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Sunday, March 16, 2008
Skeptics nix 'comedy' drive to officially fight the flab
By TOMOKO OTAKE
A sharply besuited young woman comes home and finds her dad downing a mug of beer in the kitchen, with an assortment of snacks on the table. She playfully warns him, pointing to his potbelly: "Oto-san (Daddy)! You're drinking again! You are eating too much, aren't you? Metaborikku Shindoromu (Metabolic Syndrome)!'
Father looks startled, and points to his round belly. "Metabo? You mean here? Is that the thing that's in vogue these days?"
Yes. In vogue. Big time. These days, not a single day goes by, it seems, without there being a fitness-club flier, a beverage ad or a new recipe that contains some mention of metabo, short for "metabolic syndrome."
A relatively new phrase in Japan, metabolic syndrome refers to a cluster of risk factors such as visceral fat (fat between organs), high blood sugar, high blood pressure and high cholesterol levels, which together are said to greatly increase your chance of suffering from diabetes, strokes and heart attacks.
In fact, the father-daughter exchange was part of a promo video created by the government to "educate" the public about the start next month of compulsory tests for the syndrome, which will cover 56 million people age 40 and over.
In the tests, people will have their waists measured. If a man's girth is 85 cm or more, or a woman's is 90 cm or more, they will be placed in a "high-risk" group where, depending on the results of other tests, they will have an "action plan" drawn up by experts to change their eating and exercise habits. Some would also be asked to see a doctor.
But these checks for metabolic syndrome, aimed at curbing the nation's mushrooming health care costs — totaling ¥33.1 trillion in fiscal 2005 and projected to rise further as the population ages — are controversial among experts. Some say the thresholds of 85 cm and 90 cm are not fully supported by evidence, while others say cutoff levels for other items, such as blood pressure and cholesterols, are so strict that half of the 56 million would be considered "abnormal."
In fact, the ethnicity-specific waistline threshold recommended by the International Diabetes Federation for Japanese people is actually 90 cm for men and 80 cm for women.
What has added to controversy is that the health ministry in Japan has determined that, at least in corporate checkups, people can choose how to have their waistlines measured. If someone is too embarrassed to bare their midriffs, they will be able to insist on having their waists measured while staying clothed — in which case 1.5 cm will be subtracted from their figures. Thinner people will also be allowed to measure their waists themselves.
Asked if this "flexible" approach does not compromise the accuracy of waist measurement, Tomohiro Yoshimi, a health ministry official in charge of supervising the health and safety of workers, conceded: "It's true that figures would be more accurate if people were measured with no clothes on. But we have come up with this alternative because we heard from businesses that their workers might not cooperate."
It also seems an impossible task to record the waistlines of 56 million people with technical precision. In fact, in a letter in last November's issue of the British medical journal The Lancet, researchers led by Satoru Yamada of Kitasato Institute Hospital in Tokyo reported that, depending on who does the testing, there can be a maximum difference of 7.8 cm in the waistline measurement.
"It's a comedy," sneers Yoichi Ogushi, professor of medical informatics at Tokai University and a critic of the new checkup. Ogushi has argued that the flab checks are a big waste of money and could make many healthy people swallow drugs they don't need.
"If you follow the government's logic, you can do whatever you want (to damage your health) as long as you have a slim waist," he said. He added that the government has meanwhile turned a blind eye to smokers.
Ogushi predicts, however, that the government will cancel the metabo exams in a few years, after realizing that they won't save any money.
Businesses jumping on the metabo bandwagon — from makers of Joba (horse-riding) exercise machines to green-tea marketers to fitness clubs — might find the boom to be short-lived. Until then, though, the "Waist Size Story" — a bizarre pun on the Broadway classic used here often by bloggers and pundits alike to refer to the fight against flab — will go on.