Japan: The obesity police

illegal_tobe_fatIt’s illegal to be fat in Japan. For reals. Okay, there are a few caveats. More specifically, you can’t be fat if you’re over 40.

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.

I can’t imagine how they’ll enforce it. The article mentions offenders will get counseling; the companies they work for will have to pay more into a health fund for the elderly. Hmm. Where is Teijo when we need him? I’m sure he will explain in more detail.

So maybe you think the Japanese are being unreasonable but they could be more so. The IDF (International Diabetes Federation) recommends 35″ waists for Japanese men and 31.5″ for Japanese women. What I want to know is if the law applies to tourists. It goes without saying that this would never fly here…

See also: How Japan defines fat.

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  1. Theresa in Tucson says:

    So what happens to the sumo wrestlers? They certainly must make exceptions for them, or maybe when they retire they all get put on diets to scale them back to normal.

  2. Kate says:

    Is this true?

    The idea is depressing. It allows society to stigmatize people as has occurred so often in human cultures. Must this continue? While every measure ought to be available to keep a population healthy, it is troubling to target a specific group. Why give people an excuse to look down on those whose difficulty is weight? What is the saying…everyone is fighting a great battle?

    Moreover, there are studies which suggest that use of antibiotics may contribute to people’s excess weight. (The Huffington Post ran an article, which was written by Dana Ullman.) When individuals who are unable to control their weight are worried about being stigmatized they may make risky choices (especially in a nation where judgement and shame have an historic role). Hum, evidently I’m passionate about this. Off soap box.

  3. Jen in NYS says:

    I am not Japanese, but I’ve spend some time in Japan and part of my family is Japanese–so this is the basis of my perspective. First, Japanese people are *a lot* smaller than your average American, especially on horizontal measurements. I’m about a US size 12 (whatever that means), about 5’6″, and I have felt like an elephant walking down the street. Okay, a bit of an exaggeration, but I was conscious of how much larger I was than most women and some men. Still, I think that a Japanese woman with a 33″ or 35″ waist would be somewhat unusual. Japan is a true bureaucracy and I suspect the “fat law” actually has something to do with the national healthcare system. Japan is a really health conscious society and “food is medicine” is the general perspective. The health aspect of food is (often) more important than the instant gratification/indulgence that is the focus of many Americans. Also, the sumo wrestlers are not considered to be fat – a little confusing – but it (the bulk) is considered to be part of their physical training.

  4. Teijo says:

    Hi Kathleen!!

    Fine… let’s start with a summary background. Instead of a public health care system Japan has a mandatory health insurance system paid for either by the individual or the employer. The government oversees the programs and likes to feel in charge. Most municipalities offer free annual health inspections for people over 40. Heights and weights are part of the data collected.

    This part is a bit sketchy as I’ve not read the studies myself, but apparently a team at the Osaka University suggested some years ago that the the risks of cardiovascular disease could be predicted by the cross-sectional area of a person’s intra-abdominal fat. About 100 square cm is supposed to triple the risk. The Japan Obesity Association then announced projected borderline waist circumferences based on the average Japanese physique.

    The Ministry of Health, Labour and Welfare was convinced, and decreed in article 4 of statute 157 passed in 2007 that men and women whose whose BMI is over 25 or whose waists are respectively over 85 and 90 cm, and whose blood pressure, triglyceride, HDL or blood sugar values correspond to certain values would be designated “individuals who must strive to maintain their health” and must be offered health counselling.

    While this might not be taken quite as seriously elsewhere, in Japan most people are somewhat conscientious. In addition, larger companies are obligated to pay the insurance of employees, and when the insurance companies saw an opportunity to squeeze a bit more money out of them, some set guidelines on maximum waist circumferences.

    The wording being what it is, the media of course also had a party.

    Sumo is a young men’s sport. Most of the wrestlers are in their twenties or early thirties, and I can remember only one who was over forty years old…

  5. Reader says:

    Interesting. As long as the government, employers, and insurance companies are shouldering some of the financial burden and offering support I can’t say I have a problem with this. Extreme overweight and obesity are linked to serious health problems that also are costly to society, not matter what “Fat Acceptance” proponents claim.

    I remember reading about Japanese companies’ weight requirements at least five years ago.

    Teijo, thanks for the added info.

  6. Kathleen says:

    Why give people an excuse to look down on those whose difficulty is weight? What is the saying…everyone is fighting a great battle?

    Evidently, the great battle in Japan isn’t weight. Only 5% of the population is overweight.

    Owing to my fascination with anthropometry, Japan is a compelling case study due to their culture and homogeneity.

    I should have linked to an earlier post I wrote about weight gain in Japan (see note at the end). The incidence of obesity is increasing in children. It isn’t far fetched to think that instituting this law is an indirect way to get parents to mind their children’s weight now before it becomes a roadblock to future employment.

    Re: sumo wrestlers, this is second hand from a non-expert (Mr. F-I). He says they don’t live long, they tend to die young. A cursory search shows deaths usually result from liver disease, diabetes and heart attacks. It serves as a contradiction to those in the US who claim that you can be obese and healthy when it doesn’t seem to hold true in Japan.

    Mr. F-I also mentioned it was ironic that sumo wrestlers are universally admired in Japan (“treated like gods”) when the population is so thin. I remarked it is no different from the US. We treat top models like stars and we are so fat. Our cultures respectively admire that which we are not. Which is in a manner of speaking, why I say it is only logical that models become progressively thinner as the average person gets fatter.

    Teijo -a thousand thanks for the information!

  7. Donna says:

    Reminds me of the time a tour guide in Egypt wanted to know why my friend and I weren’t fat like the rest of America. I best stop with that comment before I offend.

  8. Jen in NYS says:

    On a minor tangent…it is interesting to me that the Japanese people are so health conscious about nutrition. Yet, it seems as though smoking is still prevalent (at least among men) and not particularly criticized. Maybe the issue just hasn’t gotten the same media attention.

  9. Tula says:

    I suspect they don’t have the same junk-food culture in Japan that we have here in the US. So many people here brag about not being able to cook, so it’s no wonder that we have so much obesity. If people would learn to find their kitchens and eat real food instead of the chemical- and sugar-laden processed franken-food, we would probably cut obesity in half (at the very least). I’m partial to the low-carb/paleo diet myself, but there are many diets that are far healthier than what most Americans typically eat.

    I don’t think showing concern or offering assistance to deal with obesity is the same as “looking down on” the obese. I guess it’s a matter of where one draws the line between political correctness and health. One of my co-workers jokingly said of himself, “I’m not obese, I’m horizontally-challenged.” We can laugh at that, but all the euphemisms in the world won’t make an obese person healthier.

  10. Trudy says:

    “It goes without saying that this would never fly here…”

    I’m assuming you are employing your usual laconic wit here Oh She Who Must Be Obeyed (Kathleen!) because we both know that the health police started with the smokers, they’re working on the fatties (that would be me then) and they’ll be starting on the drinkers soon enough.

    All for our own good of course, and won’t someone think of the children?

    @Tula, FWIW I personally do follow a healthy low-carb diet, with barely any processed food, I cook very very well and all my blood pressure readings & lab works are perfect.

    I’m still obese though. Just shows what works for one person doesn’t always work for another, food & nutrition-wise.

  11. clf says:

    Japan is a fascinating country. Life expectancy at birth is 83.
    [supporting link removed because this site deemed my original post “spammy”]

    Okinawans are some of the longest lived people in the world, due to their diet and lifestyle.

    [supporting link removed because this site deemed my original post “spammy”. i mentioned a book that covers this subject and where you can get that book.]

    My guess is that this law is as much about maintaining Japan’s cultural norms as it is about anything else. Japanese live by the credo “Hara hachi bunme” (eat until you’re 80 percent full).

    [supporting link removed because this site deemed my original post “spammy”]

    The Japanese also have high rates of lung cancer and stomach cancer, both of which are linked to cigarette smoking. (My guess is that if they didn’t smoke the Japanese would pretty much live forever.)

    [supporting link removed because this site deemed my original post “spammy”]

    Everyone in Japan has healthcare. Japan spends only 8 percent of it’s GDP on healthcare but offers quality care. Japanese people tend to go to the doctor more often than Americans.

    [supporting link removed because this site deemed my original post “spammy”]

    More on Japanese healthcare here:

    [supporting link removed because this site deemed my original post “spammy”]

    Anybody interested in the truth about fat and obesity should really read New York Times science writer Gina Kolata’s fascinating book on the subject.
    [supporting link with the book title removed because this site deemed my original post “spammy”]

    *All supporting links to charts, statistics and books relating to Japan’s healthcare were removed because my original post was deemed “spammy” by this site. Sites I linked to included PBS and Unicef.

  12. Kathleen says:

    Was that really necessary?

    The software doesn’t care if you’re linking to God himself, it doesn’t judge the caliber or quality of the links. Rather, it counts them.

    I’ve tried adjusting the settings from the back end but it hasn’t worked. If you know how to over ride that setting I’m all ears but as it stands, the software won’t let anyone, even me, to leave more than 4 links. If I want to post more, I have to log in. Obviously you don’t have that option but you’re free to send the links to me so I can add them.

  13. Marie-Christine says:

    Actually, the association between waist size and metabolic syndrome is about -ratio- of waist to hips, ie 0.8 being the max for health. Using absolute numbers is totally bunk, and probably wouldn’t work even in such a homogeneous society as Japan or Denmark, to take opposite examples on human size scales.

    Don’t bother using too many of clf’s links.. At first glance, stomach cancer rates in Japan have to do with soy sauce and pickles, not with cigarettes (and I’m -not- a pro-cigarette person..). Okinawans are some of the longest-lived people, but nobody knows what it’s due to, diet or lifestyle are just vague speculation. I also bet ‘everyone’ in Japan doesn’t have health care, not after last year’s many crisis at least. Maybe compared to the US, but that’s setting a very low standard. And finally Japan does have the particularity of ‘inventing’ koroshi, or death from overwork, so let’s not get too carried away about how -perfect- they are and everyone there, OK? One fascist government regulation, even if an unenforceable one you happen to approve of, does not make a healthy country.

  14. Paul says:

    A peculiar fact is Asians have fewer beta cells in their pancreas compared to Caucasians. No one seems to know why. As a result, it takes less body fat to induce metabolic syndrome and type II diabetes (aka insulin resistant diabetes).

  15. Tula says:

    @Trudy: I hear you. I’m not obese, but I’m not thin either. I’m trying to lose 40 pounds and it isn’t easy. The second I hit menopause at 40, my metabolism fell into the basement and even eating a healthy, low-carb diet of under 1000 calories per day doesn’t result in weight loss. Exercise would probably help, but severe arthritis make it difficult.

    So yes, we’re all different and have different body chemistry. I do still believe that people in general would be healthier and less overweight if they learned to cook and eat real food instead of takeout and junk food. I don’t think government mandates are the way to do that, either, but it will be interesting to watch what happens in Japan.

    I’ve heard some mentions of health insurers in this country wanting to charge higher premiums for the obese, along with offering more weight-management services. Several of the employers I’ve worked for in the last few years have run weight-loss contests and other healthy-living programs in the workplace, so it’s definitely an issue that’s getting a lot of attention.

  16. Teijo says:

    Yes… the Okinawans do have a very different diet than the Japanese. (Okinawa was an autonomous country until it was annexed by Japan – a bit like Hawaii.) Their longevity is exceptional even in Japan.

    There are several factors that contribute to stomach cancer, and while theories abound it is difficult to determine the main cause. As mentioned, overuse of salt has been cited, as have fern shoots, but some say stress is also a factor. Interestingly the incidence appears to be quite low in districts where people snack on nozawa-na pickles with green tea. In any case it was the largest single cause of death until a few decades ago, but recently diabetes, cardiovascular disease and other cancers are on the rise.

    As Marie-Christine says, not everyone here has health care. While it is legally required, there are ways to wriggle out of it, if one tries. Since e.g. the Tokyo individual insurance rate for last year was 6.13% of a person’s annual earnings, with a cap of about 770,000 yen, those with steady and/or high incomes (or practically no income) most likely don’t find it an unbearable burden. However, since the rates are based on the previous year’s earnings, if a freelancer earns a good amount one year and very low the next it can be a drain. I know at least one of my artist friends was let off the system after complaining rather bitterly about, but was asked to sign a document that stated he’d not try to get back in. (I suspect that the statement really had no legal basis – the law does require everyone to be insured, and it at least used to be that if someone uninsured applied for national insurance it would apply to any costs incurred in the three months prior to the application.)

    Also, while the municipal governments try to pressure everyone to join, most don’t overexert themselves pursuing foreign residents.

    There are also gaps in coverage (e.g. the incisors, since the policy considers them unnecessary for mastication), and only 70% of the regular medical costs of people who are of working age are covered, so many buy additional policies to cover the balance. Elders used to get 100% coverage until a few years ago, but I think they now also have to pay 10% of the actual costs.

    Koroshi actually refers to manslaughter. Karo-shi means death from over-exhaustion… but I really should stop here lest I bore everyone to death.

  17. Jen in NYS says:

    As Teijo-san mentioned above, elderly people now have to pay some part of the costs. I am also aware that there is a shortage of doctors in Japan – particularly in the rural areas – which seem to have a higher percentage of the elderly. Nevertheless, even as a foreign tourist in Japan, paying for healthcare (should you need it) is not expensive like it is here in the US. An (uninsured tourist) friend of mine ended up in what we would call an emergency room or urgent care and I think he paid less than $50, including medication that he needed. I’m not sure if that is the same now with the recent changes.

    Back on the subject of waist size, Japanese people are typically not as tall as Americans, and so that waist measurements are proportionally different. Japanese “fast food” tends to be a bit healthier (lower fat) than in the US. However, there is certainly no shortage of “junk food” either. Portions and packaged quantities are smaller, not dissimilar to US portions in about 1975. I tend to think that the Buddhist principle of moderation plays a role in the tendency of Japanese people to not overeat. Also, people do not tend to have a denial of cause and effect (that consuming the ex-lg fries will have a physical result). Just my opinion.

    I don’t think that Japanese “look down” on the obese as some have suggested, though it is not considered to be a positive thing. However, as a woman, it was difficult to find ready made clothes in my size in Japan (US size 12-14ish). I am both too wide and usually too tall for the sizing. So, I’m usually limited to buying t-shirts and accessories.

    It’s been interesting reading the comments here. Thank you for posting the topic, Kathleen.

  18. JustGail says:

    Interesting. While the government hasn’t (yet) taken this step in the US, health insurance companies have. Where I work, we have the option of doing a screening for BMI, blood sugar, cholesteral, etc. If our numbers are below a limit, or improved by a certain amount from the prior year, we get a cheaper rate on health insurance. Those who are over, show no improvement, or bypass the screening pay higher. It’s been that way for about 3 years now, we suspect that the difference in cost will be increasing as time goes by.

  19. ensete says:

    it turns out smoking does not reduce lifespan of japanese men nearly as much as it does americans.
    in japan, where 63% of men smoke, it reduces their life expectancy by only 3 years compared to non-smokers.
    Life Expectancy among Japanese of Different Smoking Status in Japan: NIPPON DATA80]
    whereas the cdc says in the usa
    On average, adults who smoke cigarettes die 14 years earlier than nonsmokers

    3 years vs 14 years! that’s astonishing.

    there is so much else about japanese lifestyle’s affect on health that is puzzling, such as why the men arent infertile from those hot baths, why a culture that traditionally used nightsoil [human manure] as fertilizer eats so much raw food [unlike the chinese], and why they have a word –karoshi– for dying from workaholism, when they live so long on average. add to this, american ‘nutrition experts’ claim everything from the japanese have a soy based diet, to the japanese eat only a fraction of an ounce of soy products a day [which they additionally allege are all fermented–even though edamame and tofu are not.]

    on a more fashion-related topic. kimono:
    all over the world, men are supposed to favor an hourglass figure of some sort. but in japan, there is an unusual phenomenon, the ideal figure for wearing traditional kimono is a tube. women pad out their waists, [and if necessary bind their breasts] to achieve this cylindrical silhouette.
    this tube is a fairly modern kimono style; in previous eras [like the heian 794-1185 a.d.], kimonos flared out gracefully to wide hems and swept the floors. i think the waists were stiill padded under the obi, but the clothing of the era was gorgeous, with multiple layers [12 layers!] of fabric revealed at the flowing hem edge [see liza dalby’s Kimono: Fashioning Culture.]

  20. Paul says:

    There seems to be a bit of confusion about a term that is used in Asia but means something different to westerners and that is fermentation. Did you know that the difference between green tea and black tea is that black tea is fermented? Soya products in Japan are fermented but not in the way we think of fermentation in the west. Fermentation of tea means oxidation only. Fermentation of soya beans uses the same process except for sauces, which are cooked. Fermented soya beans means beans that have been crushed and oxidized usually with the application of heat. So too with tea. So soya milk should be brown in color not white. When I was growing up I could not drink cows milk so I drank a soya product made by Borden. It was the color of chocolate milk, was very thick, and was high in nutrients without any of the naturally occurring detrimental chemicals you will find in non-fermented soya.

  21. ensete says:

    i know how black tea, and soymilk, and tofu and tempeh are made. i’ve even made homemade yuba [tofu skin sheets — like skimming the skin off pudding, except its skimmed off boiling soymilk].
    i am unfamiliar with the borden product you mention. it is not what the japanese or chinese would regard as soymilk.
    normal soymilk and tofu involve regular cooking, and are very white. edamame is cooked green unripe soybeans.
    soybeans have a nasty compound [trypsin inhibitor] in it that needs de-activating by heat. even soybean sprouts, which are a larger sprout than the usual mung bean sprout, need brief cooking.
    fermentation of the usual sort is part of making miso, natto, tempeh [indonesian, not japanese product] and natural soy sauce.
    you are correct that tea is oxidized, not fermented: leaves are oxidized under controlled temperature and humidity. (This process is also called “fermentation”, which is a misnomer since no actual fermentation takes place.)[google]
    in reference to the ‘fat police’, japanese citizens accept the following level of police monitoring: [Home visit is one of the most important duties of officers assigned to police…’ explains the Japanese National Police Agency. In twice-a-year visit, officers fill out Residence Information Cards about who lives where and which family member to contact in case of emergency, what relation people in the house have to each other, what kind of work they do, if they work late, and what kind of cars they own.[37] The police also check on all gun licensees, to make sure that no gun has been stolen or misused, that the gun is securely stored, and that the licensees are emotionally stable.[38]http://www.guncite.com/journals/dkjgc.html].
    i think this would count as unacceptable ‘police state’ interference in america. even among liberal democrats like me. remember, this is for every family, not just for people on parole, or in a ‘bad’ neighborhood. apparently some city apartment dwellers are starting to rebel and slam the door on police visit attempts, according to another article.

    gee, monitoring citizen’s waistlines seems like just another aspect of government involvement in culture very different from ours.

  22. Teijo says:

    Interesting. . . the police have never visited my house to ask questions, but then I live in a city and not a village. Perhaps they don’t relish the effort of interviewing 12 million people twice each year.

    I do understand that the constable stationed in each village is – or was – supposed to know everyone, and be the person to turn to for help regarding basically anything. However, at least in the metropolitan areas they are becoming increasingly bureaucratic.

    Yes, the gun and sword laws here are quite strict. I guess the occupying forces felt they had to limit people’s access to them to feel safe. That said, I’ve not personally heard of annual visits to licensees — although people do take their firearms to the police station periodically for mandatory inspections and license renewals. A sword “license,” on the other hand, belongs to the sword itself and does not expire.

    The English term for tofu is bean curd. It was traditionally made by congealing freshly extracted soy milk using brine (left-overs from extracting salt from sea water, largely magnesium chloride.) It is usually eaten fresh, although there are regional preserves/delicacies made by fermenting it.

    An Aspergillus strain is used to ferment soy sauce (shoyu) and soy paste (miso) Families and neighbourhoods used to get together once a year to make their own, but the practice has now all but disappeared except in the most rural areas. The fermentation is stopped in at least industrially bottled soy sauce, but the micro-organisms in miso are more often left alive.

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