Health targeting in obesity


Japan has introduced new legislation that requires everyone between 40 and 74 years of age - almost half of the country's population - to have their waist measured. The waist limits are set at 33.5 inches for men and 35.4 inches for women. People who exceed this measure are supposed to run high risks of diabetes and heart disease. Those with larger waist have only three months to get in to shape; after that compulsory health re-education kicks in and their employers have to pay penalties.

This is absolute amazing, given that Japan still has the world’s skimpiest and longest living population. It has only recently faced an increase of obese people. 1997 figures from a WHO task force show Japan has got only 3% obese people (defined by body mass index of over 30) which has changed little in the preceding forty years. Even more upsetting is that the Japanese have actually cut their energy intake (from 2104 kcal/day to 1967 kcal/day) during these 40 years. So what happened? Well it’s all about policy targets. The Japanese obesity task force (JASSO) has simply decreased the obesity cut off for their generally lean subjects to BMI=25, which in the West only counts as overweight. This trick exploded Japanese obesity to 30% in the group of men over 30 years and made them the suitable target for draconian health policies.

Now the link between diabetes and waist measurement is still very contentious. Two large studies, one in Britain the other in the US, by Naveed Satter of Glasgow Faculty of Medicine, published in Lancet, have plainly rejected it because the evidence supports rather the opposite. In fact, men and women with large waist sizes had lower risks for CVD (heart disease) mortality than the thinner-waisted. Moreover, these were Americans, who generally have larger waists than the Japanese. Certainly, in Japan the number of diabetics has doubled in the last 15 years. Yet as this study suggests, the link to obesity is weak and in sharp contrast to the dramatic reaction of the Japanese lawmakers.