The health of North Korea's leaders is typically a tightly held state secret in a nuclear-armed country dominated by the Kim family dynasty since its founding in 1948.
Current leader Kim Jong Un, believed to be 37 years old, sparked new speculation when in early June he appeared to have lost significant weight.
State media made a rare mention of the issue last week by quoting an unnamed Pyongyang resident who said everyone was concerned about the "emaciated" leader.
Here are other ways that North Korea's government has handled reports about its supreme leaders' health over the years.
Missed Anniversary
In early 2020, speculation about Kim's health exploded after he was not shown in state media coverage of the birth anniversary celebrations of state founder Kim Il Sung on April 15.
State outlets never mentioned or explained the absence, despite intense speculation and rumours in international media.
South Korea's spy agency said in May 2020 that Kim was performing his duties normally but had reduced public activity due to coronavirus concerns.
'Discomfort'
In 2014, speculation that an unusually long absence from public view may have been due to Kim's ill health was fuelled by a rare North Korean TV report that he was suffering from "discomfort," which was regarded as an implicit acknowledgement that he was sick.
In a pre-recorded documentary broadcast by state media, Kim appeared to have difficulty walking.
Later, a senior North Korean official on a rare visit to South Korea denied that the country's young leader was ill, saying there was "no problem at all," according to a South Korean official at the time.
Secret Death
The death of Kim Jong Un's father and predecessor, Kim Jong Il, by heart attack was announced on Dec. 19, 2011, when he was reported by official media to have died on December 17.
According to North Korean state media at the time, his passing was marked by plunging temperatures, mourning bears and flocks of magpies.
Dismissing Reports
In October 2008, state media said news reports about Kim Jong Il's health were false, after US and South Korean officials said he may have suffered a stroke several months before.
A French doctor who had treated Kim in Pyongyang told a French newspaper the North Korean leader had suffered a stroke but did not undergo an operation and had recovered.
A year earlier, Kim denied he was in bad health, saying reports of him showing signs of illness at the time were the work of "fiction writers."
Forbidden Filming
Kim Jong Un's grandfather, North Korea's founder Kim Il Sung, had a large and inoperable tennis-ball sized growth on the back of his neck which meant state media were forbidden from filming him from certain angles.
Kim Il Sung ruled North Korea until his death in 1994.
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