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On the Front Lines of Japan's War on Fat

One of the less fun things each winter at the Tokyo unit of BusinessWeek parent McGraw-Hill (MHP) is the annual health check. One by one, staffers disappear into a clinic in an adjacent office block and are prodded, poked, and generally given a thorough going-over. Just about everything measurable is measured, blood is taken, and, for those older than 35, a barium meal is consumed. Make no mistake, it's a serious business. One colleague told me he was sent away after he turned up chewing gum. The receptionist deemed that he had broken the rule that insists patients mustn't eat for 10 hours before the checkup.

This year, though, was even more trying than usual because of some hard-hitting new regulations introduced in 2008. As part of a government drive to stem the prevalence of metabolic syndrome, a previously rarely mentioned disease that seems to cover everything that can increase the risk of cardiovascular disease or diabetes, waistlines are now being stringently monitored and, for anyone even slightly plump, acted upon.

That might sound harmless enough, but the new rules in the fight against metabo, as metabolic syndrome is called, are pretty tough. For men 40 and over, waists must be no more than 85cm, or 33.5 in. Women get a bit more leeway and can swell to 90cm, or 35.4 in. Those exceeding the limits are given dietary guidance if they haven't lost weight within three months. Guidance includes things like agreeing to a weight-loss target and exercise program, e-mails to check on progress, and so forth.

A Serious Effort

To show they mean business, Japanese bureaucrats will impose financial penalties on companies and local governments that don't hit targets. For large companies with lots of employees the fines are potentially quite large, running to millions of dollars if they miss targets.

If that all sounds a bit Big Brother, it is. For the first time, I had to give a photocopy of my medical results to the company, presumably so the government can assess our collective health. Meanwhile, after the introduction of the rules last year, companies began marketing metabo-busting products, such as government-approved teas that help burn fat.

The thinking behind the scheme is, predictably, to save on ballooning health-care costs, which increased 68% between 1989 and 2006, to $370 billion a year. In Japan, most people are covered by the public health-care system. Typically, individuals pay a chunk of their monthly salaries, matched by their employers, toward state health insurance. By reducing the number of overweight people, the hope is that costs will rise less quickly, putting less financial pressure on the state and companies. That's vital given Japan's rapidly aging workforce—already about 20% of Japanese are over 65—and shrinking numbers of young people.

What's Considered Chunky?

Luckily for me, I'm still under 40, so there's still some time before I get sent to fat camp. Nevertheless, I was still measured and, to my horror, exceeded the limit. That it was delivered by a nurse sporting a slightly sinister mask, designed to limit the spreading of colds, didn't make the process less painful. Apparently, I came in at a chunky 87cm, or 34 in., so I need to either shed an inch or change sex.

What really surprised me, though, was my final results. The clinic advised that my body mass index (BMI), at just under 23, was borderline fat and that I should consider losing a pound or two. At 185cm tall, or 6 feet 1 inch, and 78kg, or 173 lb., I don't consider myself particularly chunky. Only recently, and after embarking on an exercise campaign, have I discovered that Japan's (and some other Asian countries') interpretation of the BMI is stricter than that of the rest of the world. In most places, a BMI of up to 25 is considered fine.

If all that weren't confusing enough, while pedaling away on an exercise bike recently I caught details of a new Ministry of Health, Labor & Welfare survey on NHK, Japan's national broadcaster. The extensive survey monitored the health prospects of 96,000 Japanese aged 40 to 69 over a 10-year period and, oddly enough, it found that those with the best chance of living longest neither drink much alcohol nor smoke, but they are a bit chubby. Apparently, nonsmokers with a BMI between 25 and 27 who drink alcohol a few times a month have the lowest risk of cancer and cardiovascular disease. The survey also found that merely lowering one's BMI has little impact on longevity—seemingly at odds with the war on metabo. Perhaps pressuring businesses to measure the waistlines of every Japanese employee isn't such a smart move after all.

Rowley is a reporter in BusinessWeek's Tokyo bureau. With Hiroko Tashiro

Rowley is a correspondent in BusinessWeek's Tokyo bureau.

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