therapy, is increasingly being raised.

 

According to the guidelines released on January 9, 2023, by the American Academy of Pediatrics (AAP) for the evaluation and treatment of childhood obesity, pharmacological therapy is recommended for children aged two and older, and surgical interventions are permitted from age 13 onward—emphasizing active intervention from the early stages of diagnosis.

 

The recommended medications include Saxenda (liraglutide), Wegovy (semaglutide), Xenical (orlistat), and Qsymia (phentermine/topiramate).

 

This has sparked debate by overturning the tendency to prioritize traditional dietary and behavioral therapies in children and adolescents, but it also underscores the urgent need for obesity management in severely obese children and adolescents.

 

Korea has also recognized the need for pharmacotherapy.

 

In 2022, the Korean Society for the Study of Obesity recommended considering drug therapy under the supervision of experienced specialists if intensive diet, exercise, and behavioral therapy fail to control ongoing weight gain and obesity-related comorbidities in children Furthermore, the first guidelines on childhood obesity that was published in Asia, which was in 2019, covered the ▲definition and diagnosis of overweight and obesity in children, ▲treatment principles of pediatric obesity, ▲behavioral therapy (including diet, exercise, lifestyle, and mental health), ▲pharmacological treatment, and ▲surgical treatment.

 

For each area, they established recommendations and their respective levels of evidence (Level A–D).

 

Professor Hye-Woon Jung of Kyung Hee University Hospital’s Department of Pediatrics said, “Lifestyle intervention is important for severely obese children and adolescents, but it may not be enough.

 

In such cases, active pharmacological treatment should be considered.

 

Although some medications are approved for severe pediatric obesity, treatment options remain limited in Korea.”