Q. I've heard that the causes of obesity differ depending on body constitution. What criteria are used to analyze this?

Yes, as you mentioned, even the same excess weight can have different causes. I initially wondered, 'It's all just fat—why treat it differently?' but after some trial and error, I realized that the approach must differ significantly based on constitution and organ state. In Korean medicine, analysis primarily uses the Sasang constitutional types (四象體質) and organ deficiency-excess (臟腑虛實). For example, Soeumin type often has spleen deficiency (脾虛), leading to water retention even from just drinking water, poor digestion, and easy fat accumulation. In contrast, Taeumin type has relatively strong liver function but easily develops phlegm-fluid (痰飮)—sticky waste products—resulting in prominent abdominal obesity. In clinical practice, we use ▶ pulse diagnosis (脈診) to assess the strength of organ qi, ▶ tongue diagnosis (舌診) to detect blood stasis (瘀血) or phlegm-fluid, and ▶ abdominal diagnosis (腹診) to check epigastric tenderness and periumbilical tension. Combined with the patient's dietary habits, sleep, and stress responses, we classify the individual as, for instance, 'spleen deficiency + blood stasis type' or 'liver stagnation + phlegm-fluid type,' and then prescribe herbal medicine and lifestyle guidance accordingly. Ultimately, the criterion is to find which metabolic pathway is blocked in the body. It's not just about constitution alone; a comprehensive assessment of where the current body state is straining is crucial.