Q. I heard that the causes of obesity differ by constitution. What criteria are used to analyze this?

At first, the concept of 'constitutional obesity' may feel vague. In Traditional Korean Medicine, obesity is not simply a matter of calorie intake but is seen as a result of how Qi, Blood, and Body Fluids flow and function in the body. The basic framework for analyzing causes includes three main patterns. First, **Spleen Deficiency (脾虛, Bi Heo)** – the spleen's function is weak, so food cannot be properly digested and absorbed, leading to accumulation of wastes. This often presents with a protruding belly and post-meal bloating. Second, **Phlegm-Fluid (痰飮, Dam Eum)** – fluid metabolism is impaired, causing unnecessary dampness (phlegm) to accumulate. Typical signs include facial or body puffiness, excessive sweating, or frequent phlegm. Third, **Blood Stasis (瘀血, Eo Hyeol)** – blood circulation is blocked, preventing waste removal and causing localized buildup. This is common in those with stubborn fat on thighs/buttocks, cold extremities, or severe menstrual pain. The analysis uses a simple checklist: ✓ body shape and fat distribution (upper body suggests blood stasis, lower body phlegm-fluid, abdomen spleen deficiency); ✓ appetite and digestion (constant hunger indicates Stomach Heat; gaining weight despite low intake suggests Spleen Deficiency or Phlegm-Fluid); ✓ coldness and fatigue (general coldness and low energy point to Qi and Blood deficiency; heat with sweating suggests Damp-Heat); ✓ stress response (emotional overeating when angry indicates Liver Qi Stagnation, which leads to different dieting failure patterns). By listening to the patient's lifestyle and physical responses, we can identify the dominant pattern, e.g., 'This is mainly a Phlegm-Fluid issue.' However, mixed patterns are common, so a more precise diagnosis through pulse and abdominal examination is done during consultation. Constitutional guessing without diagnosis is unreliable, but with step-by-step treatment, obesity can be effectively managed.