Government Intervention For Fighting Flab Will Not Be Welcome, Experts Say


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

Government Intervention for Fighting Flab Will Not Be Welcome, Experts
Say
By RADHA CHITALE
ABC Medical Unit
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."


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