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Reconsideration of Body Mass Index for Diagnosing Sasang Constitution

사상체질 진단지표로서 체질량지수에 대한 재고

  • Sang-Hyuk Kim (KM Data Division, Korea Institute of Oriental Medicine)
  • 김상혁 (한국한의학연구원 한의약데이터부)
  • Received : 2024.04.24
  • Accepted : 2024.08.24
  • Published : 2024.08.25

Abstract

Recent studies have emphasized Body Mass Index (BMI) as a potential indicator for constitutional diagnosis, noting the higher BMI observed in Taeeumin compared to other constitutions. However, 『Donguisusebowon(東醫壽世保元)』 「Sasanginbyeonjeunglon(四象人辨證論)」 have indicated similarities in body shape between Taeeumin and Soeumin, suggesting that physique size alone may not be sufficient for constitutional diagnosis. This study aims to investigate the reasons for this disparity and to reassess the suitability of BMI as a diagnostic indicator for Sasang constitution. An analysis was conducted to explore the utilization of BMI across eighteen studies focused on body shape for diagnosing constitution. These studies were identified through a search of Korean medicine journals, including the Journal of Sasang Constitutional Medicine. Additionally, the body shape-related items in eleven Questionnaires for Sasang constitution diagnosis were examined. While BMI has been extensively utilized in numerous studies within the field of Sasang constitutional medicine due to its simplicity, its effectiveness is not without limitations. Despite its widespread use, BMI does not fully capture the nuanced concept of body type as delineated in 『Donguisusebowon(東醫壽世保元)』. Moreover, there has been a lack of deliberation regarding whether statistical differences in BMI between constitutions should serve as a definitive criterion for constitutional diagnosis. Ensuring external validity posed challenges in several studies, and the role of BMI was at times exaggerated. Consequently, the reliance on BMI as a constitutional diagnostic indicator presents inherent limitations. Prudent caution should be exercised in utilizing BMI as a major determinant in constitutional diagnosis.

Keywords

Acknowledgement

이 연구는 2024년도 한국한의학연구원의 '빅데이터 기반 한의예방 치료 원천기술 개발'(KSN1732121)과제의 지원을 받아 수행되었습니다.

References

  1. Kim SH, Jang ES, Koh BH. The Methodological Review on the Accuracy Study of Questionnaire for Sasang Constitution Diagnosis. J Sasang Constitut Med. 2012;24(3):1-16. DOI: 10.7730/JSCM.2012.24.3.1
  2. Song IB. The Future Prospect of the Studies on the Objectification of Sasang Constitution. J Sasang Constitut Med. 1998;10(1):1-11.
  3. Huh MH, Koh BH, Song IB. The Body Measuring Method to Classify to Sasang Constitutions. J Sasang Constitut Med. 2002;14(1):51-66.
  4. Kim JW, Jeon SH, Sul YK, Kim KK, Lee EJ. A Study on the Body Shape classified by Sasang Constitutions and Gender using Physical Measurements. J Sasang Constitut Med. 2006;18(1):54-61.
  5. Lee SW, Jang ES, Lee J, Kim JY. Current Researches on the Methods of Diagnosing Sasang Constitution: An Overview. Evid Based Complement Alternat Med. 2009:6(Suppl 1):43-49. DOI: 10.1093/ecam/nep092
  6. Pham DD, Do JH, Ku BC, Lee HJ, Kim HG, Kim JY. Body Mass Index and Facial Cues in Sasang Typology for Young and Elderly Persons. Evid Based Complement Alternat Med. 2011 Article ID 749209, DOI:10.1155/2011/749209
  7. Chae H, Lee SJ, Park SH, Jang ES, Lee SW. Validation of Sasang Personality Questionnaire (SPQ) with Positive and Negative Affection Schedule and Body Mass Index. J Sasang Constitut Med. 2012;24(2):39-46. https://doi.org/10.7730/JSCM.2012.24.2.039
  8. Baek YH, Jang ES, Park KH, Yoo JH, Jin HJ, Lee S. Development and Validation of Brief KS-15 (Korea Sasang Constitutional Diagnostic Questionnaire) Based on Body Shape, Temperament and Symptoms. J Sasang Constitut Med. 2015;27(2):211-221. DOI: 10.7730/JSCM.2015.27.2.211
  9. NECA. NECA's guidance for undertaking systematic reviews and meta-analyses for intervention. Seoul:National Evidence-based Healthcare Collaborating Agency. 2011.
  10. Koh BH, Song IB. A Study on the Methodology of Sasang Constitution Diagnosis (1st Report). J Korean Oriental Medicine. 1987;8(1):139-45.
  11. Koh BH, Song IB. A Study on the Methodology of Sasang Constitution Diagnosis (2nd Report). J Korean Oriental Medicine. 1987;8(1):146-60.
  12. Lee EJ, Koh BH, Song IB. The Study on the Validity of "Questionnaire of Sasang Constitution Classification(1)". J Sasang Constitut Med. 1995;7(2):89-100.
  13. Kim SH, Koh BH, Song IB. A Validation Study of Questionnaire for Sasang Constitutional Classification (QSCC). J Sasang Constitut Med. 1993;5(1):67-85.
  14. Kim SH, Koh BH, Song IB. A Stduy on the Standardization of QSCCII (Questionnaire for the Sasang Constitution Classification II). J Sasang Constitut Med. 1996;8(1):187-246.
  15. Kim JY, Kim KY, Song JM. A Study on the Objectification of Sasang Constitution Diagnosis Using Constitutional Discrimination Table. J Sasang Constitut Med. 1998;10(1):181-214.
  16. Kim YW, Kim JW. The Study in Objectification of the Diagnosis of Sasang Constitution(According to Analysis of the Past Questionnaires). J Sasang Constitut Med. 1999;11(2):151-84.
  17. Kim SB, Lee JH, Park GS, Jeong YJ, Lee SK, Song IB. A Study on Responses to the Questionnaire Based on of Revised Sasang Constitution Classification II(QSCCII+). J Sasang Constitut Med. 2001;13(3):15-23.
  18. Park EK, Lee YS, Park SS. A Study of Constitution Diagnosis using Decision Tree Method. J Sasang Constitut Med. 2001;13(2):144-55.
  19. Korean Institute of Oriental Medicine. A Study on the Development of a Questionnaire for Sasang Constitution Diagnosis. In: Korean Institute of Oriental Medicine. Objectification and Industrialization of Oriental Medicine Diagnosis and Treatment (Part I Objectification and Industrialization of Oriental Medicine Diagnosis). 2003:2-147.
  20. Kim YW, Shin DY, Kim JH, Choi DS, Lim MK, Lee KL, Song JM. A Development of the Two Step Questionnaire for the Sasang Constitution Diagnosis (TS-QSCD). J Sasang Constitut Med. 2006;18(1):75-90.
  21. Baek YH, Jang ES, Park KH, Yoo JH, Jin HJ, Lee S. Development and Validation of Brief KS-15 (Korea Sasang Constitutional Diagnostic Questionnaire) Based on Body Shape, Temperament and Symptoms. J Sasang Constitut Med. 2015;27(2):211-21. DOI: 10.7730/JSCM.2015.27.2.211
  22. Pak YS, Kim JS, Park BJ, Yoo JH, Lee JH, Koh BH, Lee EJ. The Reliability and Validity Test of Sasangin Diagnostic Questionnaire for Specialist(SDQ_S). J Sasang Constitut Med. 2016;28(2):110-22. DOI: 10.7730/JSCM.2016.28.2.110
  23. Lee MH, Hong SY. A Study on the Correlation Lee Jae Ma's Four Types of Essential Phsical Constitution and From index. J Sasang Constitut Med. 1990;2(1):71-85.
  24. Lee SH, Han JH, Hing SY. An Experimental Study of Figure Tae-Eum-In and Content of Gatecholamine and Cholinesterase in Blood. J Sasang Constitut Med. 1991;3(1):185-99.
  25. Huh MH, Song JM, Kim DR, Koh BH. A Study on the Morphological Diagrgmmings of Four Constitutiens. J Sasang Constitut Med. 1992;4(1):107-48.
  26. Kim DR, Baek TH. Clinical Study on Correlation of Obesity and Sasang Constitution. J Sasang Constitut Med. 1996;8(1):319-35.
  27. Lee SK, Lee EJ, Hong SC, Koh BH. An Analysis on the Characteristics of Sa-sang Constitution. J Sasang Constitut Med. 1996;8(1):349-76.
  28. Lee EJ, Lee JG, Kim JY, Song JM. The Study on the Biomechanical Biomechannical Body Segment Parameters of Korean Adults with Reference to Sasang Constitutional Mediine. J Sasang Constitut Med. 1998;10(1):143-60.
  29. Lee EJ, Koh BH, Song IB. A Morphologic Study of Sasang Constitution. J Sasang Constitut Med. 1998;10(2):181-220.
  30. Kim DR, Park SS, Gun GR. An Objective Study of Sasang Constitution Diagnosis by Sound Analysis. J Sasang Constitut Med. 1998;10(1):65-80.
  31. Choi SM, Chi SE, Jung BY, Sung HJ, Ahn KS, Koh BH. A Study on the Association between Sasang Constitutions and Body Composition. J Sasang Constitut Med. 2001;13(1):24-34.
  32. Kim DR. A Study on the Sound Characteristic and B.M.I by Sasang Contitution. J Sasang Constitut Med. 2004;16(1):53-60.
  33. Lim JN, Lee IS, Koh BH, Song IB, Lee SK. A Study on the Sasang Constitutional Characteristics of Obese Middle-Aged Women. J Sasang Constitut Med. 2004;16(3):59-69.
  34. Kim JW, Jeon SH, Sul YK, Kim KK. Lee EJ. A Study on the Body Shape classified by Sasang Constitutions and Gender using Physical Measurements. J Sasang Constitut Med. 2006;18(1):54-61.
  35. Sul YK, Lee EJ, Kim KK, Kim JW. Comparative Study of Sasang Constitutions Diagnostic Accuracy Rate on Measurement Method of Body Shape by IBS-2000 Compensator. J Sasang Constitut Med. 2007;19(1):78-89.
  36. Yeo HR, Kim KK, Lee MH, Park YC, Jeon SH, Kwon SD, etc. A Study on the Sasang Constitutional Charateristics by Obesity Grade. J Sasang Constitut Med. 2008;20(1):89-99.
  37. Jang ES, Park KH, Baek YH, Lee SW, Kim SH, Joo JC. A Development of Sasang Constitution Diagnosis Program Based on Characteristics of Body Shape Face Physiological Symptom and Personality. J Sasang Constitut Med. 2012;24(1):21-31.
  38. Kim EJ, Seo SH, Park SE, Na CS, Son HS. A Study on Sasang Constitutional Classification Factor using Sasang Constitutional Analysis Tool 2. J Sasang Constitut Med. 2018;30(3):40-7. DOI: 10.7730/JSCM.2018.30.3.40
  39. Chae H, Jeon ES, Lim SH, Lee SJ. Universal index for Sasang typology using Cloninger's biopsychological theory. J Sasang Constitut Med. 2019;31(3):34-47. DOI: 10.7730/JSCM.2019.31.3.34
  40. Chae H, Hwang YS, Kim MS, Baek YH, Jeong KS, Lee JY, etc. Study on the Sasang Type Diagnosis Using Objective Biopsychological Measures. J Sasang Constitut Med. 2021;33(2):1-13. DOI: 10.7730/JSCM.2021.33.2.1
  41. Jin HJ, Baek YH, Kim HS, Ryu JH, Lee SW. Constitutional Multicenter Bank Linked to Sasang Constitutional Phenotypic Data. BMC Complement Altern Med. 2015:15:46. DOI: 10.1186/s12906-015-0553-3
  42. You HS, Choi SH, Oh MS, Song TW. A Clinical Study on the Correlation between Indices related with Obesity and Sa-sang Constitutional Distribution. J Oriental Rehab Med. 2002;12(3):65-77.
  43. Kim JW, Kim KK, Lee EJ, Lee YT. Study on the Body Shapes and Features of Four Constitutional Types Based on Physical Measurements 1. J Physiol & Pathol Korean Med. 2006;20(1):268-72.
  44. Jin SS, Song YK, Lim HH. The Study on Somatotype of Elementary Students in Incheon according to Sasang Constitutions and Obesity. J Oriental Rehab Med. 2006;16(2):145-65.
  45. Kim JW, Yeo HR, Kim KK, Jeon SH, Lee MH, Lee YT. Study on the Characteristics of Body Shapes Classified by Sasang Constitutions According to Age Groups. J Physiol & Pathol Korean Med. 2007;21(1):258-62.
  46. Kim HJ, Kim YS, Lim EM. A Study of the Change of Body Weight and BMI during Some Pregnant and Postpartum Periods Based on the Sasang Constitution. J Oriental Obstetrics & Gynecol. 2007:20(4):87-100.
  47. Song MS, Baek JU, Choi CH. Study of Psychological Traits in Sasang Constitution According to QSCCII, MBTI, STAI - Preliminary Study for Yangsaeng(養生) in Sasang Constitution -. J Oriental Preventive Med. 2009:13(2):65-76.
  48. Jang ES, Lee SJ, Park SH, Lee SW, Joo JC, Lee MS, etc. Clinical Validation of the Sasang Personality Questionnaire. J Oriental Neuropsychiatry. 2012;23(3):23-32. https://doi.org/10.7231/JON.2012.23.3.023
  49. Lee JC, Dong SO, Park SJ, Joo JC, Lee SK. Comparison Study between Quality of Life and Body Mass Index, Age, Gender in Sasang Constitution among Healthy Subjects in One Korean Medicine Hospital. Kor J Oriental Med. 2012;18(3):95-101.
  50. Lee ME, Seo HG, Kim PJ, Chae H, Kwon YK. Study on Sasang Constitutional Characteristics using Sasang Personality Questionnaire and Sasang Digestive Function Inventory in Clinical Level. J Physiol & Pathol Korean Med. 2016;30(6):426-31. DOI: 10.15188/kjopp.2016.12.30.6.426
  51. Chae H, Kown Y. Best-fit Index for Describing Physical Perspectives in Sasang Typology. Integr Med Res. 2015:4(1):20-8. DOI: 10.1016/j.imr.2014.11.001
  52. Ko YS, You SE. Comparisons of Physical Fitness and Body Composition among Sasang Types with and without Body Mass Index as a Covariate. Integr Med Res. 2015;4(1):41-7. DOI: 10.1016/j.imr.2015.01.002
  53. Lee SJ, Choi MH, Chae H. Biopsychological Structure of the Sasang Personality Questionnaire in Elementary School Students. J Pediatr Korean Med. 2017;31(1):12-24. DOI: 10.7778/jpkm.2017.31.1.012
  54. Celentano D, Szklo M. Gordis Epidemiology. 6th ed. Canada:Elsevier. 2018:223-24.
  55. WHO expert consultation. Appropriate Body Mass Index for Asian Populations and Its Implications for Policy and Intervention Strategies. Lancet. 2004;363:157-63. DOI: 10.1016/S0140-6736(03)15268-3
  56. Caleyachetty R, Barber TM, Mohammed NI, Cappuccio FP, Hardy R, Mathur R, etc. Ethnicity-specific BMI Cutoffs for Obesity Based on Type 2 Diabetes Risk in England: A Population-based Cohort Study. Lancet Diabetes Endocrinol. 2021;9(7):419-26. DOI: 10.1016/S2213-8587(21)00088-7
  57. Park KH, Kim SH, Kim HG, Lee SW. An Evaluation of the Statistical Techniques Used in Papers of the Journal of Sasang Constitutional Medicine (2000-2009). J Sasang Constitut Med. 2010;22(4):49-55.
  58. Kim SJ, Kim SH, Lee SW. Analysis of the Statistical Techniques and Errors in the Field of Sasang Constitution Researches: from 2011 to 2015. J Sasang Constitut Med. 2016;28(1):51-6. DOI: 10.7730/JSCM.2016.28.1.51
  59. Celentano D, Szklo M. Gordis Epidemiology. 6th ed. Canada:Elsevier. 2018:276-80.
  60. Keys A, Fidanza F, Karvonen MJ, Kimuru N, Taylor HL. Indices of Relative Weight and Obesity. J Chron Dis. 1972;25:329-43. DOI: 10.1016/0021-9681(72)90027-6
  61. Lemond A. Is Body Mass Index (BMI) an Accurate Way to Measure Health? Everydayhealth. 2023 Sep 19[cited 2024 Feb 28]. Available from:URL:https://www.everydayhealth.com/diet-nutrition/bmi/bmi-flaws-history-other-ways-measure-body-weight/
  62. Blackburn H, Jacobs D Jr. Commentary: Origins and Evolution of Body Mass Index (BMI): Continuing Saga. Int J Epidemiol. 2014;43(3):665-9. DOI: 10.1093/ije/dyu061
  63. Lopez-Jimenez R, Fitch A, Zarabi S. Obesity and Body Mass Index (BMI). Healthcentral. 2020 Aug 26[cited 2024 Feb 28]. Available from:URL:https://www.healthcentral.com/condition/obesity-and-body-mass-index
  64. Knezevic T. Why Body Mass Index Isn't the Best Measure of Health. Reader's Digest Canada. 2022 Apr 21[cited 2024 Feb 28]. Available from:URL:https://www.readersdigest.ca/health/weight-loss/body-mass-index-issues/
  65. Chae H, Lyoo IK ,Lee SJ, Cho S, Bae H, Hong M, etc. An Alternative Way to Individualized Medicine: Psychological and Physical Traits of Sasang Typology. J Altern Complement Med. 2003;9(4):519-28. DOI: 10.1089/107555303322284811
  66. Park JE, Mun SJ, Lee SW. Effect of Sleep Quality on Fatigue and Quality of Life : a Sasang Constitutional Medicine Perspective. J Physiol & Pathol Korean Med. 2020;34(1):37-44. DOI: 10.15188/kjopp.2020.02.34.1.37
  67. Kim JE, Jeong KS, Baek YH, Lee SW. A Relationship of Healthy Eating Status and Body Composition in Korean Adults by Their Constitution Type: A Cross-sectional Study. J Sasang Constitut Med. 2022;34(1):46-57. DOI: 10.7730/JSCM.2022.34.1.46
  68. Kim HS, Baek YH, Lee SW, Yoo JH. A Comparison for Constitutional Body Type between Korean and Chinese-Korean - Using Propensity Score Matching -. J Sasang Constitut Med. 2016;28(1):11-8. DOI: 10.7730/JSCM.2016.28.1.11
  69. Yu JS, Baek Y, Hyun D, Chang SJ. Customized BMI and Waist Circumference Cut-off Values Are Needed to Identify Metabolic Syndrome among South Koreans according to Their Sasang Constitutional Type. J Korean Med. 2018; 39(4):51-61. DOI: 10.13048/jkm.18034
  70. Park J, Lee S, Lee Y, Lee J, Chae H. Resting Metabolic Rate for Diagnosing Tae-Eum Sasang Type and Unraveling the Mechanism of Type-Specific Obesity. Diagnostics (Basel). 2023;13(4):672. DOI: 10.3390/diagnostics13040672