Background and Purpose
Obesity is a growing global health issue, and despite social efforts, its complications remain a significant cause of death and disability. With its multifaceted approach, Korean Medicine (KM) is well-suited for treating and managing obesity, and is commonly practiced in Korean Medicine clinics and hospitals. In response to this need, the Society of Korean Medicine for Obesity Research and the Korea Institute of Oriental Medicine jointly published the first Obesity KM Clinical Practice guideline (CPG) in July 2016, which applied the internationally accepted GRADE methodology to assess the quality of evidence and grade of recommendation.
Subsequently, updated CPGs have been requested, incorporating new recommendations for interventions widely used in KM clinical practice, as well as new randomized controlled trials (RCTs). This updated CPG for KM employs a hybrid method that combines new developments, such as Thread Embedding Acupuncture (TEA) therapy and fasting, with the adaptations used in the original KM CPG for obesity published in 2016 and subsequent KM obesity studies. The recommendations in this CPG are focused on providing KM doctors with recommendable KM treatment for obesity in KM clinics and hospitals. Although there is insufficient scientific evidence on KM treatment, this CPG aims to provide clinically practicable recommendations applicable to the Korean clinical environment.
Overview of disease
Obesity is a chronic disease characterized by the accumulation of excess fat in the body, resulting from a disorder of energy metabolism caused by multiple complex factors. Over the past decade in South Korea, the prevalence of obesity has continuously increased, with rates rising from 29.7% in 2009 to 35.7% in 2018 in the total population (45.4% in males and 26.5% in females). The “Yellow Emperor’s Inner Canon” (黃帝內經) was the first text to discuss the etiology of obesity. Various terminologies, such as fat (肥), fat and plump (肥胖), fat person (肥人), large person (肉人), and obese person (肥貴人), were used to describe obesity in the text. The text identified excessive intake of fatty foods as a major cause of obesity (肥貴人 膏粱之疾也), confirming a high intake of fatty foods as a significant factor contributing to obesity.
KM categorizes obesity into excess syndrome (實證) caused by dampness (濕), phlegm (痰), blood stasis (瘀血), heat accumulation in the stomach and spleen (脾胃積熱), and aggregation-accumulation (積聚), and deficiency syndrome (虛證) caused by qi deficiency (氣虛), spleen deficiency (脾虛), and yang deficiency (陽虛). Furthermore, excessive eating (飮食過多), excessive nutrition (營養過剩), hypoactivity (活動過少), inherent traits (先天稟賦), physical constitution, exogenous dampness evil (外感濕邪), and endogenous seven emotions (內傷七情) are also factors that can contribute to obesity.
Notably, obesity is caused not only by an energy imbalance but also by factors such as hormonal changes, genetics, mental health, and socioeconomic status. In the South Korean ethnic group, overweight is defined as having a body mass index (BMI) of 23-24.9 kg/m2, Class 1 obesity as a BMI of 25-29.9 kg/m2, Class 2 obesity as a BMI of 30-34.9 kg/m2, and Class 3 obesity as a BMI over 35 kg/m2.
This CPG pertains to adult simple obesity with a BMI of 25 kg/m2 or higher, as defined by the Asian ethnic group obesity definition, and excludes obesity caused by other diseases.
