Japan's New Public Health Problem Is Getting Big

By Akiko Yamamoto
Special to The Washington Post
Tuesday, June 19, 2007

TOKYO -- When he arrives home late from work, Keizo Takemi says, he often furtively opens the refrigerator and searches for something to quiet his growling stomach. He is about to pounce when he hears his daughter's voice. "Daaaaad," she snaps, and he guiltily closes the fridge and slinks off to bed chastened, his stomach grumbling in vain.

Takemi is 55 years old and Japan's vice minister for health, welfare and labor, so he is not used to being told what he can and cannot eat, certainly not by his daughter. But Takemi is no ordinary politician. In a bid to foster awareness of a growing problem with obesity in Japan, he put himself on a six-month diet and turned himself into a national guinea pig.

On a daily blog he lists what he eats, how much exercise he does, how much his waistline fluctuates. There are even photos of his belly, the source of his woes, before and after.

At a recent public weigh-in, Takemi said dieting in the spotlight hadn't been easy. "The toughest thing was having to cut down on the things I really want to eat," said Takemi, who admits to loving meat and deserts. But the hardship has paid off. Since December, Takemi has lost 16.4 pounds, and his waist has shrunk three inches.

Outside Japan, the country is known for a high reliance on low-fat fish and seaweed dishes. But meat and high-fat foods feature ever more prominently on Japanese tables. While per capita calorie intake is stable, animal fat and protein consumption has grown fourfold over the last 50 years.

As a result, obesity and other dietary complaints have become major public health problems. At risk is one of Japan's proudest accomplishments, its longtime position at the top of global longevity tables.

According to the Health Ministry, the rate of obesity in Japanese people over age 20 is increasing in every age group except women ages 20 to 29 and 40 to 59. Men have gained most of the country's extra weight, but obesity in children also has risen significantly, from 18.9 percent in 1988 to 24.3 percent in 2005, according to a survey.

In Tokyo, the local government has started offering lifestyle coaching for obese children. At one children's center, counselors advise children on eating habits, exercise and dieting safely. The weekly program has about 50 children on its waiting list.

In January, Manami Sugimachi, 12, started attending sessions at the National Children's Castle, a kind of giant museum and activity center for young people here. It pains her to have to check the calorie values of snacks before deciding what to eat. But she has lost weight since joining the program and has started to enjoy exercise. "I don't want to be sick as an adult," she said. "And I want to be able to wear the clothes I think are cool."

The Japanese government wants to combat obesity because it has started to weigh down the national health system. According to government estimates, about 10 trillion yen -- almost a third of national medical expenditures -- goes to the fight against lifestyle-related diseases enhanced by obesity. Sixty-one percent of Japanese deaths are due to these ailments.

"We want to set up an environment where when you decide, 'I am going on a diet,' you can," said Hiroyuki Tanaka, director for nutritional education promotion at the Health Ministry. "You can eat one MegaMac a week," he said, referring to a four-patty burger sold at McDonald's in Japan. "But it is important to choose what else you would eat that week."

Many were once convinced that Japanese people lacked the fat genes found in other groups. According to figures compiled in 2005 by the Paris-based Organization for Economic Cooperation and Development, only 3.2 percent of Japanese people had a body mass index greater than 30, compared with 30.6 percent in the United States.

But experts say Japan is on the cusp of its own crisis. Katsuhiko Yano, a senior investigator at the Pacific Health Research Institute in Hawaii, is concerned. Since 1965, he has conducted dietary studies of Japanese people in Japan and Japanese Americans in the United States. He found that Japanese Americans, eating a Western diet higher in fat and animal protein, are at higher risk of heart disease.

"Genes alone can't stop the steady move toward obesity," Yano said.

The archetypal burger-eating man in the southern prefecture of Okinawa has fast become a symbol of what is at stake in Japan.

For decades, the life expectancy of Okinawan men was among the world's highest. But after American fast food arrived in the late 1940s, Spam and taco-rice slowly supplanted the much healthier local diet. Every year, the government in Tokyo publishes longevity statistics for Japan's 47 prefectures. After falling in the rankings from the top to fifth in 1990, Okinawan men slumped to 26th in 2000.

Takemi, the vice health minister, sympathizes with how hard it can be to turn away from steaks and cream puffs. Yet he hopes that his battle with his weight can inspire other Japanese to wage their own. "Losing weight has made a huge difference," he said. "I feel lighter even when I am walking. And I feel much less tired after work."

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