The overlooked crisis of youth obesity

Shin Sung-sik

The author is a welfare specialist reporter at the JoongAng Ilbo. 

A heated debate has emerged over the government's plan to extend National Health Insurance coverage to hair-loss treatment for young people. The Ministry of Health and Welfare recently confirmed that treatment for androgenetic alopecia, including male-pattern hair loss, will be covered beginning in the second half of this year. The proposal stems from President Lee Jae Myung's youth policy agenda and has reignited questions about whether health insurance is becoming politicized. Critics argue that the measure conflicts with the fundamental purpose of Korea's social health insurance system, which is to prioritize serious illnesses.

At a Cabinet meeting and emergency economic review on Tuesday, Lee said the government must "take young people's sense of alienation seriously." During a ministry policy briefing last December, he argued that many young people faithfully paid insurance premiums but received little in return despite facing pressing needs. He first raised the issue of hair loss, asking whether insurance coverage had been considered, before also questioning officials about obesity treatment. When Health and Welfare Minister Jeong Eun-kyeong replied that the issue was under review, Lee pressed for a timetable.

Lee has long shown a particular interest in hair-loss treatment. During the 2022 presidential campaign, he proposed insurance coverage for hair-loss medication as one of his "small but certain happiness" pledges. That emphasis has inevitably pushed obesity treatment down the policy agenda. Last December, Jeong argued that hereditary hair loss had limited medical significance and expressed reservations about insurance coverage, though she now appears to have changed her position.

Meanwhile, doctors say patients with severe obesity continue to wait.

One example is a 34-year-old man with autism who has a body mass index (BMI) of 49.3. At 183 centimeters (6 feet) tall and 165 kilograms (364 pounds), he suffers from diabetes, hypertension and hyperlipidemia. Because his developmental disability makes conventional weight management nearly impossible, physicians say antiobesity drugs such as Wegovy or Mounjaro are medically essential rather than optional.

Another patient, a 22-year-old woman with diabetes, reduced her weight from 107 kilograms to 90 kilograms with diabetes medication, but her progress has stalled. Her physician says Ozempic could further improve both her diabetes and obesity, yet strict reimbursement rules place it beyond her reach.

Obesity among young Koreans is also increasing rapidly. According to the Korea National Health and Nutrition Examination Survey, the obesity rate among people aged 19 to 29 rose from 27.6 percent in 2019 to 33.5 percent in 2024. The rate also increased among those in their 30s and 40s.

Oh Sang-woo, a professor of family medicine at Dongguk University Ilsan Hospital, does not advocate covering obesity medication for everyone. Instead, he argues that priority should go to socially vulnerable groups, including people with disabilities, psychiatric disorders and low incomes, who often cannot manage their weight independently. Even patients who undergo bariatric surgery frequently regain weight. "Which is more urgent," he asks, "insurance coverage for obesity medication or for hair-loss treatment?"

Patients with Prader-Willi syndrome face even greater challenges. The rare genetic disorder causes an uncontrollable drive to eat, forcing many families to lock refrigerators to prevent constant food seeking. Most patients have a BMI above 40 and also live with intellectual disabilities. Earlier this year, three patients in their 20s died, including a woman whose obesity-related sleep apnea proved fatal. Lee Eun-young, head of the Korea Prader-Willi Syndrome Association, says insurance coverage for antiobesity medication is often the only realistic treatment option.

Article 1 of the National Health Insurance Act defines the program's purpose as preventing, diagnosing, treating and rehabilitating disease and injury while supporting childbirth. It is difficult to find a clear legal basis for covering ordinary hair loss. The rationale for routine obesity treatment may also be limited. Morbid obesity, however, is comparable to other serious illnesses. Left untreated in young adulthood, it frequently progresses into diabetes, kidney disease, fatty liver disease, cardiovascular disease and fatal sleep apnea later in life.

The views of young patients themselves reinforce that distinction. Several office workers in their early 30s who take inexpensive hair-loss medication said insurance coverage would be welcome but should not come before treatment for severe diseases. A 31-year-old man with obesity summed up the issue simply: "Hair loss affects quality of life. Obesity affects whether you continue living."