Fat Fines: Could Japan Plan Work in U.S.?

June 27, 2008 — -- As waistlines continue to expand in Japan, the country's lawmakers are taking the unusual step of fining companies that employ overweight workers — an approach that diet experts say would likely meet with failure in the United States.

"They'd never get away with that here," said Dr. Keith Ayoob, associate professor of pediatrics at Albert Einstein College of Medicine in New York. "I'm sure the intent is to get a healthier society, but I'm not sure this is the best way to go."

Still, in Japan, the national program to trim tummies and prevent diseases such as diabetes and heart disease has taken a proactive, group approach to the problem of "metabo" — a shorter, and some say cuter, term for metabolic syndrome.

And when it comes to the Asian country's fight against metabolic syndrome — the collection of illnesses known to accompany obesity — the effort appears to be working.

According to the New York Times, weight-loss groups in Japan exercise together, singing inspirational weight-loss songs with lyrics such as "Goodbye, metabolic. Let's get our checkups together. Go! Go! Go!" Meanwhile, posters in Japan feature rotund cartoon figures with buttons popping off their pants urging people to overcome "metabo," reported the newspaper.

As a country with more than one-third of its population classified as obese, the U.S. might benefit from a stringent program like Japan's. But part of the reason a program like Japan's has no place in the U.S. is because American's would be far less tolerant of government involvement in what can be a highly personal issue, said Dr. David Katz, director of the Prevention Research Center at the Yale University School of Medicine.

"In Japan there is a sense of communal engagement, what's right for the public good," Katz said. "We don't like being told what to do, saying 'You're not the boss of me.' What works at the population level is dictated by cultural standards."

The goal measurements for Japanese men's and women's waist circumferences are 33.5 inches and 35.4 inches, respectively — guidelines straight from the International Diabetes Federation in Belgium. People who exceed these measurements will be targeted for health education initiatives. If they fail to lose the extra inches, their employers could be fined.

A Weighty Issue

Weight and body shape can be an emotionally charged issue, and being penalized for it, particularly with a "one size fits all" health model, may backfire.

"Obesity is stigmatizing as it is. Talk about adding insult to injury," Katz said. "Also it seems to me unfair to 'require' people to control their weight in an environment that makes obesity the path of least resistance and the road most followed."

According to the Centers for Disease Control and Prevention, 78 million Americans are obese. In addition, 20.8 million people in the United States have diabetes, according to the American Diabetic Association, and half of those people are over 60. Weight, and waist size, is one of the best ways to assess the risk of diabetes, as well as other diseases such as stroke, some cancers and heart disease, the leading cause of death in the U.S.

"Forget the government and regulations, this is a personal issue you need to take care of," Ayoob said. "If you do reduce your waist size you really do improve your health."

Ayoob also noted that the waist circumference guidelines used for the Japanese program seemed odd because women typically have smaller waists than men.

By contrast, the be American Diabetes Association guidelines state that healthy men and women have waist circumferences of 40 and 35 inches, respectively.

But even these guidelines can be hard to follow.

"Many people in our culture, we can't even find our waist," said Dr. Madelyn Fernstrom, professor and director of the UPMC Weight Management Center in Pittsburgh. "We don't need a tape measure to know, 'Are you an apple or a pear [shape]'?"

And Fernstrom added that people don't take steps to deal with their weight problems early, when intervention would be most helpful, until they become sick.

"It's a focus on the wrong thing," Fernstrom said. "People think if I'm not sick, it doesn't matter what my waist is."

Grab the Carrot, Lose the Stick

Experts say that a better model for the U.S. would be incentive based as opposed to penalty based. That is, people should be rewarded for being healthy and attempting to take control of their weight rather than being fined for being overweight.

To that end, many companies are implementing programs that offer cash and gift cards to employees who are actively trying to be healthier. A new survey, conducted by ERISA Industry Committee and the National Association of Manufacturers, showed that 71 percent of employers offer incentives for health and wellness programs, a 15 percent increase since 2007.

Similar programs that help people stop smoking have been successful.

"Employers realize this," said Dr. George Blackburn, associate director of the Division of Nutrition at Harvard Medical School. "How do we motivate this, how do we nudge it? Everyone says with money."

Fixating on body size can be potentially dangerous, as it makes people more vulnerable to drastic weight reduction measures, such as eating disorders. Experts say keeping the emphasis on health is a better approach.

"For people who are otherwise OK, this is not something you want to put off doing," Ayoob said. "This is doable for most people."