A woman in a kimono poses for a photo in front of a billboard of sumo wrestlers at the 'Ryogoku Kokugikan' sumo venue in Tokyo, May 25, 2008. (Kim Kyung-Hoon/Reuters)

Fat in Japan? You're breaking the law.

As the health care debate rages in the US, Tokyo lawmakers set a maximum waist size. Are you too fat for Japan?

By David Nakamura — Special to GlobalPost
Published: November 10, 2009 06:29 ET
Updated: November 11, 2009 08:40 ET

Editor's note: David Nakamura also contributes to The Atlantic's excellent Food blog. Read his personal take on this story, which includes the shocking revelation of his own waist size.

TOKYO, Japan — In Japan, being thin isn’t just the price you pay for fashion or social acceptance. It’s the law.

So before the fat police could throw her in pudgy purgatory, Miki Yabe, 39, a manager at a major transportation corporation, went on a crash diet last month. In the week before her company’s annual health check-up, Yabe ate 21 consecutive meals of vegetable soup and hit the gym for 30 minutes a day of running and swimming.

“It’s scary,” said Yabe, who is 5 feet 3 inches and 133 pounds. “I gained 2 kilos [4.5 pounds] this year.”

In Japan, already the slimmest industrialized nation, people are fighting fat to ward off dreaded metabolic syndrome and comply with a government-imposed waistline standard. Metabolic syndrome, known here simply as “metabo,” is a combination of health risks, including stomach flab, high blood pressure and high cholesterol, that can lead to cardiovascular disease and diabetes.

Concerned about rising rates of both in a graying nation, Japanese lawmakers last year set a maximum waistline size for anyone age 40 and older: 85 centimeters (33.5 inches) for men and 90 centimeters (35.4 inches) for women.

In the United States, the Senate and House health care reform bills have included the so-called “Safeway Amendment,” which would offer reductions in insurance premiums to people who lead fitter lives. The experience of the Japanese offers lessons in how complicated it is to legislate good health.

Though Japan’s “metabo law” aims to save money by heading off health risks related to obesity, there is no consensus that it will. Doctors and health experts have said the waistline limits conflict with the International Diabetes Federation’s recommended guidelines for Japan. Meantime, ordinary residents have been buying fitness equipment, joining gyms and popping herbal pills in an effort to lose weight, even though some doctors warn that they are already too thin to begin with.

The amount of “food calories which the Japanese intake is decreasing from 10 years ago,” said Yoichi Ogushi, professor of medicine at Tokai University and one of the leading critics of the law. “So there is no obesity problem as in the USA. To the contrary, there is a problem of leanness in young females.”

One thing’s certain: Most Japanese aren’t taking any chances.

Companies are offering discounted gym memberships and developing special diet plans for employees. Residents are buying new products touted as fighting metabo, including a $1,400 machine called the Joba that imitates a bucking bronco. The convenience store chain Lawson has opened healthier food stores called Natural Lawson, featuring fresh fruits and vegetables.

Under Japan’s health care coverage, companies administer check-ups to employees once a year. Those who fail to meet the waistline requirement must undergo counseling. If companies do not reduce the number of overweight employees by 10 percent by 2012 and 25 percent by 2015, they could be required to pay more money into a health care program for the elderly. An estimated 56 million Japanese will have their waists measured this year.

Though Japan has some of the world’s lowest rates of obesity — less than 5 percent, compared to nearly 35 percent for the United States — people here on average have gotten heavier in the past three decades, according to government statistics. More worrisome, in a nation that is aging faster than any other because of long life spans and low birth rates, the number of people with diabetes has risen from 6.9 million in 1997 to 8.9 million last year.

Health care costs here are projected to double by 2020 and represent 11.5 percent of gross domestic product. That’s why some health experts support the metabo law.

“Due to the check up, there is increased public awareness on the issue of obesity and metabolic syndrome,” said James Kondo, president of the Health Policy Institute Japan, an independent think tank. “Since fighting obesity is a habit underlined by heightened awareness, this is a good thing. The program is also revolutionary in that incentivizes [companies] to reduce obesity.”

Comments:

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Posted by john_vinzetti on November 11, 2009 04:02 ET

This article and especially the title is grossly misleading and you should retract several parts. Let me say this, no one, absolutely no one in Japan is being punished by law for being overweight the so-called 'counseling' you are referring to is simply the doctor making some suggestions on how you could lose weight. It is not some kind of mandatory community service where you could be arrested or fined. By reading this article one would think that the police are going around measuring peoples' waists.

I am so sick of these inaccurate articles about Japan. These are the type of shoddy, exaggerated, poorly researched articles that lead to the Mainichi Daily News being shut down.

Diggers: Bury this article.

Posted by Sunflower on November 11, 2009 20:52 ET

I have tried to post my own thoughts and apparently had them deleted twice by machines, not people, I hope.

Let me just say that you are right on about all points. Particularly, shoddy exaggeration drives me nuts also. Japan's health outcomes obviously deserve better treatment by journalists. I would have settled for a shoutout from Michael Moore in Sicko, but it was not forthcoming.

America needs to learn about Japan in a more evenhanded way or it will never be able to benefit from Japan's experience. America keeps inventing the wheel, European-style, with the help of people like D. Nakamura.

Posted by Guyver on November 12, 2009 09:29 ET

Fines are punishment. Those fines are by law.

Posted by Kyle Armbruster on November 11, 2009 09:21 ET

Unbelievable.

Where exactly did you get the idea that it is illegal to be fat in Japan? Oh, I know, you made it up to sensationalize the second-largest economy in the world, because they are so wacky and mysterious.

Here's how it works: When your company gives the free annual health checkups required by law (required for the company to offer them, not for you to take them, but they are quick, comprehensive, and free--Just did mine this morning!), if the results show too many people over the (admittedly preposterously small) arbitrary waistline chosen by the idiot old men running the country, the company will have to pay more to the insurance company to cover the extra costs associated with all the fatties in their employ.

That's it.

Although I believe the story about the woman in the article, that kind of idiotic loyalty to company still exists in Japan; usually, in my experience, among morons who know they'd be the first on the chopping block if the company were to downsize. There's no reason she needs to worry, however; she just doesn't want to be seen as one of the poeple who might bump up everyone's health insurance rates.

So the public/private insurance companies are adding a "fat tax" to organizations with too many fat people, to offset costs.

Not so wacky or mysterious now, is it?

Posted by Sunflower on November 11, 2009 21:05 ET

Of course you are right Kyle. It seems that you have been in Japan long enough to know that these "Laws" amount to guidelines. Someday violation of this "law" will justify something that someone wanted to do anyway. That is how it works. Personally, I doubt even that will happen. It amounts to a drum beat telling people to slim down. Nothing more.

You and I know the drill. Whenever a journalist gets assigned to Japan, they have to write the wacky anecdote just to show how weird Japan is. Ugh. It all seems so harmless and it has gone on for ... well... truly forever. Of course, it is harmful, however, in this day and age where words like "death panels" and "fat laws" and "government laws about waistlines" will pop up to silence or obscure debate on reasonable health policy.

I see a time in the not too distant future where a US lawmaker will say, "Maybe we can learn a thing or two from Japan." Then some congressman from South Carolina will interrupt him to say, "David Nakamura from the Washington Post says that Japan has Fat Laws that discriminate against people with waistlines bigger than 33 inches! That's not MY AMERICA!" earning general applause from the beef and corn lobbies.

Posted by LeanDream on November 11, 2009 12:53 ET

I love this. We need this in America!!

Posted by rjusicsonpier on November 11, 2009 15:25 ET

Too much pecknamedfo I guess.

Posted by Guyver on November 11, 2009 14:52 ET

CNN Video on Japanese Fat Fines: http://tinyurl.com/4nzn8w

ABC Article on the same topic: http://tinyurl.com/5shmkx

Posted by Sunflower on November 11, 2009 20:45 ET

My comments were erased when the page refreshed.

David Nakamura is a CFR Fellow and award-winning Washington Post reporter, from what I gather. Despite that, I hope not BECAUSE of that, this headline and the article distort the processes, impacts, and outcomes of health policy.

Japan's longer life expectancy and better health are not the outcome of universal health care, lower poverty, better prenatal care, lack of firearms, slow traffic, and a lot more looking out for the other guy. No. Japan is better off because of Fat Police and Fat Laws.

What a wonderful implication for American people. Thanks to your article, they will be able to rest assured that they have the best healthcare system in the world, where people can be free from FAT PANELS, discrimination in the workplace, and government intervention with respect to the depth of their navel. USA! USA!

An award winning journalist has reduced effective health policy-making to the absurd, presumably to make it palatable for an American audience. What a terrible disservice. America could learn a lot from Japan, but it won't... no thanks to Mr. Nakamura and the Council on Foriegn Relations.

Posted by Guyver on November 12, 2009 09:28 ET

No thank you. I would rather take personal responsibility for myself than to have government spoon feed me what they think I should be doing.

Posted by Ranba Ral on November 16, 2009 06:01 ET

This sounds exaggerated to me, based on what little bit I know of Japan, but I guess it's possible.

For the people lauding a plan like is described in the article, I have a question. What do you do about the people who aren't obese, but the obesity indicator numbers say they are?

For example, I am now fat. I admit this (several years of being stuck doing research and working a fairly sedentary job will do that...). However, a few years ago I was able to pass the Army's Special Forces Entrance Physical, and before that I was able to jog C.A.P.'s 20 mile Search and Rescue qualifications test without ever stopping. My breaks consisted of slowing to 5-10 minutes of walking. Yet, no matter when BMI (America's obesity measure) was taken, I was ALWAYS in the range of Obese to Morbidly Obese, depending on who made the scale in a given year. It didn't matter that, at the time, I was pretty much a walking tube of muscle; the numbers said I was loaded with fat. Everyone I've ever known who isn't a beanpole has had the same issues as well when they've been in a field of work that has BMI checkups.

So I reiterate, if you make a counseling plan for obese people how do you deal with people who are like I was? Do they just get to be bugged by some bureaucrat, who only looks at numbers and could give a dang less about what may actually be the case, for the rest of their days no matter what?

Hint: Based on how government operates, the answer to this is "Yes, you get to have letters mailed to you complaining about how you're hurting everyone else's insurance rates, etc., with your fatness and that you need to exercise more and eat better...even if your daily exercise is a 2 mile run and other mixed exercises and your diet is balanced."

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