The prevalence of obesity among elderly populations is a matter of increasing concern. Elderly obesity is a pathophysiologically complex issue, and predictions regarding obesity-related comorbidity and weight management are challenging. As individuals age, changes in the body composition, such as increase in fat mass and decrease in muscle mass, are observed even in the absence of changes in body weight and body mass index. Hence, body mass index and other indices of obesity should be cautiously interpreted in the elderly, and weight loss should be recommended for obese elderly individuals with functional limitations or metabolic complications that may improve with weight loss. By the year 2026, more than 20% of the Korean population will be aged 65 years or older, and this along with the obesity epidemic is expected to pose an increasingly serious financial problem for the Korean healthcare system. This review summarizes the epidemiology of obesity in Korea, the clinical implications of elderly obesity, and considerations regarding weight management. Understanding the complexity of elderly obesity could facilitate the design of preventative and therapeutic strategies that would have a positive impact on the overall health of the Korean population.