I was going to start on what I saw as the potential imbalances that might cause someone to be fat but being thorough, I wanted to define fat before doing so.
I started with Giovanni Maciocia’s Foundations of Chinese Medicine (yeah, really the older one). In the index, there is no reference to the words,”fat”, “overweight”, or “obesity”. So I read through the organ systems, paying particular attention to the spleen and stomach areas. No reference to fat. I recall reading somewhere that fat was dampness so I also paid particular attention to any damp related pathology as well as triple warmer. Nothing on “fat”.
Next, I looked through the pathologies of each organ, once again paying particular attention to spleen and stomach. Not one pathology references “fatness” or “obesity” as a symptom.
Finally I got to his chapter on the five constitutional types. Earth types were drawn as being rather heavy and in fact, it talks about earth types as having a large stomach (looks “fat” in the drawing) as well as large muscles. Water too appears to carry some extra weight all over and is considered a constitutional type. There is no mention of defining this person as fat or treating a water type for being fat. This is considered a constitutional type that is built this way, unlike the wood type that does look naturally slender.
I also looked in Maciocia’s Practice of Chinese Medicine. Again there is no listing for “fat” or “obesity” in any of the syndromes or in the index. He does talk about the excess dampness under the skin being oedema but that is different from “fat”.
Of course, overeating is mentioned and the distention of the stomach and fullness that can cause illness when one overeats. Again, this is different from being fat given that the vast majority of fat people did not get there because they ate too much.
This leads me to wonder what people are reading when they talk about Chinese Medicine and obesity. I talked to a friend who is very well versed in Classical Chinese Medicine. His response was that he doesn’t recall reading anything about fat. The ancient Chinese were much more likely to have starvation and famine and underweight was probably a bigger problem. As to treating fat, well you’d go by the imbalances and once in balance the body would find it’s own normal weight (whatever that is).
There is discussion of dampness residing in the muscles, but I’m not sure that it manifests as fat so much as it manifests as that early morning muscle stiffness. After all, colds often start out that way as well. It could also be referring, as Maciocia did, to oedema under the skin.
That means that any acupuncture practitioner who is determining if someone is fat is doing so by modern standards. So that leads us to BMI, which of course really doesn’t mean anything. BMI is as arbitrary and inaccurate as height/weight charts. In fact, in 1998, the BMI charts changed so that people in the normal range suddenly became overweight because the classification changed, not because they gained any weight. Additionally there are a variety of recommendations for different BMI classifications as to what is normal versus overweight.
The other option is the waist/hip ratio. This is great for those of us who gain weight on our hips and thighs. However, if like most earth and water types, one puts on weight around the belly, one will still be considered fat even if it is normal for the person’s constitutional type. I’m not sure what I am. I have a BMI of 33 and a normal hip/waist ratio so do I split the difference and come out “overweight”? Slightly fat?
Even using modern standards, there are no set standards for the point at which a normal person becomes fat. Like beauty, fat, for the most part appears to be a cultural manifestation. Now I haven’t had the time to look through everything in terms of defining fat to see if there is some objective standard. However, I’ve done as more or more research into this than the vast majority of people who claim to treat “fat”. For me, this offers a level of concern over why any acupuncture practitioner, who is treating the whole person, would want to treat someone for being fat, when no one has asked what is too much. After all, everyone has some fat, that’s normal. The question becomes when it is it abnormal from a health perspective versus abnormal from a cultural sense of what is beautiful? That’s not something we can tell by looking at someone and I’m not sure there is anything in the classics that offers me a place to start.