I posted a few weeks ago about North Carolina’s plan to require higher health care premiums from state employees who are obese – a proposal that generated criticism especially from those who felt that reversing obesity was more appropriately done through education.

The “tea-party” crowd and Republicans who are so up in arms about various policies espoused by Barack Obama and the Democrat controlled Congress and especially health care reform should be glad that they don’t live in Japan. I say this because Japan is the only nation that has decided to mandate the waist size for men and women!

In an effort to combat obesity and the corresponding impact on rising health care costs, Japan has legislated that, after the age of 40 years, men must have a waist size of not more than 33.5″ and women must have a waist size of 35.4″. This is all the more remarkable in that Japan has a minimal problem with obesity, as evident in the chart shown below (courtesy of OECD) – only 3% of the population has a BMI greater than 30:

  • Incidentally, take a look at where the US ranks when it comes to obesity compared to other countries, with over 32% of the population with a BMI over 30!

    The program in Japan, which aims to cut down on metabolic syndrome, a leading indicator for heart disease and diabetes, has been controversial and critics feel the thrust of the program is not scientifically well grounded. Some of the supporters say that Japan is being pro-active and addressing the problem before it gets out of hand. Japan like other countries is faced with the problem of rising healthcare costs for the aged – and this is an attempt to address a major factor in wellness care.

    What the program demands is fairly clear: under Japan’s health care coverage, companies will be required to administer check-ups to employees once a year. If an employee does not meet the waistline requirement he/she must undergo counseling. If companies do not reduce the number of overweight employees by 10 percent by 2012 and 25 percent by 2015, they may 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!

    Companies are offering discounted gym memberships and developing special diet plans for employees in an effort to motivate and assist employees in meeting the waist measurement requirements.

    The hesitancy of some Japanese to expose their bare stomachs to the tape measure has led the government to allow the tape measures to be administered to clothed patients. Those who elect not to strip down are permitted to deduct 1.5 centimeters from their results. But the approach is considered crude by critics – Satoru Yamada, a doctor at Kitasato Institute Hospital in Tokyo, published a study two years ago in which several doctors measured the waist of the same person. Their results varied by as much as 7.8 centimeters. “I cannot agree with waist size being the essential element,” Yamada said.

    There are fundamental contradictions in the Japanese approach quite apart from the validity of waist size being an accurate measure of obesity, there is an irony in that Japan has one of the highest percentage of its population who are smokers.

  • As will be apparent over 29% of Japanese smoke – contrast that with the US which has one of the best records in the world with less than 17% of the population who smoke regularly! One would have thought that the focus of the Japanese government should be on curbing smoking!

    But the Japanese are doing a lot of things right. Whether it is the Japanese diet with its emphasis on fish and seafood or the lack of obesity or other life-style issues, Japan has the highest life-expectancy of any country in the world at over 82 years! The US has a life expectancy of just under 78 years.

  • The Japanese program to prevent obesity is probably in need of refinement and only works because it is a nation that is relatively conformist – and the people are happy to conform. I cannot see something this drastic ever being implemented in the US despite its huge problem with obesity which shows no signs of reversing – as portion sizes get larger, people eat more fast food and exercise less. But as healthcare reform gets underway in the US, the opponents should realize the magnitude of the life-style issues that are responsible for some our healthcare woes and be receptive to the changes needed to address some of these challenges.

    4 Responses to “Waist size by decree”

    1. saira says:

      I think this is a terrible idea :)…I wouldn’t want people measuring my waist size!!!

    2. Richard says:

      The US could start by making GYM mandatory through college.

    3. TJ says:

      Saira, the interesting thing about the Japanese mandate re waist size is that the penalties are incurred by the employer and it is a testament to the conformist aspect of Japanese society that employees would feel pressured to achieve “compliance” because of the impact it would otherwise have on their employer. I can’t see penalties on an employer causing any modification on employee behaviour in the US – short of his/her job being in jeopardy, which would of course be illegal here in most occupations.

    4. TJ says:

      Richard, I am convinced that behaviour modification in the US and probably most countries is best achieved through a combination of education and financial incentives/disincentives as has happened with cigarette smoking in the US.

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