Obesity in South Korea

Obesity in South Korea Nah-Mee Shin, Ph.D, Assistant Professor, APRN, BC (Nurse Practitioner) Korea University, College of Nursing 1 To get to know South Korea Geography: area: 98,477 sq.km. (38,022 sq.mi.); the size of Indiana. Population (2006): 48.85 million, Korea has one of the world s highest population densities (1,288/sq.mi). Capital--Seoul (10.3 million); increased urban population: 1/5 of total population in Seoul. Ethnically & linguistically homogenous population 2

Health Report of Korea Infant mortality rate (2006): 6.2/1,000. Life expectancy (2006) 79.2yrs (men 75.7yrs.; women 82.4yrs) Labor force (2005): 23.5 million. Rapidly aging population: major health problems of elders--htn, CVA, CHD; CA (stomach, liver); DM; Dementia (Korea National Statistics Office) Population annual growth rate (2006): 0.4%. 3 Life Expectancy (Year) All Female Male Gap (Female-Male) 1970 61.93 65.57 58.67 6.90 1980 65.69 70.04 61.78 8.26 1990 71.28 75.51 67.29 8.22 1995 73.53 77.41 69.57 7.84 1998 74.82 78.45 71.09 7.36 1999 75.55 79.22 71.71 7.51 2000 76.02 79.60 72.25 7.35 2001 76.53 80.04 72.82 7.22 2002 77.02 80.45 73.40 7.05 2003 77.44 80.81 73.86 6.95 2004 78.04 81.35 74.51 6.84 2005 78.63 81.89 75.14 6.75 2006 79.18 82.36 75.74 6.62 Source: KOSIS (Korean Statistical Information Service) 4

Obesity in Korea Low Risk of Obesity: only 8% had BMI >30 kg/m² (in 1996) 47% of African American women & 37% of Latino women in Detroit area (1998-2001) were overweight (BMI 25-29.9) or obese (BMI 30). http://www.nhlbisupport.com/bmi/ BMI Categories (National Heart Lung and Blood Institute) Underweight = <18.5 Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater 5 Year 1996 Total Total Prevalence of Obesity (Age 15) Over Normal Underweight Overweight Subtotal Obesity 100 20.6 21.9 1.3 58.6 19.5 City 100 21.8 23.3 1.5 57.5 19.1 Rural 100 16.2 16.8 0.6 62.5 20.6 Male 100 16 16.9 0.9 60.4 22.7 Female 100 25.1 26.9 1.8 56.8 16.5 Age 15~19 100 13 13.9 0.9 69.7 16.5 Age 20~29 100 16 17.1 1.1 65.2 17.7 Age 30~39 100 23 24.5 1.5 57.8 17.9 Age 40~49 100 26.5 28.1 1.6 54.4 17.5 Age 50~59 100 24.8 26.2 1.4 53.8 20 Age 60 100 19.4 20.8 1.4 48.9 30.4 6

Then, No Worries about Obesity? In 05, obesity rate in Korea was 3.5 (ot 27) Koreans may need a different interpretation of BMI for clinical use: BMI 25 regarded as obesity BMI 23-24.9 as overweight; BMI 18.5-22.9 normal; BMI <18.5 as underweight (WHO Asian-Pacific region) Waist circumference 90cm (36 ) for men & 85cm (34 ) for female Obesity rate in Canada is 18 (ot 32); 23 (ot 37) in England; 32.2 (ot 34) in US BMI categories (NHLBI) Obesity: 30 Overwt: 25-29.9 Nl wt: 18.5-24.9 Underwt <18.5 Waist C: 40 ( ), 35 ( ) 7 % Prevalence of Obesity in Population (age 15): {(lbs x 705)/inches} /inches Korea Japan Overweight (OT) 2001 2002 2004 2005 Obesity (OB) OT+ OB OT OB OT + OB OT OB OT + OB OT OB OT + OB 27.4 3.2 30.6 - - - - - - 27 3.5 30.5 21.4 3.2 24.6 22.2 3.6 25.8 20.3 3 23.3 - - - Canada USA Italy 31.2 13.9 45.1 - - - - - - 31.9 18 49.9 - - - 35.1 30.6 65.7 34.1 32.2 66.3 - - - 33.9 8.5 42.4 33.5 8.5 42 - - - 34.7 9.9 44.6 England 40 22 62 38 23 61 39 23 62 37 823 60 England

Why Do We Care? While prevalence of obesity (BMI 30) among Koreans remains low, prevalence of metabolic disorder, hypertension (HTN), hyperlipidemia ( total cholesterol, HDL, LDL, TG), and DM have been increasing. In 2006, stroke is the 2 nd cause of death; heart disease is the 3 rd, DM is 4 th. With the modified BMI categories, obesity rate for men increased to 35.2%, 28.3% for women. 9 Cause of Death (per 100,000) Rank 1996 Total Female Male Ratio (M/F) 1 Cancer 110.1 79.4 140.4 1.8 2 Stroke 74.7 78.4 71.0 0.9 3 Accident/Trauma 38.3 19.9 56.6 2.8 4 Heart Disease 1) 35.7 32.9 38.4 1.2 5 Liver Disease 27.3 10.5 44.0 4.2 6 DM 17.4 17.3 17.4 1.0 7 Suicide 14.1 8.7 19.4 2.2 8 Chronic Lower Respiratory Illness 14.0 12.6 15.4 1.2 9 Hypertension 13.8 15.7 12.0 0.8 10 Tuberculosis 7.3 3.8 10.7 2.8 Rank 2006 Total Female Male Ratio (M/F) 1 Cancer 134.8 97.7 171.7 1.8 2 Stroke 61.4 63.7 59.2 0.9 3 Heart Disease 1) 41.5 40.9 42.0 1.0 4 DM 23.7 23.7 23.8 1.0 5 Suicide 23.0 14.8 31.1 2.1 6 Accident/Trauma 16.0 8.6 23.3 2.7 7 Liver Disease 15.6 6.0 25.1 4.2 8 Chronic Lower Respiratory Illness 14.5 10.7 18.2 1.7 9 Hypertension 9.5 12.4 6.5 2) 0.5 10 Pneumonia 9.4 9.1 9.7 1.1 Source : Korean Statistical Information Service (Kosis) 1) ischemic heart disease and other heart dz are included 10

Age & BMI As we get older, BMI (kg/m²) increases. Male: 23.7 (40-49y/o: 24.3) Female: 23.4 (50-59y/o: 24.7; 60-69y/o: 24.9) In 2005, prevalence of obesity was high in 40s and 50s in men; 50s & 60s in women 11 Educational Background (2001) Overall, the more educated, the less BMI For female, the influence of educational background on the BMI is clear. Distribution of BMI ( 20y/o) Whole Male Female Elementary School 24.3 23.4 24.7 Junior High School 24.6 23.8 25.1 High School 23.4 23.7 23.1 2year College 22.8 23.9 21.6 12

Influence of Household Income (2001) for female, the less they In 2005, this pattern make, the more is the BMI. was repeated (Korea National Health & Nutrition for male, the more they Examination Survey: make, the more is the BMI KNHNES). Monthly household Income Whole Female Male <$1,000/month 23.4 23.6 23.2 $ 1,001-2,000 23.6 23.5 23.8 $ 2,001-3,000 23.5 23.1 24.0 >$3,000 23.3 22.7 24.1 13 Environmental Influence (KNHNES, 2005) Both men and women live in cities showed higher prevalence of obesity than people reside in rural areas in 1996 and this pattern was repeated in 2005. Year 1996 Tota l Prevalence of Obesity (Age 15) Over Overweight Subtotal Obesit y Normal Underweight Total 100 20.6 21.9 1.3 58.6 19.5 City 100 21.8 23.3 1.5 57.5 19.1 Rural 100 16.2 16.8 0.6 62.5 20.6 14

Korean Immigrants to U.S. Korea has experienced one of the largest rates of emigration; primarily, China (1.9 million), U.S. (>1.5 million), Japan, & the countries of the former Soviet Union. Korean-Americans (KA) are the fastest growing subgroup of Asian-Americans. Since 1975, Koreans have ranked in the top 5 of immigrants to the U.S. Over 1 million U.S. residents identified their race as Korean (US Census, 2000). The number of KA is expected to continue to increase. 15 Health Risk in KA As Koreans move away from their home country, their health risks are subject to change. In 1999, the most KA lived in metropolitan areas of the western U.S. (53%), and the South (20%). Depression: associated w/the process of acculturation (Choi et al., 2005; Miller et al., 2006) Nutrition: Korean diet is high in salt; high fat d/t westernized food intake (high fat), 44-66% of KA in Michigan were found to have borderline (201-240) or undesirable total cholesterol (>240). 16

Leading Cause-Specific Rates: 2000 Michigan Residents & 1999 US Residents (Source: 2000 Michigan Resident Death File; National Vital Statistics Reports, vol 49, no. 3) Rates are per 100,000 population. Cause of Death MI US Heart Disease 279 266 Cancer 200 202 Stroke 59 61 Chronic Lower Respiratory Disease 44 46 Unintentional Injuries 33 36 DM 27 25 17 U21 Health Sciences 2009 18