Q. What exactly are the criteria for class II/III (severe) obesity? Also, why is it said that it's harder to lose weight once you reach this level?

During my own studies, I struggled with weight control. I remember trying to starve myself out of sheer willpower, only to end up feeling dizzy and seeing my productivity plummet. Having gone through that trial and error, I realized that at the level of severe obesity, the simple formula of 'eat less, move more' often fails. Medically, severe obesity is not just about excess weight; it is a state characterized by high insulin resistance, which makes blood glucose regulation difficult and increases inflammatory markers. This leads to 'metabolic stagnation,' where the body continuously tries to store energy but fails to burn it when necessary. In Traditional Korean Medicine (TKM), this is viewed as a state of exacerbated 'Dameum' (phlegm-fluid) and 'Eohyeol' (blood stasis). Dameum refers to the sticky accumulation of metabolic waste, while Eohyeol refers to stagnant, impure blood. When these two block the body's pathways, the efficiency of exercise and herbal treatments inevitably decreases. Particularly for those with 'Bi-heo' (Spleen Deficiency), the impaired ability to transport and absorb nutrients leads to chronic fatigue and low energy. If such individuals attempt extreme fasting, the body perceives a crisis and clings more tightly to fat stores. Therefore, the core of managing severe obesity is not forced weight loss, but rather opening the blocked circulatory pathways to create an internal environment where the body can naturally expend energy again.