Japanese mandate is latest diet craze

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 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 was a strict 33.5 inches, he had 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 ages 40 to 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the population.

Those exceeding government limits — 33.5 inches for men and 35.4 inches for women, which are similar 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.

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 penalize companies and local governments that fail to meet specific targets. The country's Ministry of Health argues the campaign will keep the spread of diseases like diabetes and strokes in check.

The ministry also says 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.

But critics say the guidelines — especially the one about male waistlines — are 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 there was "no need at all" for the Japanese to lose weight.

"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 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.

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, 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: 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 metabo, and it has become the nation's shorthand for overweight.

Under the new law, companies like Matsushita, which makes Panasonic products, must measure the waistlines of at least 80 percent of their employees and get 10 percent of those deemed metabolic to lose weight by 2012. They also must get one-fourth of those deemed metabolic to lose weight by 2015. Failure would bring penalties from the government, though exceeding specific targets could lower their financial contributions to the nation's health system.

NEC, Japan's largest maker of personal computers, said if it failed to meet its targets, it could incur as much as $19 million in penalties. Some experts say 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 physicians who administer physical exams, said he endorsed the government's campaign but that the real priority should be to reduce smoking rates, which remain among the highest among advanced nations, in strong 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."