Background: This study aimed to analyze the medical expenses covered by the Korean National Health Insurance Service (KNHIS) according to body mass index (BMI) in Korean adults. Methods: We included 1,170,464 adults (623,498 men and 546,966 women) aged ≥19 years from the KNHISNational Sample Cohort database (2016 to 2019) after excluding individuals with cancer. Average annual medical expenses per person and average annual medical expenses (Korean won [KRW], 1 United States dollar=1,292 KRW) by BMI classification were assessed according to age and sex. Medical expenses comprised those for medication and combined outpatient department (OPD) and hospitalization services. Means and 95% confidence intervals were analyzed using a two-part model. Results: Average annual medical expenses increased in higher BMI quintile groups (P for trend <0.001). Average annual medical expenses per person increased significantly as BMI increased in women but not in men. Average annual medical expenses were highest in the highest quintile of BMI among women and in all age groups.While BMI showed a U-shape association with medical expenses for OPD and hospitalization in young individuals, medical expenses for medication in all age groups and those for OPD and hospitalization in middle-aged individuals increased sharply in the highest BMI quintile. Conclusion All types of average annual medical expenses increased in higher BMI groups in Korean adults, particularly in women. Individuals with the highest BMI quintile incurred the greatest medical expenses among women and across all age groups. Strategies for preventing and managing obesity are warranted to reduce the burden of obesity-related medical expenses.

Obesity is a chronic disease associated with substantial health consequences, including cardiovascular disease, type 2 diabetes, and certain cancers. Although lifestyle modifications remain foundational to treatment, pharmacotherapy has become a crucial strategy, particularly for patients unable to achieve sustained weight loss. This review aims to provide an updated overview of long-term anti-obesity medications, discussing their mechanisms of action, efficacy, safety profiles, clinical applicability, and future perspectives on emerging therapeutic agents.Current Concepts: Recent pharmacological advancements have substantially transformed obesity management. Glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide (2.4 mg) and the dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist tirzepatide (15 mg) have demonstrated significant weight loss effects (15–21%) and have shown benefits across various obesity-related comorbidities, including type 2 diabetes, cardiovascular disease, and heart failure with preserved ejection fraction. Additionally, investigational agents such as CagriSema, retatrutide, and oral GLP-1 receptor agonists hold promise for enhanced efficacy and improved patient convenience. These developments underscore a shift toward personalized, mechanism-based pharmacotherapy.Discussion and Conclusion: Despite encouraging outcomes, significant challenges remain. Issues such as weight regain after discontinuation, limited long-term safety data, and access barriers due to high treatment costs continue to present obstacles. In Korea, the absence of insurance reimbursement for most anti-obesity medications severely restricts patient access, even among high-risk populations. Given the recognition of obesity as a chronic, relapsing disease, treatment strategies should incorporate the individual patient's comorbidity profile and personal needs. Alongside pharmacologic advancements, healthcare policies must evolve to ensure equitable medication access and optimize clinical outcomes.

Background: This study aimed to analyze the medical expenses covered by the Korean National Health Insurance Service (KNHIS) according to body mass index (BMI) in Korean adults. Methods: We included 1,170,464 adults (623,498 men and 546,966 women) aged ≥19 years from the KNHISNational Sample Cohort database (2016 to 2019) after excluding individuals with cancer. Average annual medical expenses per person and average annual medical expenses (Korean won [KRW], 1 United States dollar=1,292 KRW) by BMI classification were assessed according to age and sex. Medical expenses comprised those for medication and combined outpatient department (OPD) and hospitalization services. Means and 95% confidence intervals were analyzed using a two-part model. Results: Average annual medical expenses increased in higher BMI quintile groups (P for trend <0.001). Average annual medical expenses per person increased significantly as BMI increased in women but not in men. Average annual medical expenses were highest in the highest quintile of BMI among women and in all age groups.While BMI showed a U-shape association with medical expenses for OPD and hospitalization in young individuals, medical expenses for medication in all age groups and those for OPD and hospitalization in middle-aged individuals increased sharply in the highest BMI quintile. Conclusion All types of average annual medical expenses increased in higher BMI groups in Korean adults, particularly in women. Individuals with the highest BMI quintile incurred the greatest medical expenses among women and across all age groups. Strategies for preventing and managing obesity are warranted to reduce the burden of obesity-related medical expenses.

Background: This study aimed to analyze the medical expenses covered by the Korean National Health Insurance Service (KNHIS) according to body mass index (BMI) in Korean adults. Methods: We included 1,170,464 adults (623,498 men and 546,966 women) aged ≥19 years from the KNHISNational Sample Cohort database (2016 to 2019) after excluding individuals with cancer. Average annual medical expenses per person and average annual medical expenses (Korean won [KRW], 1 United States dollar=1,292 KRW) by BMI classification were assessed according to age and sex. Medical expenses comprised those for medication and combined outpatient department (OPD) and hospitalization services. Means and 95% confidence intervals were analyzed using a two-part model. Results: Average annual medical expenses increased in higher BMI quintile groups (P for trend <0.001). Average annual medical expenses per person increased significantly as BMI increased in women but not in men. Average annual medical expenses were highest in the highest quintile of BMI among women and in all age groups.While BMI showed a U-shape association with medical expenses for OPD and hospitalization in young individuals, medical expenses for medication in all age groups and those for OPD and hospitalization in middle-aged individuals increased sharply in the highest BMI quintile. Conclusion All types of average annual medical expenses increased in higher BMI groups in Korean adults, particularly in women. Individuals with the highest BMI quintile incurred the greatest medical expenses among women and across all age groups. Strategies for preventing and managing obesity are warranted to reduce the burden of obesity-related medical expenses.

Obesity is a chronic disease associated with substantial health consequences, including cardiovascular disease, type 2 diabetes, and certain cancers. Although lifestyle modifications remain foundational to treatment, pharmacotherapy has become a crucial strategy, particularly for patients unable to achieve sustained weight loss. This review aims to provide an updated overview of long-term anti-obesity medications, discussing their mechanisms of action, efficacy, safety profiles, clinical applicability, and future perspectives on emerging therapeutic agents.Current Concepts: Recent pharmacological advancements have substantially transformed obesity management. Glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide (2.4 mg) and the dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist tirzepatide (15 mg) have demonstrated significant weight loss effects (15–21%) and have shown benefits across various obesity-related comorbidities, including type 2 diabetes, cardiovascular disease, and heart failure with preserved ejection fraction. Additionally, investigational agents such as CagriSema, retatrutide, and oral GLP-1 receptor agonists hold promise for enhanced efficacy and improved patient convenience. These developments underscore a shift toward personalized, mechanism-based pharmacotherapy.Discussion and Conclusion: Despite encouraging outcomes, significant challenges remain. Issues such as weight regain after discontinuation, limited long-term safety data, and access barriers due to high treatment costs continue to present obstacles. In Korea, the absence of insurance reimbursement for most anti-obesity medications severely restricts patient access, even among high-risk populations. Given the recognition of obesity as a chronic, relapsing disease, treatment strategies should incorporate the individual patient's comorbidity profile and personal needs. Alongside pharmacologic advancements, healthcare policies must evolve to ensure equitable medication access and optimize clinical outcomes.

Obesity is a chronic disease associated with substantial health consequences, including cardiovascular disease, type 2 diabetes, and certain cancers. Although lifestyle modifications remain foundational to treatment, pharmacotherapy has become a crucial strategy, particularly for patients unable to achieve sustained weight loss. This review aims to provide an updated overview of long-term anti-obesity medications, discussing their mechanisms of action, efficacy, safety profiles, clinical applicability, and future perspectives on emerging therapeutic agents.Current Concepts: Recent pharmacological advancements have substantially transformed obesity management. Glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide (2.4 mg) and the dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist tirzepatide (15 mg) have demonstrated significant weight loss effects (15–21%) and have shown benefits across various obesity-related comorbidities, including type 2 diabetes, cardiovascular disease, and heart failure with preserved ejection fraction. Additionally, investigational agents such as CagriSema, retatrutide, and oral GLP-1 receptor agonists hold promise for enhanced efficacy and improved patient convenience. These developments underscore a shift toward personalized, mechanism-based pharmacotherapy.Discussion and Conclusion: Despite encouraging outcomes, significant challenges remain. Issues such as weight regain after discontinuation, limited long-term safety data, and access barriers due to high treatment costs continue to present obstacles. In Korea, the absence of insurance reimbursement for most anti-obesity medications severely restricts patient access, even among high-risk populations. Given the recognition of obesity as a chronic, relapsing disease, treatment strategies should incorporate the individual patient's comorbidity profile and personal needs. Alongside pharmacologic advancements, healthcare policies must evolve to ensure equitable medication access and optimize clinical outcomes.

The traditional definition of obesity, relying solely on body mass index, inadequately captures individual health status and is insufficient for guiding therapeutic interventions. In January 2025, The Lancet Diabetes & Endocrinology Commission proposed a paradigm-shifting redefinition that introduces the concepts of “clinical obesity” and “preclinical obesity.” Clinical obesity is defined as a chronic, systemic illness characterized by excess adiposity resulting in functional impairments in tissues, organs, or overall individual health. In contrast, preclinical obesity involves excess adiposity without current functional impairment. This review examines the significance of this new diagnostic paradigm for cardiovascular disease prevention and risk assessment. From a cardiovascular perspective, the new framework offers several advantages: it facilitates personalized intervention strategies based on individual risk profiles, refines cardiovascular risk assessments by incorporating body fat distribution and functional parameters, promotes more efficient resource allocation, and shifts treatment goals toward functional improvements beyond mere weight loss. Although further research is required to evaluate practical implementation and long-term outcomes, this novel approach represents a substantial advancement in obesity management and cardiovascular disease prevention.

In patients with type 2 diabetes mellitus (T2DM), diabetic kidney disease (DKD) is diagnosed based on clinical features. A kidney biopsy is used only in selected cases. This study aimed to reconsider the role of a biopsy in predicting renal outcomes. Methods: Clinical and laboratory parameters and renal biopsy results were obtained from 237 patients with T2DM who underwent renal biopsies at Soonchunhyang University Cheonan Hospital between January 2000 and March 2020 and were analyzed. Results: Of 237 diabetic patients, 29.1% had DKD only, 61.6% had non-DKD (NDKD), and 9.3% had DKD with coexisting NDKD (DKD/NDKD). Of the patients with DKD alone, 43.5% progressed to end-stage kidney disease (ESKD), while 15.8% of NDKD patients and 36.4% of DKD/NDKD patients progressed to ESKD (p < 0.001). In the DKD-alone group, pathologic features like ≥50% global sclerosis (p < 0.001), tubular atrophy (p < 0.001), interstitial fibrosis (p < 0.001), interstitial inflammation (p < 0.001), and the presence of hyalinosis (p = 0.03) were related to worse renal outcomes. The Cox regression model showed a higher risk of progression to ESKD in the DKD/NDKD group compared to the DKD-alone group (hazard ratio [HR], 2.73; p = 0.032), ≥50% global sclerosis (HR, 3.88; p < 0.001), and the degree of mesangial expansion (moderate: HR, 2.45; p = 0.045 and severe: HR, 6.22; p < 0.001). Conclusion: In patients with T2DM, a kidney biopsy can help in identifying patients with NDKD for appropriate treatment, and it has predictive value.

Purpose: To evaluate the effectiveness of an instrument devised for slit-lamp examination of donor corneas suspended in preservation medium. Methods: The study examined two donor corneas received at Yeouido St. Mary's Hospital in February 2023 and March 2023. The instrument has three main components: a plastic holder to hold the preservation medium bottle, a cube with a mirror for reflecting the slit beam, and a stand to attach the device to the slit-lamp. Using the instrument, the donor corneas were examined via slit-lamp: microscopy with the endothelium facing upward and downward. Specular microscopy and anterior segment optical coherence tomography (OCT) were also performed on the preserved donor corneas. Results: Slit-lamp examination of donor corneas in preservation medium using the instrument showed overall corneal buttoning and optical sections of the donor cornea. Using specular reflection and retroillumination, the endothelial layer was partially visible. However, specular microscopy and anterior segment OCT could not examine the donor cornea in preservation medium using the instrument. Conclusions The devised instrument facilitates slit-lamp examination of donor corneas in preservation medium, enabling a qualitative assessment of donor corneas before corneal transplantation surgery.

Background: Evidence on the association between obesity parameters, including body mass index (BMI) and waist circumference (WC), and osteoarthritis is limited. This study aimed to investigate these associations in Korean adults. Methods: This nationwide cross-sectional study used data from 24,101 adults aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey 2016–2020. Odds ratios (ORs) and 95% confidence intervals (CIs) for osteoarthritis according to BMI and WC were analyzed using multivariable logistic regression analyses. Results: The prevalence of osteoarthritis was higher in individuals with general (10.0%) and abdominal obesity (12.8%) compared with those without. Greater BMI and WC were associated with a higher prevalence (P<0.001) and risk of osteoarthritis (Model 3, P for trend <0.001). Individuals with general and abdominal obesity were associated with a 1.50-fold (OR, 1.50; 95% CI, 1.35–1.67) and 1.64-fold (OR, 1.64; 95% CI, 1.47–1.84) increased risk of osteoarthritis, compared with those without. Similar associations were observed in subgroups according to age, sex, smoking status, and presence of diabetes mellitus. The odds of osteoarthritis 1.73-fold increased (OR, 1.73; 95% CI, 1.53–1.95) in individuals with both general and abdominal obesity compared with those without any of them. Conclusion Greater BMI, WC, and general and abdominal obesity were associated with an increased risk of osteoarthritis in Korean adults. Appropriate management of abdominal and general obesity may be important to reduce the risk of osteoarthritis.