[Reporter's View] New obesity drug sparks dilemma

Gray area between 'misuse or abuse' and treatment

Following approval of an expanded indication for Wegovy (semaglutide), a Glucagon-like Peptide-1 (GLP-1)- based obesity treatment, to include adolescents aged 12 and older in South Korea, the discussion surrounding pediatric and adolescent obesity has once again come into the spotlight.

 

While the global market already defines pediatric obesity as a medical disease requiring early intervention, South Korea is still lagging in both social awareness and institutional support.

 

Obesity cannot be explained merely as an aesthetic or lifestyle issue.

 

In particular, obesity during the growth period is highly likely to persist into adulthood.

 

It serves as the starting point for chronic diseases such as Type 2 diabetes, hypertension, non-alcoholic fatty liver disease, and cardiovascular disease.

 

The Obesity Fact Sheet 2025, published by the Korean Society for the Study of Obesity (KSSO), demonstrates this reality.

 

Although the obesity rate in children and adolescents has slightly decreased in the last five years, approximately three out of 10 are still classified as obese.

 

The obesity rate peaked at age 14 for boys and after age 16 for girls.

 

It was also confirmed that the probability of obesity in children is five times higher if their parents are in obesity class 2 or higher.

 

The problem is that it does not end with simple weight gain.

 

Adult chronic diseases such as Type 2 diabetes, hypertension, and liver disease are actually increasing among obese and overweight children and adolescents.

 

The pace of change has accelerated to the point where Type 2 diabetes in adolescents is no longer considered a rare condition in modern clinical practice.

 

Experts note that obesity during the growth period is not a short-term problem; instead, the timing of exposure determines the severity of the disease.

 

Obesity starting early in life has a prolonged duration, increasing the risk of complications and potentially exploding lifelong management costs and medical burden.

 

The current situation is different from the era when obesity was dismissed as merely an aesthetic concern.

 

Despite this severe situation, the treatment environment in South Korea remains stagnant.

 

While innovative treatments like GLP-1 drugs have emerged, the perception that obesity is a treatable disease is spreading among adult patients.

 

Conversely, in the U.S., major new obesity drugs have already been approved for adolescents and are actively used in clinical practice.

 

Although South Korea tends to tighten regulations due to concerns over misuse and abuse, some critics suggest that patients in need are being deprived of the right to choose treatment.

 

Obesity cannot be explained solely by willpower or lifestyle choices.

 

Appetite is a biological system involving the pituitary-hypothalamic axis, adipose tissue, and various hormones.

 

It is structurally harder for growing adolescents to control their appetite than it is for adults.

 

Without addressing the underlying physiological factors, lifestyle modifications alone will inevitably face apparent limitations.

 

However, drug therapy is not an answer for everyone.

 

The effectiveness of obesity treatments is maximized when combined with healthy lifestyle modifications.

 

Especially during the growth period, lifestyle education, continuous counseling, and long-term management are essential.

 

However, experts are deeply concerned that delaying drug treatment for adolescents who already show signs of complications, such as hypertension, elevated liver enzymes, or pre-diabetes, will exponentially increase the future disease burden.

 

The core of the problem is the social frame through which obesity is viewed.

 

Many still interpret obesity as a failure of lifestyle or lack of willpower, and the perception exists that obesity during childhood and adolescence will 'naturally resolve itself as individuals grow.' However, obesity during the growth period cannot be solved by time.

 

Delayed early intervention exponentially increases long-term health risks and places an even greater medical and social burden on the patient than adult obesity.

 

While the perception of obesity as a disease is slowly being built, regulations remain overly strict, and access to treatment is restricted.

 

While preventing misuse is critical, a situation where even patients in need cannot access medication is another form of neglect.

 

What is needed now is not more regulation, but balance.

 

Ensuring safety and preventing misuse must be fundamental policy goals, but those principles should not stand in the way of timely treatment.

 

Obesity during childhood and adolescence is a key turning point that determines lifelong health.

 

The treatments are available.

 

The remaining challenge is for social awareness and institutional support to catch up so that these treatments can reach the patients who need them.