http://www.nytimes.com/2008/06/13/world/asia/13fat.html?em&ex=1213502400&en
=c6f2623fbee96495&ei=5087%0A
June 13, 2008
Japan, Seeking Trim Waists, Measures Millions
By NORIMITSU ONISHI
AMAGASAKI, Japan — Japan, a country not known for its overweight people,
has undertaken one of the most ambitious campaigns ever 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 in Japan these days.
But because the new state-prescribed limit for male waistlines is a strict
33.5 inches, 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 now 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 having 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.
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 brought a
parliamentary censure motion Wednesday against Prime Minister Yasuo Fukuda,
the first against a prime minister in the country’s postwar history.
But 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.
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, Mr.
Ogushi said. “But the Japanese are so slender that they can’t afford to
lose weight.”
Mr. 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 since waistlines have not
been measured officially in the past. But private research on thousands of
Japanese indicates that the average male waistline falls just below the new
government limit.
That fact, widely reported in the media, has heightened the anxiety in the
nation’s health clinics.
In Amagasaki, a city in western Japan, 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, an “extremely difficult” goal, acknowledged Midori
Noguchi, a city official.
When his turn came, Mr. 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 the nation’s shorthand for
overweight.
The mayor of one town in Mie, a prefecture near here, became so wrapped up
in the anti-metabo campaign that he and six other town officials formed a
weight-loss group called “The Seven Metabo Samurai.” That campaign ended
abruptly after a 47-year-old member with a 39-inch waistline died of a
heart attack while jogging.
Still, at a city gym in Amagasaki recently, dozens of residents — few of
whom appeared overweight — danced to the city’s anti-metabo song, which
warned against trouser buttons popping and flying away, “pyun-pyun-pyun!”
“Goodbye, metabolic. Let’s get our checkups together. Go! Go! Go!
Goodbye, metabolic. Don’t wait till you get sick. No! No! No!”
The word metabo has made it easier for health care providers to urge their
patients to lose weight, said Dr. Yoshikuni Sakamoto, a physician in the
employee health insurance union at Matsushita, which makes Panasonic
products.
“Before we had to broach the issue with the word obesity, which definitely
has a negative image,” Dr. Sakamoto said. “But metabo sounds much more
inclusive.”
Even before Tokyo’s directives, Matsushita had focused on its employees’
weight during annual checkups. Last summer, Akio Inoue, 30, an engineer
carrying 238 pounds on a 5-foot-7 frame, was told by a company doctor to
lose weight or take medication for his high blood pressure. After dieting,
he was down to 182 pounds, but his waistline was still more than one inch
over the state-approved limit.
With the new law, Matsushita has to measure the waistlines of not only its
employees but also of their families and retirees. As part of its
intensifying efforts, the company has started giving its employees “metabo
check” towels that double as tape measures.
“Nobody will want to be singled out as metabo,” Kimiko Shigeno, a company
nurse, said of the campaign. “It’ll have the same effect as non-smoking
campaigns where smokers are now looked at disapprovingly.”
Companies like Matsushita must measure the waistlines of at least 80
percent of their employees. Furthermore, they must get 10 percent of those
deemed metabolic to lose weight by 2012, and 25 percent of them to lose
weight by 2015.
NEC, Japan’s largest maker of personal computers, said that if it failed to
meet its targets, it could incur as much as $19 million in penalties. The
company has decided to nip metabo in the bud by starting to measure the
waistlines of all its employees over 30 years old and by sponsoring metabo
education days for the employees’ families.
Some experts say the government’s guidelines on everything from waistlines
to blood pressure are so strict that meeting, or exceeding, those targets
will be impossible. They say that the government’s real goal is to shift
health care costs onto the private sector.
Dr. Minoru Yamakado, an official at the Japan Society of Ningen Dock, an
association of doctors who administer physical exams, said he endorsed the
government’s campaign and its focus on preventive medicine.
But he said that the government’s real priority should be to reduce smoking
rates, which remain among the highest among advanced nations, in large part
because of Japan’s powerful tobacco lobby.
“Smoking is even one of the causes of metabolic syndrome,” he said. “So if
you’re worried about metabo, stopping people from smoking should be your
top priority.”
Despite misgivings, though, Japan is pushing ahead.
Kizashi Ohama, an official in Matsuyama, a city that has also acted
aggressively against metabo, said he would leave the debate over the
campaign’s merits to experts and health officials in Tokyo.
At Matsuyama’s public health clinic, Kinichiro Ichikawa, 62, said the
government-approved 33.5-inch male waistline was “severe.” He is 5-foot-4,
weighs only 134 pounds and knows no one who is overweight.
“Japan shouldn’t be making such a fuss about this,” he said before going
off to have his waistline measured.
But on a shopping strip here, Kenzo Nagata, 73, a toy store owner, said he
had ignored a letter summoning him to a so-called special checkup. His
waistline was no one’s business but his own, he said, though he volunteered
that, at 32.7 inches, it fell safely below the limit. He planned to
disregard the second notice that the city was scheduled to mail to the
recalcitrant.
“I’m not going,” he said. “I don’t think that concerns me.”
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