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Waist Not: Japan Measures Up In Fight Against Obesity
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Published: June 13, 2008
AMAGASAKI, Japan - As a country not known for its overweight people, Japan has undertaken one of the most ambitious campaigns by a nation to slim down its citizenry.
Summoned by the city of Amagasaki one recent morning, Minoru Nogiri, 45, a flower shop owner, found himself lining up to have his waistline measured. With no visible paunch, he seemed to run little risk of being classified as overweight, or metabo, the preferred word these days.
Because the new state-prescribed limit for male waistlines was a strict 33.5 inches, however, he had anxiously measured himself at home a couple of days earlier. "I'm on the border," he said.
Under a national law that came into effect two months ago, companies and local governments must measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.
Those exceeding government limits - 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks - and suffering from a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months.
It All Comes Down To Money
To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country's Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.
The ministry also says that curbing widening waistlines will rein in a rapidly aging society's ballooning health care costs, one of the most serious and politically delicate problems facing Japan today. Most Japanese are covered under public health care or through their work. Anger over a plan that would make those 75 and older pay more for health care recently brought a parliamentary censure motion against Prime Minister Yasuo Fukuda, the first against a prime minister in the country's postwar history.
Critics say that the government guidelines - especially the one about male waistlines - are simply too strict and that more than half of all men will be considered overweight. The effect, they say, will be to encourage overmedication and ultimately raise health care costs.
Need For Crackdown In Question
Yoichi Ogushi, a professor at Tokai University's School of Medicine near Tokyo and an expert on public health, said that there was "no need at all" for the Japanese to lose weight.
"I don't think the campaign will have any positive effect. Now if you did this in the United States, there would be benefits, since there are many Americans who weigh more than 100 kilograms," or about 220 pounds, Ogushi said. "But the Japanese are so slender that they can't afford to lose weight."
Ogushi was actually a little harder on Americans than they deserved. A survey by the National Center for Health Statistics found that the average waist size for Caucasian American men was 39 inches, a full inch lower than the 40-inch threshold established by the International Diabetes Federation. American women did not fare as well, with an average waist size of 36.5 inches, about two inches above their threshold of 34.6 inches. The differences in thresholds reflected variations in height and body type from Japanese men and women.
Comparable figures for the Japanese are sketchy, but a 1998 study of a sample of white-collar men found an average waist size of 30.8 inches. But that modest number apparently was not enough to ease the concerns of Japan's health bureaucrats.
In Amagasaki, officials have moved aggressively to measure waistlines in what the government calls special checkups. The city had to measure at least 65 percent of the 40- to 74-year-olds covered by public health insurance.
When his turn came, Nogiri, the flower-shop owner, entered a booth where he bared his midriff, exposing a flat stomach with barely discernible love handles. A nurse wrapped a tape measure around his waist across his belly button: 33.6 inches, or 0.1 inch over the limit.
"Strikeout," he said, defeat spreading across his face.
The campaign started a couple of years ago when the Health Ministry began beating the drums for a medical condition that few Japanese had ever heard of - metabolic syndrome - a collection of factors that heighten the risk of developing vascular disease and diabetes. Those include abdominal obesity, high blood pressure and high levels of blood glucose and cholesterol. In no time, the scary-sounding condition was popularly shortened to the funny-sounding metabo, and it has become shorthand for overweight.
The word metabo has made it easier for health care providers to urge their patients to lose weight, said Yoshikuni Sakamoto, a physician.
"Before we had to broach the issue with the word obesity, which definitely has a negative image," Sakamoto said. "But metabo sounds much more inclusive."
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