- KOREAN
- P-ISSN2951-0333
- E-ISSN2951-0597
Vol.4 No.2
Abstract
The Lancet Commission recently proposed a diagnostic paradigm that redefines obesity based on the presence or absence of adiposity-related tissue and organ dysfunction, classifying individuals as having either preclinical or clinical obesity . This framework shifts the diagnostic focus away from body mass index (BMI) as the primary criterion and addresses the inherent limitations of BMI-based classification. By emphasizing functional impairments attributable to excess adiposity, the Commission advances a pathophysiologically grounded approach to assessing obesity-related health risks. In this review, we discuss the rationale for incorporating the concept of clinical obesity into routine clinical practice and outline key considerations for its application in real-world settings.
Abstract
The 2025 Lancet Commission proposed a new framework for diagnosing obesity, defining ‘Clinical Obesity’ as a chronic, systemic disease resulting from excess adiposity leading to detectable changes in the function of tissues, organs, or the whole individual. Conversely, ‘Preclinical Obesity’ is defined as a state of excess adiposity without major signs or symptoms of organ dysfunction, signifying an elevatedrisk of progression to clinical obesity or obesity-related diseases, but not classified as a disease state within their structure. While this framework advances the field significantly, concerns are raised regarding the classifying it merely as a health risk.The visibly corpulent appearance and excessive body weight characteristic of excess adiposity should be recognized as its salient, observable clinical signs and symptoms.Analogous to early stage hypertension or diabetes, preclinical obesity should be recognized as an early stage of the chronic disease where secondary preventive treatment is strongly warranted within a critical therapeutic window, aligning with the contemporary chronic disease care model. Furthermore, the extensive list of organ dysfunctions, which often necessitates high-cost medical investigation, presents challenges for the clinical applicability of the clinical obesity diagnosis. The exclusion of major obesity-related conditions such as diabetes, pre-fibrotic steatotic liver disease, and coronary artery obstructive disease, from the functional dysfunction criteria raises questions about the framework’s logical consistency. In conclusion, excess adiposity should be considered a disease entity in itself, irrespective of the presence of secondary organ dysfunction. Preclinical obesity must be recognized and actively managed as the early stage of a chronic disease.
Abstract
The Lancet Diabetes & Endocrinology Commission recently introduced a new definition of obesity, termed “clinical obesity.” This concept expands the traditional Body Mass Index (BMI)-based definition by classifying obesity as a disease when excess adiposity is accompanied by obesity-related organ dysfunction or functional limitations. In contrast, individuals with increased adiposity but without such abnormalities are categorized as having preclinical obesity. The Commission discourages reliance on BMI alone for assessing excess adiposity. Instead, the framework recommends a range of measures, including waist circumference, waist-to-height ratio, body composition analysis (ex. Dual-energy X-ray Absorptiometry and Bioelectrical Impedance Analysis), and visceral fat imaging. Clinical symptoms, comorbid conditions, and functional limitations are then integrated to determine whether a patient meets the criteria for clinical obesity. However, several challenges persist. First, the lack of a clear cutoff or standardized threshold for excess adiposity may create uncertainty in clinical practice. Second, it is often difficult to distinguish whether organ dysfunction is directly attributable to obesity or driven by pre-existing susceptibility. Third, although the new definition may support treatment prioritization and reimbursement decisions, it also raises concerns about the potential undertreatment of individuals categorized as having preclinical obesity. Additionally, the framework may conflict with existing clinical or policy structures for obesity management. Therefore, fully adopting this new definition requires further discussion and refinement. In particular, establishing updated, Korean-specific diagnostic and treatment guidelines for obesity is critical to ensure appropriate clinical application and policy alignment.
Abstract
Background: Obesity is a global public health challenge, and YouTube has emerged as a primary source of health information. To develop effective health communication strategies, researchers must understand the relationship between content topics and user engagement. However, systematic analyses of obesity-related Koreanlanguage YouTube content are limited. Methods: We collected Korean-language YouTube videos uploaded between January 1, 2020, and September 30, 2025, using obesity-related keywords. We performed Latent Dirichlet Allocation (LDA)-based topic modeling on video subtitles. We compared user engagement metrics (exposure velocity, engagement rate, interaction velocity, and popularity index) across six uploader types: individual creators, media, hospitals, medical professionals, government/public institutions, and academic organizations. Results: Of the 2,798 videos identified, those by individual creators were the most prevalent (43.4%). User engagement metrics differed significantly across uploader types (P＜0.001). Individual creators led in exposure velocity (10.91 views/day), whereas hospitals exhibited the highest engagement rate (1.8%). LDA modeling identified 11 topics, categorized broadly into medical treatment (49.8%) and lifestyle management (34.3%). Topic distribution differed significantly across uploader types (P＜0.001); specifically, individual creators emphasized exercise and diet (29.0%), whereas hospitals concentrated on bariatric surgery (43.7%). Practical topics, such as abdominal obesity management (exposure velocity: 111.99 views/day) and home training exercises (exposure velocity: 27.54 views/day), elicited substantially higher user engagement than did specialized medical topics (P＜0.001). Conclusion: User engagement and topic distribution in obesity-related YouTube content differ by uploader type. Individual creators drive faster dissemination, and practical, action-oriented topics disseminate more rapidly than specialized medical topics.
Abstract
Obesity is a multifactorial metabolic disorder characterized by energy imbalance, chronic inflammation, and insulin resistance. Regular exercise is one of the most effective non-pharmacological interventions for improving metabolic health by enhancing energy expenditure, fat oxidation, and insulin sensitivity. This review compares the physiological and metabolic effects of various exercise modalities applied for obesity management, including aerobic exercise, high-intensity interval training (HIIT), low-intensity steady-state exercise (LISS), resistance training, and concurrent exercise. Aerobic exercise improves cardiorespiratory fitness and promotes lipid oxidation, whereas HIIT induces rapid metabolic activation and enhances insulin sensitivity with high time efficiency. LISS provides stable fat oxidation and high adherence, particularly for obese or high-risk individuals. Resistance training increases lean body mass and resting metabolic rate, thereby supporting long-term weight maintenance. Concurrent exercise combines the advantages of both aerobic and resistance training, improving body composition, mitochondrial function, and metabolic flexibility. Collectively, exercise interventions play a crucial role in reversing obesity-related metabolic dysfunction, and personalized, combined, and sustainable exercise strategies are most effective for long-term obesity management.
Abstract
Young-onset type 2 diabetes mellitus (T2DM), defined as diagnosis before the age of 40 years, has emerged as a major public health challenge worldwide. Its prevalence has risen markedly over the past decade, paralleling the increase in obesity rates among adolescents and young adults. Compared with later-onset disease, youngonset T2DM exhibits distinct clinical and pathophysiological characteristics, including more severe insulin resistance, rapid ß-cell decline, and early deterioration of glycemic control. Contributing factors include obesity, strong familial predisposition, genetic susceptibility, intrauterine hyperglycemia, puberty-related insulin resistance, and early-life determinants such as small for gestational age (SGA) or low birth weight (LBW). Patients with this condition experience a substantially higher risk of premature microvascular and macrovascular complications; furthermore, long-term mortality—reflected by substantial standardized mortality ratios—far exceeds that of the general population. Despite the aggressive nature of the disease, therapeutic options remain limited for adolescents, highlighting the need for individualized management. Early, intensive lifestyle intervention and weight reduction can induce diabetes remission in selected patients, whereas novel agents such as Glucagon-Like Peptide-1 (GLP-1) receptor agonists and Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors show promise for expanded use. To optimize long-term outcomes in this high-risk population, clinicians must understand the epidemiology, pathophysiology, and clinical course of young-onset T2DM.
Abstract
Obesity in older adults constitutes a distinct clinical entity shaped by age-related changes in body composition, chronic inflammation, neuromuscular decline, and multimorbidity. In later life, weight loss carries metabolic benefits and functional risks: intentional weight reduction can ameliorate hypertension, diabetes, hepatic steatosis, sleep apnea, and mobility issues, yet may also accelerate muscle and bone mass loss, thereby worsening gait speed, balance, and independence. Accordingly, management must prioritize muscle preservation, physical function, and quality of life rather than weight reduction alone. Dietary interventions emphasizing adequate protein intake, moderate caloric restriction, and anti-inflammatory dietary patterns, such as the Mediterranean can optimize body composition while minimizing sarcopenia risk. Exercise—particularly resistance training—is the most effective strategy to maintain muscle mass, strength, and mobility, and it should be integrated with aerobic training. As incretin-based anti-obesity medications become widely available, their use in older adults requires careful assessment of frailty, baseline muscle function, and lean mass loss risk; furthermore, combined nutrition and exercise support is essential. A frailty-centered perspective is critical: in individuals with frailty or sarcopenia, functional preservation often supersedes weight loss, whereas healthy older adults may benefit from modest, well-supervised weight reduction. Ultimately, the most effective strategy is prevention—maintaining a healthy weight, muscle mass, and physical activity from midlife onward to mitigate later-life sarcopenia, visceral adiposity, and metabolic decline. Managing obesity in older adults demands a function-centered, individualized, and life-course–oriented clinical framework.
Abstract
Concomitant metabolic dysfunction-associated steatotic liver disease (MASLD) and autoimmune hepatitis (AIH) complicates diagnosis, even when liver biopsy is performed. Furthermore, corticosteroid treatment can exacerbate steatosis, often impeding a complete biochemical response. As a result, assessing the histological response remains challenging, even when performing follow-up liver biopsies. Although implementing lifestyle modifications can normalize liver enzyme levels, most patients are unable to achieve adequate weight loss. In contrast, the use of semaglutide facilitated a more effective improvement in liver tests when compared to general lifestyle modifications, thereby enabling clearer assessment of liver function deterioration due to MASLD. Here, we report two cases of a diagnostic trial using semaglutide in patients with MASLD combined with AIH.
Abstract
Obesity is a well-recognized risk factor for chronic kidney disease (CKD), and proteinuria is an important predictor of progression to end-stage renal disease. Semaglutide, a Glucagon-Like Peptide-1 (GLP-1) receptor agonist, has demonstrated renoprotective potential through weight reduction, anti-inflammatory effects, and improvement in glomerular hyperfiltration. We present a case involving a 27-year-old male with class III obesity (BMI 35.1 kg/m²) and persistent proteinuria. Semaglutide was initiated to address obesity-related renal injury, alongside lifestyle modification and angiotensin receptor blocker administration. Over 20-week follow-up period, the patient achieved significant weight reduction (−13 kg; 14% of baseline weight). Concurrently, proteinuria improved markedly, from dipstick grade +++ (~300 mg/dL) and spot urine protein 247.7 mg/dL at baseline to ++ (~100 mg/dL) and 67.7 mg/dL of follow-up. The urine protein-to-creatinine ratio (UPCR) decreased from 0.93 g/g Cr at baseline to 0.37 g/g Cr at follow-up. Renal function remained stable throughout the observation period. This case suggests that semaglutide may improve obesityassociated proteinuria. However, given the limitations inherent to a single-patient, short-term observation, long-term follow-up and controlled studies are required to validate durability and mechanistic pathways of renal benefit.