1. Japan and the “Metabo Law”
Mark J. Manansala
Why Japan and Obesity?
I just remember seeing this silly news story online about Japanese companies doing
mandatory waist line measurements of their employees in an effort to curb obesity. After
doing the research on the topic, it revealed some really interesting information about the
state of health care in Japan. Even though, it’s known for being pretty healthy when
compared to the rest of the world, they are facing some challenges ahead.

2. Japan and the “Metabo Law”
Mark J. Manansala
Japanese history is rich in mythology, and has influences
from China. It’s first emperor was believed to be a direct
descendant of the sun. After centuries of isolation,
Japan first opened its ports to the west when it signed
the Treaty of Kanagawa with the United States in 1854.
Since then, it has strived to find a balance between
centuries of tradition and modernization.
(History of Nations, 2004, CIA, 2012)
Tokyo, Japan

3. Japan and the “Metabo Law”
Mark J. Manansala Health Care System
2012
Total GDP: $4.617 trillion
Health expenditures: approx $387 billion (9.3% of GDP)
In the 1960s, Japan instituted a national public
health insurance system that is funded by:
1. government subsidies
2. insurance premiums
3. individual copayments There are approximately 3,500 private insurers and government
municipalities that provide insurance for the population.
(CIA, 2012)
The Two Broad Groups of Beneficiaries:
1. Employees and their dependents under the age of 75 (65%)
2. Self-employed, unemployed, and elderly (35%)
(Matsuda, 2012)
Employee Health Insurance (EHI)
Civil Health Insurance (CHI)
*see slide notes to
compare to American
health care system

4. Japan and the “Metabo Law”
Mark J. Manansala
Demographics
Population: 127 million (10th)
Growth Rate: -0.077% * Population is shrinking. Declining for
the third year in a row, and on pace to be
Life Expectancy: 83.91 years (3rd) halved by the end of the century
(Traphagan, 2012).
Median Age: 45.4 years
Obesity Rate: 3.1% (US: 33.9%)
(CIA, 2012)
* Population is also aging, with people
over 65 making up almost a quarter of
the population and teens only 13%
(Traphagan, 2012).

5. Japan and the “Metabo Law”
Mark J. Manansala Looming Demographic Crisis
Population: 127 million (10th)
Growth Rate: -0.077% * Population is shrinking. Declining for
the third year in a row, and on pace to be
Life Expectancy: 83.91 years (3rd) halved by the end of the century
(Traphagan, 2012).
Median Age: 45.4 years
Obesity Rate: 3.1% (US: 33.9%) The current health care system is held together, because much
of the services are paid for by the working population –
(CIA, 2012)
approximately 4% of their salaries plus the 30% co-payments
(Oda, 2011). As many of these people begin to retire, there
will be an increased demand for medical services. When there
are not enough working people that contribute to the health
care system, and pay for this new influx of health care
demands, a deficit will be created. Oda (2011) compares the
situation to the current health care crisis in America as baby
* Population is also aging, with people boomers switch from “being contributors to the system to being
over 65 making up almost a quarter of beneficiaries” (p. 261).
the population and teens only 13%
(Traphagan, 2012).

6. Japan and the “Metabo Law”
Mark J. Manansala
Metabolic Syndrome
a collection of factors that increase
the risk of cardiovascular disease
and diabetes:
• abdominal obesity
• hypertension
• elevated blood glucose
Japan’s Ministry of Health, Labor, and
Welfare released a study finding that • high cholesterol
half of all men and 1 in 5 women (Onishi, 2008)
between the ages of 40 and 74
showed signs of metabolic syndrome.
The report caused a public outcry
against metabolic syndrome – dubbed
“metabo.”
(Singer, 2008) 56 million citizens
(age 40-74)

7. Japan and the “Metabo Law”
“Metabo Law”
Mark J. Manansala
The report from the Ministry of Health, Labor, and
Welfare led to legislation, passed on April 1, 2008
(Singer, 2008). The “Metabo Law” refers to a set of
guidelines officially called the Standards Concerning
Implementation of Special Health Examinations and
Special Public Health Guidance, under the Ministry of
Health, Welfare, and Labor Order 159 (Oda, 2011).
With a goal of shrinking the overweight population by
10% over the next 5 years and by 25% over the next 7
years, these guidelines call for local governments and
employers to conduct mandatory annual examinations,
including measurement of waistlines for people
Basically…
between the ages of 40 and 74 – representing 56
million or 44% of the entire population (Onishi, 2008).
For individuals that exceed the maximum waist line of
33.5 in (85 cm) for men and 35.4 in (90 cm) for women, People between the ages of 40 and
doctors will consider other diagnostics to determine the 74 are required to get annual waist
severity of the metabolic syndrome; those in the highest line measurements.
category will be required to attend counseling sessions
over the next three months to lose weight and make If they exceed the maximum
lifestyle changes (Oda, 2011, p. 265). Employers are measurement, they get counseling.
required to ensure a minimum of 65% participation with
the exam and 25% reduction in obesity within 7 years, Their insurers and employers are
or face penalties of up to 10% of the current payments responsible for achieving at least 65%
which will go to fund elderly care (Oda, 2011). compliance and a 25% reduction in
obesity by 2015, or face fines that will
go on to fund elderly care.

8. Japan and the “Metabo Law”
Mark J. Manansala
Who is Affected?
56 million citizens
There are no incentives or repercussions age 40-74 now “required” to get annual exams
for those that fail to get their waist line
measured. There is also no penalty for
refusing to follow the treatment
recommendations after “failing” the exam.
Companies will pay fines if they do not
meet the 65% compliance and 25%
reduction of obesity by 2015.
Those fines will go toward paying for health
care for the elderly.
Oda (2011) suggests that the whole set of guidelines is
Meanwhile, childhood obesity numbers a clever way to benefit…
continue to rise; now at 20% (Rohana &
Aiba, 2012). “not the 3% of Japan’s population considered obese so
much as it is the scores of elderly Japanese endangered by
a healthcare system going bankrupt” (p. 269).

9. Japan and the “Metabo Law”
Mark J. Manansala Legislating Health Around the World
In 2011, Denmark passed a “fat tax” that implemented an
across-the-board tax on all foods with saturated-fat content
above 2.3% (Kliff, 2012). Instead of causing consumers to
make healthier food choices, people bought their fatty foods
online or in neighboring Germany (Kliff, 2012). By 2012, the
Danish government announced that it would abolish the tax.
In America, the Safeway Amendment that allows employers to offer
insurance incentives and discounts to people who take steps toward
better health (Borrell, 2011). The amendment got its name from the
Safeway Chief Executive Steve Burd, who wrote of his company’s
Healthy Measures program was “proof that incentives could cut our
nation’s healthcare costs by 40%” (as cited in Borrell, 2011, para 3).
The goal is to keep workers healthy, reduce sick time, and
ultimately reduce health care costs. However, critics said that the
program was poorly designed and created inequality by benefiting
those that are already healthy at the cost to those who are
unhealthy, and unfairly to those who are unhealthy despite efforts to
improve their healthy (Borrell, 2011).

10. Japan and the “Metabo Law”
Mark J. Manansala Pros & Cons
Pros: Cons:
“Metabo” has become a cultural phenomenon Currently, less than half of the 56 million people between the
– leading to an increased awareness of health ages of 40 and 74 are attending their “required” annual check-
and fitness. ups. If this number does not reach the 65% goal of the law by
Japan is still one of the thinnest countries in 2015, companies will face heavy fines. A large company like
the world with an obesity rate of 3.1% (CIA, NEC said that it could face up to $19 million in penalties
2012). (Singer, 2008)
Fines from the 2015 deadline will fund health Only 12.3% of those that receive counseling follow through
care for the elderly, maintaining universal with the medical advice (Lhuillery, 2013).
health care in Japan. Does not address rising childhood obesity rates.
Companies are offering healthier food choices Companies may start to discriminate against overweight
and metabo-education for employees and their people to avoid paying fines.
families.
The waist line measurements conflict with recommendations of
the International Diabetes Federation.