obesity is associated with many illnesses that are related to , and might be caused by , excess fat . obesity is associated with increased risks of type 2 diabetes mellitus ( t2 dm ) , hypertension , dyslipidemia , metabolic syndrome , coronary heart disease , other atherosclerotic diseases , non - alcoholic steatohepatitis , and gout . obesity substantially increases the risk of morbidity from osteoarthritis , low back pain , sleep apnea , asthma , and stress incontinence , as well as cancers of the endometrium , breast , prostate , and colon . since the impact of obesity on health is enormous , much effort has been made to find optimal managements . this practice guideline is designed to help patients to achieve and sustain weight loss , so as to prevent these chronic diseases . in white populations , obesity is widely defined as a body mass index ( bmi ) 30 kg / m and is a key risk factor for diabetes . asian populations generally have a higher percentage of body fat than do western populations at the same bmi levels . consequently , the world health organization ( who ) recommends that cutoff values for the definition of overweight and obese should be lower for asian populations than for western populations . in a prospective cohort study of more than 1 million koreans , the average baseline bmi in both sexes was 23.2 , and the death rate from any cause had a j - shaped association with the bmi , regardless of cigarette - smoking history . the risk of death from any cause was lowest among patients with a bmi of 23.0 to 24.9 . in cohorts of east asians , including chinese , japanese , and koreans , the lowest risk of death was seen among persons with a bmi of 22.6 to 27.5 . there is a significantly increased risk of t2 dm and hypertension among those with a bmi of 23 to 24.9 , as compared to those within the normal range . the cutoffs used for the definition of obesity are based on the excess morbidity and mortality associated with increasing body fat content . consequently , for the korean population , we defined overweight based on an increase in morbidity and obesity based on an increase in mortality : overweight is defined as a bmi of 23 to 24.9 kg / m and obesity as a bmi 25 kg / m . current estimates are that 32.8% of adults are obese : 36.1% of men and 29.7% of women . based on the who recommendations , the waist circumference ( wc ) cutoff for asians was suggested as 90 cm for men and 80 cm for women , respectively , which was different from that of other ethnic groups such as europeans . however , applied the who asia - pacific criteria , the prevalence of abdominal obesity in korea was 20% in men and 40% in women , so the prevalence of abdominal obesity in men was two times higher than in women . therefore , the study of the wc cutoff points for defining abdominal obesity in koreans was performed using the data from the korean national health and nutritional examination survey 1998 . the optimal wc to predict the risk factors of metabolic syndrome in koreans , was 82 to 84 cm for men , and 79 to 82 cm for women . wc in the 80th percentile in the korean population is 90 and 86.5 cm for men and women , respectively . abdominal obesity is defined as a wc 90 cm for men and 85 cm for women in korea . when assessing a patient for treatment of overweight and obesity , consider the patient 's weight , wc , and presence of risk factors . management involves not only weight loss and maintenance of body weight but also measures to control other risk factors . since obesity is associated with increased risks of hypertension , dyslipidemia , diabetes mellitus ( dm ) , and a host of other comorbidities , the clinician should assess patients for associated conditions . some obesity - associated disease and risk factors place patients at very high - risk for subsequent mortality . patients with these diseases will require aggressive modification of risk factors in addition to the clinical management of the disease . in obese patients , control of cardiovascular risk factors deserves the same emphasis as weight loss therapy . since sustained weight loss of as little as 3% to 5% of body weight can lead to clinically meaningful reductions in cardiovascular risk factors and dm risk , as an initial goal , we recommend the loss of 5% to 10% of baseline weight within 6 months . typically , in patients undergoing a lifestyle intervention , the maximum weight loss is achieved in 6 months , followed by a plateau , and then a gradual regain over time . this is also true for medication - assisted weight loss , although the regain in weight might be slower with continued medication use . for bariatric surgery patients patients should be advised that participation in a long - term ( > 1 year ) weight - maintenance program ( dietary , physical activity , and behavior therapy ) can improve successful weight maintenance . weight loss requires creating an energy deficit through caloric restriction , physical activity , or both . an energy deficit of > 500 kcal / day can typically be achieved with a dietary intake of 1,200 to 1,500 kcal / day for women and 1,500 to 1,800 kcal / day for men . the choice of calorie - restricted diet can be individualized to the patient 's preferences and health . very low - calorie diets ( < 800 kcal / day ) should be used only in limited circumstances in a medical care setting where medical supervision and high - intensity lifestyle intervention can be provided . alcohol consumption not only increases the number of calories in the diet but has also been associated with obesity in epidemiologic studies . the impact of alcohol calories on a person 's overall caloric intake needs to be assessed and controlled appropriately . although various diets ( low - fat , low - carbohydrate , or high protein diet , etc . ) can be used , it should be a calorie - reduced , nutritionally balanced diet . therefore , we recommend prescribing a calorie - reduced diet based on the patient 's health profile and food preferences . if a specialized diet for cardiovascular risk reduction , dm , or other medical conditions is prescribed , referral to a dietician is recommended . this includes monitoring the patient 's requirements for medication change as weight loss progresses , particularly for antihypertensive medications and diabetes medications that can cause hypoglycemia . physical activity should be an integral part of weight - loss therapy and weight maintenance . initially , moderate levels of physical ( aerobic ) activity for 30 to 60 minutes or 20 to 30 minutes twice , 5 days per week , should be encouraged . the exercise prescription should include the mode of activity and frequency , intensity , and duration of exercise . resistance training should be progressive in nature , individualized , and stimulate all of the major muscle groups . one set of 8 to 10 exercises that conditions the major muscle groups twice a week is recommended . comprehensive lifestyle interventions usually provide a structured behavior - change program that includes regular self - monitoring of food intake , physical activity , and weight . these same behaviors are recommended to maintain lost weight , with the addition of frequent monitoring of body weight . pharmacotherapy is recommended as an adjunct to comprehensive lifestyle intervention to help achieve targeted weight loss and health goals for individuals with a bmi > 25 kg / m or a bmi > 23 kg / m with more than one obesity - associated comorbid condition ( dm , hypertension , dyslipidemia , or sleep apnea ) in patients who are motivated to lose weight ( table 1 ) . drugs should be used only as part of a program that includes diet , physical activity , and behavior therapy . since sustained weight loss of as little as 3% to 5% of body weight can lead to clinically meaningful reductions in cardiovascular risk factors and dm risk , as an initial goal we recommend the loss of 5% to 10% of baseline weight within 6 months . if a patient does not lose 2 kg in the first 4 weeks after initiating therapy , the likelihood of a long - term response is very low . if a patient does not respond to a drug with reasonable weight loss , the clinician should assess whether the patient is adhering to the medication regimen and adjunctive therapies , and the need to adjust the dosage . if the patient continues to be unresponsive ( less than 5% to 10% weight loss of baseline weight for 3 months ) to the medication , or serious adverse effects occur , the clinician should consider discontinuing the treatment . currently , orlistat is approved by the korea food and drug administration ( kda ) for long - term use ( 1 year ) in weight loss . phentermine , diethylpropion , phendimetrazine , and mazindol are approved by the kda for short - term use ( up to 12 weeks ) in weight loss . lorcaserin ( belviq ) will be approved by kda and will be available in korea in early 2015 . it is uncertain when extended release phentermine and topiramate combination ( qysmia ) and sustained release bupropion and naltrexone ( contrave ) become available to patients in korea . for adults with a bmi > 40 kg / m or a bmi > 35 kg / m with obesity - related conditions who fail to respond to behavioral treatment ( with or without pharmacotherapy ) with sufficient weight loss to achieve targeted health outcome goals , bariatric surgery might be an appropriate option to improve health . asian populations have an elevated risk of t2 dm , hypertension , and dyslipidemia at a relatively low bmi . at international federation for the surgery of obesity and metabolic disorders asia pacific chapter consensus statements , it was recommended that bariatric surgery may be considered as a treatment option for obesity in people of asian ethnicity with a bmi > 35 kg / m with or without comorbidities . in adults with morbid obesity , bariatric surgery produces greater weight loss and weight loss maintenance than that produced by standard care or conventional medical treatment . the surgical treatment of obesity and metabolic disorders requires a multidisciplinary approach with a team that includes surgeons , physicians , psychiatrists , dieticians , counselors , and others , as needed . the dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in korea . the early detection and proper management of obesity are urgently needed . since obesity is multifactorial , proper care of obesity requires a coordinated multidisciplinary treatment team . it is unlikely that a single intervention can modify the incidence or natural history of obesity . although more evidence and clinical trials should be undertaken , appropriate clinical practice guidelines for koreans with obesity have been developed and updated to provide better clinical outcomes .
the dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in korea . 
 obesity is defined as a body mass index 25 kg / m2 in korea . 
 current estimates are that 32.8% of adults are obese : 36.1% of men and 29.7% of women . 
 the prevalence of being overweight and obese in national surveys is increasing steadily . 
 early detection and the proper management of obesity are urgently needed . 
 weight loss of 5% to 10% is the standard goal . in obese patients , 
 control of cardiovascular risk factors deserves the same emphasis as weight - loss therapy . 
 since obesity is multifactorial , proper care of obesity requires a coordinated multidisciplinary treatment team , as a single intervention is unlikely to modify the incidence or natural history of obesity .