The perils of being big in Japan

Japan has introduced a new law that ranks as the world’s most aggressive, and possibly most ill-informed, anti-obesity measure. The national law, which came into effect two months ago, requires companies and local governments to measure the waistlines of everyone aged 40 to 74 as part of their annual checkups.

The measure, which will cover 44 per cent of the country’s population – that’s 56 million Japanese citizens – stipulates that people whose waists exceed the allowable limit – 33.5 inches for men and 35.4 inches for women – will be given three months to get in shape. Failing that, they will be given another six months of health re-education to reduce their waist measurements. Companies with large-waisted employees will be financially penalised. Critics say that the government guidelines are too strict and that more than half of all Japanese men will be considered overweight.

The Japanese government argues that such draconian measures are necessary to prevent significant increases in diabetes and cardiovascular diseases (CVDs), as well as to rein in health care costs. According to the Ministry of Health, the underlying problem is metabolic syndrome (MS), which the Japanese call ‘metabo’, a collection of supposed risk factors, such as waist circumference, high blood pressure and high levels of blood glucose and cholesterol, which increase the likelihood of cardiovascular disease.

For MS awareness campaigners, risk factors such as waist size provide a much better indication of cardiovascular risks than Body Mass Index, the height-to-weight ratio that is the conventional obesity measurement. The argument is that fat is the real cause of MS, which puts the large-waisted at an increased risk of heart disease and sudden death.

Is this really the case? Does MS actually increase the risk of heart disease? Two studies published a fortnight ago in the British medical journal, The Lancet, suggest that it does not.

The studies, led by professor Naveed Sattar from the University of Glasgow’s faculty of medicine, examined the link between MS and CVD and diabetes in the elderly. Sattar and his colleagues focused on the elderly as the association between MS and CVD and diabetes in younger populations remains, as they note, ‘contentious’. As they observe, the lack of supporting evidence for a link between MS and, with it, waist sizes, and heart disease and diabetes, has led to significant questions as to whether MS can usefully predict the onset of these diseases.

In order to test the MS-waist-size-heart disease-diabetes link, Sattar used two prospective studies – ‘the Prospective Study of Pravastatin in the Elderly at Risk’ (PROSPER) and ‘The British Regional Heart Study’ (BRHS), involving over 7,000 patients aged 60 to 82 who were observed for three years.

The results are astonishing; they completely discredit the assertion that MS, with its claims about waist size and heart disease risk, provides a reliable predictor of CVD. In both PROSPER and BRHS, there were no statistically significant differences in waist measurements, BMI or blood sugar levels between subjects who had heart disease and those who did not develop it.

Metabolic syndrome, with its regime of measuring waist circumference, was not useful in predicting risk for heart disease in the elderly. As the authors note, their findings ‘concur with data in middle-aged populations for whom criteria for metabolic syndrome are inferior to, and do not enhance conventional methods for, risk prediction of coronary heart disease’.

Lest these results be dismissed as a British quirk, the findings of ‘The Cardiovascular Health Study’, published last month and involving older Americans observed from 1989 to 2004, also refute the hysteria surrounding MS. The American study found that, after controlling for confounding factors such as smoking, drinking, and physical activity, there were no statistically significant associations between heart disease mortality and the components of MS (waist measurements, cholesterol levels, etc).

In fact, men and women with large waist sizes had lower risks for CVD mortality than the thinner-waisted. Moreover, these were Americans, who generally have larger waist sizes than the Japanese.

The assertion that those with MS (particularly those with large waists) are likely to develop heart disease and run a higher risk of dying from a heart attack is unproven hysteria on the part of the obesity-obsessed public health establishment. It is comparable to the discredited claims that those with BMIs in the overweight or obese category are likely to live shorter lives.

Let us hope that this reassuring message reaches the Japanese before 56 million people are ordered to get their waists measured, let alone sent for obesity re-education in the phoney belief that there is a connection between a small waist and avoiding a heart attack.

Patrick Basham and John Luik are co-authors, with Gio Gori, of Diet Nation: Exposing the Obesity Crusade, a Social Affairs Unit book. (Buy this book from Amazon(UK).)

Sources:

‘Metabolic Syndrome and Mortality in Older Adults’, Dariush Mozaffarian et al, Archives of Internal Medicine, 12 May 2008

Metabo Tightens Belts in Land of Rising Tum, Scotsman, 15 June 2008

‘Can Metabolic Syndrome Usefully Predict Cardiovascular Disease and Diabetes? Outcome Data from Two Prospective Studies’, Naveed Sattar et al, Lancet, 22 May 2008