Q. What exactly are the criteria for severe obesity? And why does this make dieting so much harder?

From a clinical perspective, severe obesity is more than just the accumulation of fat; it is a state of systemic chronic inflammation. In Traditional Korean Medicine (TKM), this is interpreted through the concepts of 'Dameum' (phlegm-fluid retention) and 'Eohyeol' (blood stasis). 'Dameum' refers to the accumulation of metabolic waste that clouds the body's fluids, while 'Eohyeol' refers to stagnant, thickened blood that obstructs circulation. When waste products accumulate and the flow of Qi and Blood is hindered, essential nutrients cannot reach the cells responsible for burning energy. If this is coupled with 'Bi-heo' (Spleen Deficiency), your body's ability to digest, absorb, and excrete waste drops sharply, making your body feel heavy and lethargic. Essentially, your 'metabolic switch' has been turned off. Rather than simply restricting calories, it is crucial to first remove inflammation and 'Dameum' to restore metabolic efficiency. Only then will your body begin to respond to dietary and exercise efforts. Let's evaluate your current constitution together to find the right path forward.