Metabo — your figure or your job

As first covered earlier this year, the government health ministry in Japan has mandated compulsory “flab checks” for all workers over age 40. Waistlines have to conform to regulation size or face stiff penalties; and older, heavier people are enduring certain social castigation. This Friday the 13^th, we begin coverage of the latest studies examining the medical evidence for trim waistlines.

The Japanese waistline crackdown story received renewed interest last week, when U.S. News reported on Sunstar, Inc., a oral hygiene product company that was sending its employees who failed their flab check to fat farms, as part of its program to comply with the government mandates. The Japanese regulations, that went into effect in April, are to address what the Japanese have come to call “metabo.” Workers with waists over 33.5 inches for men and 35.5 inches for women, are referred for counseling and close monitoring. Companies are also being required to slim down their workers or face higher payments into the national health insurance program.

As Rene Singer of U.S. News had reported on June 4^th:

...Companies across the country have responded with a variety of initiatives. Sunstar has its boot camp, which includes lectures on diet, exercise, and even Zen meditation. Family members of employees over 40 whose love handles won't budge will also be asked to attend the camp... NEC Corp. requires all of its employees in its Japanese offices to undergo yearly checks from the time they turn 30, a full decade earlier than the government regulations require. And all employees must attend lifestyle instruction courses. Any employee who shows "poor results" (think beer belly) will receive individual follow-up attention, says Susumu Makihara, general manager of human resources for the global giant's Japan operations...

Other companies have made ‘healthful’ eating less of a recommendation and more of a job requirement... Few Japanese are willing to criticize the government's regulations or their employer's plans for the record. But the Japan Times newspaper ran a column quoting outraged, but unnamed, workers. One worker says he intends to fast for three days before his examination to shed the inches he needs to pass his physical. Another told the newspaper, "My waistline is none of my company's business."

Many Japanese have turned to technology to fight flab. Television here is now flush with commercials for exercise equipment and electronic belts that promise to melt the fat away. And NEC has just developed a new feature for mobile phones in Japan, which analyzes the reported daily intake of the phone user and determines if the diet is healthful.

It is now a civic duty to stay fit, says Naoko Takase, assistant manager of public relations for Sunstar.

The New York Times picked up the story today, describing the Health Ministry’s claim that reducing waistlines could rein in the aging population’s health care costs. That’s become “one of the most serious and politically delicate problems facing Japan today,” said the paper, with some admitting that the government’s metabo campaign is really part of efforts to shift costs of public health care to the private sector. NEC, Japan’s largest computer manufacturer, alone, could face $19 million in penalties if it doesn’t get 25% of its employees to lose weight by 2015:

Anger over a plan that would make those 75 and older pay more for health care brought a parliamentary censure motion Wednesday against Prime Minister Yasuo Fukuda, the first against a prime minister in the country’s postwar history. But critics say that the government guidelines — especially the one about male waistlines — are simply 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 that there was “no need at all” for the Japanese to lose weight..

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... In no time, the scary-sounding condition was popularly shortened to the funny-sounding metabo, and it has become the nation’s shorthand for overweight.

The mayor of one town in Mie, a prefecture near here, became so wrapped up in the anti-metabo campaign that he and six other town officials formed a weight-loss group called “The Seven Metabo Samurai.” That campaign ended abruptly after a 47-year-old member with a 39-inch waistline died of a heart attack while jogging...

With the new law, Matsushita has to measure the waistlines of not only its employees but also of their families and retirees. As part of its intensifying efforts, the company has started giving its employees “metabo check” towels that double as tape measures. “Nobody will want to be singled out as metabo,” Kimiko Shigeno, a company nurse, said of the campaign. “It’ll have the same effect as non-smoking campaigns where smokers are now looked at disapprovingly.”...

What’s the evidence on metabo? We’ll look at that next. Don’t be surprised to find that the evidence reveals the opposite of what we’ve come to believe is true.