Penalty for the Long Waist: Japan, Going Against Obesity?

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Photo: Ko Sasaki for The New York Times

Although Japan is one of the countries with the lowest prevalence of obesity, the overweight recently has kept increasing due to the change in diet and physical inactivity. In order to mitigate the effect of obesity and reduce the expenditure for the complication of metabolic syndrome, Ministry of Health, Labor and Welfare (MHLW) of Japan proposed Metabo Law in 2008, which mandated that insurers implemented regular check-up of 40-75 year olds to screen obesity. The failure to cover more than 65% of the target population till 2015 would impose fines on the insurers, and people who exceed the maximum allowed waist lengths are required to attend various remedy programs.

This graph shows the trends of health-check coverage among 45-70 year-old adults in Japan. The health check attendance rate has increased by only 6.1% from the first year (38.9%) to 5th year (45.0%), which is still far below the targeted rate (65%).  Reference) the website of Japanese Ministry of Health, Labor and WelfareHowever, a nation-wide survey still shows so low coverage of regular health check-up (Figure) that the majority of insurers is not likely to reach 65% of coverage rate within 2 years and will be forced to pay tremendous amount of penalty. In that case, the insurers have to increase the premiums, which will cause low-income people to drop from the insurance. It will also negatively affect the people with poverty-related obesity, which will hinder ‘net’ national medical expenditure for obesity from shrinking by Metabo Law.

To prevent the calamities, the law should be urgently amended. Criteria for penalty should be reset down to 55% or lower and the due date should be extended to 2017. Also, to avoid discrimination in hiring people with overweight for fear of the fines, another regulation for nondiscrimination should be included in the amendment.

Photo: Ko Sasaki for The New York Times

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One Response to “Penalty for the Long Waist: Japan, Going Against Obesity?”

  1. pkartchner Says:

    This is an interesting topic addressing the global obesity epidemic. I had heard of such schemes to address obesity in a nation but had not heard of Japan’s plan.

    I would like to comment that it’s not clear to me that a requirement to have a regular appointment would have much if any impact on obesity rates. In the absence of clear evidence of benefit, I would recommend discarding the requirement altogether.

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