Humans are conquering cancer like they conquered the moon. What will be the disease accompanying humankind until the last day of Earth, then? Of numerous illnesses, many medical experts point to obesity. Why do they pick obesity, which can be solved by “just getting rid of fat,” among all the rare, retractable diseases? It’s because humans were born to like sweets.

Professor Kim Kyoung-kon of the Family Medicine Department at Gachon University Gil Medical Center pointed out that the intake of “simple sugar” in soft drinks and other foods is the cause of obesity in an interview with Korea Biomedical Review last Tuesday.

However, Kim confessed that he, too, “has a weakness for sweets.”

“Humans were born to like sweets very much. Memories imprinted on human genes for survival long ago have continued to this day. That explains why obesity has become a disease humans can neither avoid nor prevent,” he said.

Professor Kim, an authority on obesity drug treatment and metabolic surgery, took office as the sixth president of the Asia-Oceania Association for the Study of Obesity (AOASO) in September. AOASO, established in 1998, has 14 national obesity associations as its members, including Korea, Japan, Australia, India, Taiwan, and Singapore. It elects executives every four years through voting.

Kim, who also served as the AOASO director for general affairs and vice president, is the first Korean who heads the group.

Asked why Korea, one of the AOASO’s founding members, has produced its first chair only now, Professor Kim said, “That means obesity and bariatrics have begun to become important in Korea.”

Japan and Australia are the two traditional powerhouses of bariatrics in the Asia-Pacific region. Korea lags in obesity surgery, even in Asia. However, it is one of the front-runners in drug treatment levels and experiences, not lagging behind Japan and going ahead of Australia, according to Kim.

The appearance of the Korean executive branch in AOASO, led by Japan and Australia so far, means obesity is no longer individuals’ problem in Korea. The progress of bariatrics is also a “bittersweet indicator” of rising social crisis awareness of obesity.

Korea has become a society that encourages obesity. YouTubers compete to release “mukbang” (food porno shows), and foods with plenty of sugar have become popular amid reviews that they are "not sweet but delicious." Broadcasters magnify and reproduce it. It isn't easy to find drinks without liquid sugar, a simple sugar. No matter how much doctors warn people that “sweets are dangerous,” capitals, large or small, encourages obesity every moment.

Obesity experts believe that Korean society can no longer stop obesity. Professor Kim and other experts think that the obesity problem has already gone beyond the stage that can be solved by prevention. It's time to try to reduce obesity even a little. Even if the nation cannot prevent it, people have to live pestered by a society that encourages obesity, relying on the faint hope that it can be reduced little by little.

“Covid-19 is infected by virus. However, the cause of obesity is the entire environment surrounding us. All members of society are exposed to the causes of the disease. It is not a problem for one country. Obesity has entered a genuine pandemic stage,” Professor Kim said.

Accordingly, he stressed that the international community should cooperate in dealing with obesity as it did to respond to Covid-10. As the chair of AOASO, Kim tries to make the association an academic society true to its name. AOASO is an association of national obesity societies. Still, Kim wants to organize it more tightly to make a unified voice in shaping obesity policies and medical development in the Asia-Oceania region. First, the new AOASO chair plans to intervene in member countries’ academic events, as The Obesity Society (TSO) in the U.S. or the European Association for the Study of Obesity (EASO) do.

Changing governments’ obesity policies through positive intervention

“TOS and EASO deeply intervene in the composition of member countries’ academic events or inviting speakers. AOASO also plans to help young researchers and policymakers while joining member countries’ academic conferences. It will do by finding people who study and research by themselves, not in the capital areas but in regional university labs. These researchers often do not know the value of their studies,” Kim said. “We will invite them and give them opportunities to present their studies and connect excellent researchers to conduct joint studies.”

Sharing research experiences and policy outcomes among member nations and narrowing differences in capabilities is another important task. The first stage will likely be the obesity academic conference in Hong Kong next year.

Kim stresses the need for collaboration because he wants to change the obesity policies of the member nations through this. But unfortunately, many countries, including Korea, perceive obesity not as a disease but as a cosmetic issue and regard it as an individual problem, not a social one. As a result, the reality and policies lead to a mismatch.

“Above all, few people dislike delicious food. Many people dislike cigarettes, so it is easy for the government to stage a strong anti-smoking campaign. People also think they suffer damage due to smokers. They are more generous in drinking. Many like drinking and think it’s a problem that ends with them drinking alone,” Kim said. “The same goes for obesity. People say, ‘They gained weight by eating a lot. Why are you taking issue with what I eat, then?’ Popular resistance is bound to grow when the government intervenes with policy.”

The government has not been sitting idle exactly. Rather, Korea is one of the countries that have “tried hard to do this or that.” Since 2018, the government has announced policy steps, major or minor, including ongoing comprehensive measures to manage obesity. However, the problem is the lack of consistency. Like a diet plan that collapses in three days, the government has repeatedly stopped its policy if there is no result in a short period. Cooperation among government ministries and local governments was not properly made, either. That needs to change.

Close-to-life policies are also needed, like the "sugar tax," which suppresses the consumption of soft drinks added with simple sugar through price regulation and inserting phrases that warn against obesity, such as cigarettes, in food packaging with high sugar content.

Sugar tax and other close-to-life policies are also needed

“First, we should change the environment. That’s why we have stressed the prevention policy. But, of course, I think the prevention efforts have failed. That may not necessarily be a policy failure, however,” Kim said. “It’s because of human genes like sugar. Accordingly, it will require a biological method. So, the government should expand support for obesity surgery and medical treatment.”

Korea currently applies health insurance benefits only to surgical activities in obesity treatment. However, Professor Kim emphasized that in addition to the pre-operative process in Korea, post-surgery management should be reimbursed, and a system for continuous monitoring should be established. If the lifestyle itself is not corrected and managed through education, he added that surgical treatment comes to nothing.

He also stressed the need to give insurance benefits to drug treatment. Now, obesity drugs have risen to the level where they can control people’s appetite, like high blood pressure. However, it is so expensive as to be taken steadily. The government and the market treat obesity treatment as something like healthy functional food because they still tend to approach it from a cosmetic aspect rather than as medical care.

“The price of obesity treatments is different in Seoul and Incheon. Even in the same district, there are wide differences among pharmacies. Then the patient who needs to be treated with the drug suffers the most. Some people can die if they don't control their appetite and prevent complications using the medicine. Considering the cost of numerous diseases and deaths caused by obesity, the cost of turning part of the obesity treatments into reimbursable drugs will be relatively smaller.

The Korean Society for the Study of Obesity is asking the government to pay for obesity treatment for patients at risk of life. It aims to bring obesity treatment into the system and continuously evaluate performance to expand the scope of insurance benefits even little by little.

As a family medicine specialist, Professor Kim also stressed the role of primary care. He said that although new treatment methods, including drugs and substances, will continue to appear, only primary care can listen to patients’ stories, point out bad habits, and support continuous treatments.

Only when policies, market, and healthcare connect organically can the nation “continue the tug-of-war with obesity tirelessly,” Kim said.

Asked to offer some tips for succeeding in diet to prevent and manage obesity, he said, “Start with easier things.” For example, Kim said people could eat anything they want during three meals a day but refrain from eating food between meals, which he described as “intermittent fasting a la Kim Kyong-gon,” to give the body time to consume glycogen accumulated through meals.

“Why do we always fail in diet? It’s because we do it in such difficult ways. We give up diet because we do it using methods that can never continue for two months or more,” Kim said. “Likewise, the government should not make policies that it can implement persistently instead of trying something for the time being and abandoning it. The nation can take a better path in the long-term battle with obesity only when the government makes policies that can go together with more members of society.”