Wanted, Dead or Alive (But Especially Smaller): Your Waistline

Talk about your fashion police. A new law in Japan requires companies and local governments to measure the waistlines of citizens between the ages of 40 and 74 annually as part of a national campaign against obesity. The New York Times reported this ambitious (some would argue Draconian) new program in a front page article last week.

Concerned about the rise in what they call "metabo" (short for metabolic syndrome, described in a previous blog) among middle aged Japanese adults, the government will require men whose waists measure greater than 33.5 inches and women whose waists measure greater than 35.4 inches to participate in a dietary counseling program. Waist size is an inexact, but reasonable estimate of risk for diabetes and other obesity related health problems. Japanese companies and local governments failing to measure a certain percentage of their employees or citizens, or failing to successfully encourage them to lose inches from their waistlines, risk stiff financial penalties.

I suspect this new law will draw a mixed reaction among Americans. On the one hand, it seems the ultimate "nanny law," an intrusion by government into individuals' most personal choices about what we eat and how we look and feel. Since our colonial beginnings, Americans have always valued individuality, personal freedom, and all you can eat buffets. On the other hand, in the past few years, obesity among Americans has been recognized as a societal problem, both in its causes and effects. It's difficult to lose weight when our food supply is glutted with processed food made from government subsidized corn sweeteners, when McDonalds has concessions in schools, when health insurance companies are more likely to pay for gastric bypass surgery than gym memberships, and when poor neighborhoods lack safe recreational areas or supermarkets stocked with fresh produce. And it's difficult to define being obese as a purely personal choice when, as the Centers for Disease Control estimates, obesity related illness and disability cost $200 billion annually.

So, could an "anti-fat" law ever be passed in America? I doubt it—even the Japanese law has, according to the New York Times report, produced much grumbling and some noncompliance. Americans, being far more obese (the average American man has a waist measurement of 39 inches and American women average 36.5 inches) and wedded to a high fat diet than the Japanese, would have a much tougher time with such a law.

And yet, most people don't want to risk diabetes and heart disease and certainly don't wish these obesity-related health scourges on their children. We might welcome some help from the government, but there will be disagreement about the form that help should take. Strict limits on smoking in public places and high cigarette taxes have drastically reduced smoking rates (and, some would argue, have made smokers feel like social outcasts), but I think similar efforts to curb eating behavior would meet with more resistance. Personally, I'd rather see government efforts go toward building playgrounds and subsidizing organic vegetable gardens than lining us up to face the tape measure. What do you think?

Dr. Suzanne Koven practices internal medicine with a special interest in weight issues at Massachusetts General Hospital in Boston, and teaches at Harvard Medical School.

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