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

First, Sasang constitutional medicine (四象體質) provides a broad framework. For example, Tae-eum type often has slower metabolism with Spleen Qi Deficiency (脾虛) as a cause, while So-yang type tends to have excessive heat leading to appetite issues or Phlegm-Rheum (痰飲) accumulation. Within pattern identification, Spleen Qi Deficiency refers to impaired digestion and absorption causing nutrients to store as fat; Phlegm-Rheum involves stagnant body fluids causing edema; Blood Stasis (瘀血) indicates poor circulation, often associated with abdominal obesity or pain. Digestive status is assessed: strong appetite, bloating after meals, frequent constipation or diarrhea. Gaining weight despite small intake suggests Spleen Qi Deficiency or Kidney Deficiency (腎虛); binge eating with regret may involve Liver Qi Depression (肝鬱). Cold extremities indicate low metabolism. Lifestyle factors: irregular meals or late-night eating disrupt Spleen-Stomach rhythm worsening Spleen Qi Deficiency; lack of exercise generates Phlegm-Rheum and Blood Stasis; stress leads to Liver Qi Depression affecting appetite hormones; sleep deprivation affects leptin/ghrelin. Body shape and symptoms: upper body obesity (abdominal) correlates with Phlegm-Rheum or Spleen Qi Deficiency; lower body obesity (thighs/hips) links to Kidney Deficiency or coldness; severe edema suggests Phlegm-Rheum or Dampness (水濕); accompanying fatigue indicates Qi Deficiency (氣虛). All these factors are synthesized to determine the primary pathogenesis of obesity. In practice, pulse diagnosis (脈診) and abdominal diagnosis (腹診) further refine the analysis.