Does Korea have an obesity problem?

SOUTH KOREA - The figure sounds alarming: Almost 1 in 4 Seoul citizens are not just overweight, but obese. So reported Seoul Metropolitan Government last month with the release of a survey of more than 23,000 residents aged 19 and older.

The figure represented the fourth straight rise since 2008, when 20.6 per cent of the city's population were classified as obese. The report may have come as a surprise to many Koreans who have travelled to Western countries, not to mention the city's foreign residents: Seoul would not appear to be a city of large people, especially compared to urban centers in North America and Europe.

Such a reaction would not simply be a matter of perception: the high figure is partly a result of Korea's strict standards for defining obesity relative to Western countries. The use of body mass index, an indication of body fat derived from height and weight, is where similarities in assessment end. Whereas other developed countries and international organisations such as the Organisation for Economic Cooperation and Development and World Health Organisation define obesity as a BMI of 30 or higher, Korea uses a BMI of 25 or above.

As a result, the OCED regards just 4 per cent of Korea's population as obese, the lowest proportion among member countries. The proportion of the public considered to be obese or overweight rises to 30 per cent.

Whether different standards should be used to assess obesity among Koreans and other East Asians remains an unsettled question.

"It is true that for some Asian countries we can use lower levels of BMI to define these thresholds, but there is no consensus on that question," Marion Devaux, an OECD health analyst, told The Korea Herald. "We use one unit of comparison across countries."

While the WHO has reported that East Asians have higher body fat percentages at lower BMIs, it has recommended that standardized cutoff rates be retained for international comparison.

Government response

On the other hand, Oh Sang-woo, a professor of medicine at Dongguk University International Hospital's Center for Obesity, Metabolism, and Clinical Nutrition, said that it made sense for Koreans to be measured by a harsher standard than other ethnicities.

"(The) cutoff point of obesity in Asians should differ from that of Westerners. Previously, many studies showed that Asians are more vulnerable to obesity complications ― type 2 diabetes, dyslipidemia, hypertension, and others ― than Western populations," said Oh.

"For example, Americans are much more highly obese than Koreans. But the prevalence of type 2 diabetes, hypercholesterolemia, hypertriglyceridemia, hypertension and others in Koreans is similar to that of Americans. We believe that differences in genetic and environmental factors cause this differential effect of obesity on these diseases."

The Ministry of Health and Welfare shares a similar view. Kim Yoo-mi, deputy director of the dietary and life nutrition taskforce at the ministry, said that Japan, China and Southeast Asian countries used the same, lower BMI to define obesity.

"It is because Asians with BMI over 25 usually start to show symptoms of obesity-related diseases like hypertension and diabetes," said Kim. "It is not that Korea has legally put BMI 25 as the standard point for obesity. But it is under discussion whether to legally enshrine the use of a BMI of 25 when defining obesity."

Kim said the ministry's current goal was to keep the obesity rate stable in the coming years by encouraging people to maintain a healthy weight.

Child obesity

But whether using international or localized standards, an indiscriminate scan of the figures doesn't reveal the nuances of the situation in Korea. While obesity overall is low by international comparison, child obesity is relatively high.

"For adult obesity, Korean performs quite well. As you have said, OECD figures show 3-4 per cent of adults are overweight but for children it is different," said Devaux.

"And we have about 35 per cent and 22 per cent of girls which are overweight or obese … The average is about 20 (per cent) across OECD countries. For instance, the level of child obesity in Korea is broadly the same as the level in the US"

Not everyone, however, is convinced that obesity in Korea is that serious a problem, especially compared to the issues of malnourishment and body image anxiety. Although extreme obesity among women has doubled since the late 90s, the proportion of women classified as underweight has dramatically increased over the same period. In 2010, almost 20 per cent of young women were regarded as underweight by the government.

Ahn Chang-hye, a sociology graduate student and sex education instructor, said the pressure on young people, and women in particular, to conform to idealized body standards was a much more pressing concern than obesity at present.

"It depends on the age, but I still don't take obesity itself as a serious problem compared to the body image issues," said Ahn. "At least for younger people, I think the body image issue is so huge, obesity won't be a big deal for a while. I mean, unlike many other Koreans choose to believe."

Ahn said this pressure was especially strong for Koreans compared to other nationalities.

"People (in Korea) are more likely to make direct comments about other people's appearance and there is very little awareness that those comments can be unnecessary or inappropriate," said Ahn.

"Many Koreans hear multiple, repeated comments about their weight by family members, friends, and acquaintances on a more direct and offensive level."

Public health

But despite Korea's low obesity prevalence compared to other rich countries, Oh warned that the problem was far from trivial. He said that the increase in the size of Koreans was already having a major impact on public health.

"Recently, disease patterns in Korea have rapidly changed due to obesity. Several decades ago, diseases such as tuberculosis, hepatitis B, lung cancer ― due to smoking ― stomach cancer and stroke were the most common life-threatening ailments. But these patterns have changed rapidly with the rise of the obesity epidemic," said Oh.

"Obesity-related conditions such as type 2 diabetes, cardiovascular disease, breast cancer and colon cancer have become prevalent and the main causes of death in Korea. So, the recent obesity epidemic in Korea wields a great influence on disease patterns in Korea."