Q. Doctor, why do I seem to gain weight even if I only drink water while others lose it so easily? Is it really just a lack of willpower?

Many patients struggle with what they call 'unfair weight gain,' and there are clear physiological reasons behind it. Western medicine identifies insulin resistance as a primary culprit; when metabolic function is compromised, cells refuse to take in energy, and excess sugar is converted directly into body fat. From a Traditional Korean Medicine (TKM) perspective, this state is called Spleen Deficiency (Biheo). When the Spleen—the organ responsible for digestion and nutrient transformation—weakens, the body loses its 'fire' to burn energy. The resulting metabolic residue turns into a sticky, stagnant toxin called Phlegm-fluid (Dameum). If left untreated, this leads to Blood Stasis (Eohyeol), which further clogs the blood and lymph vessels. This stagnation causes the body temperature to drop, signaling the brain to hold onto fat as a survival mechanism. You aren't gaining weight simply because you eat too much, but because your body has lost the ability to expel waste. Simply starving yourself will only make your body 'lock its doors' tighter. True obesity treatment in TKM isn't just about appetite suppression; it is about restoring Spleen function, expelling Phlegm-fluid, and clearing the metabolic pathways to allow your body to circulate energy properly again.