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Less than 5% of Japan's population is obese. Koichi Kamoshida/Getty Images
The new Labour government appears to be as relaxed about developing a “nanny state” reputation as it is about being seen as a purveyor of economic doom and gloom. From October next year, television adverts for junk food will not be permitted before the 9pm watershed and online adverts will be banned entirely. Measures are on the way to stop children from buying high-caffeine drinks and to ban anyone born after January 2009 from buying cigarettes. Meanwhile, the NHS is poised to enter workplaces to check our weight, blood pressure and cholesterol. All this is part of a drive towards preventive medicine in the UK: a country where obesity alone — affecting more than a quarter of the population — is said to cost the NHS upwards of £6 billion per year. Compare this with Japan, where less than 5% of the population is obese.
Is there anything Sir Keir could learn from the Japanese? They certainly have a better diet. For one thing, it is easy to get hold of a wide range of fresh fish, whereas in UK supermarkets much of our fish is either frozen, breadcrumbed or gives off that tell-tale fishy smell that means it’s already going bad. Add to that tofu, fresh and pickled veg, miso soup and nattō — sticky fermented soybeans — and you have the basis of a very wholesome diet. What’s more, in Japanese cuisine there is an emphasis on high-quality ingredients, simply prepared, with comparatively little in the way of complex sauces liable to introduce large amounts of fat, sugar or salt into a meal. Japanese children learn about nutrition in depth at school, and lunches there are prepared with strict nutritional guidelines in mind. Youngsters are also taught to stop eating when they feel 80% full, on the basis that by that point they have eaten all they need and the brain just needs a little time to register the fact.
Still, there is more to the story than diet and nutrition. Successive governments stretching back to the late 19th century have had a hand in crafting Japanese attitudes towards physical health — and not always out of straightforward concern for people’s wellbeing. Some of modern Japan’s earliest nutritionists worked for the armed forces, trying to build the bodies of their soldiers in the 1860s and 1870s. One of the reasons why Japan dropped its Buddhist prohibition on meat-eating — ushering in a first generation of “stew-restaurants” — was the hope that beef-eating in particular would help soldiers to heal faster from their injuries. Everyone from the Emperor downwards soon began eating beef for its promised health benefits.
Nineteenth-century doctors in Japan took a great interest, too, in the health of pregnant women. Healthy women and healthy babies were thought to be essential to the building of a robust workforce. Much was made of how workers in Western countries were often taller and stronger, placing Japan at a competitive disadvantage in everything from industry to future combat. In short, the thought emerged very early in the life of modern Japan that a person’s health is a public good.
This was part of a bigger picture in which the job of the state was not so much to fulfil the wishes of the population as to manage it according to what a small ruling elite regarded as being in the country’s best interests. Japan’s civil servants regarded themselves as “shepherds of the people”: they would research the sorts of Western social problems to which a modernising Japan was liable to fall victim, come up with solutions and then implement them with the help of doctors, midwives and school teachers. Compared to countries such as the UK, mass party politics and the idea of bottom-up political change never really took hold in pre-war Japan. People were taught that the state, as the expression of the Emperor’s will (in reality, the will of a tiny ruling clique), knew best. This idea survived into the postwar period, when after a brief flirtation with Left-wing politics an “iron triangle” of Right-leaning politicians, businesses and the civil service helped to manage the country’s remarkable economic recovery.
The result of all this has been that people in Japan accept a degree of paternalism and official cajolery from their leaders that would feel culturally alien in the UK. Public trust is sometimes undermined, when politicians are revealed to be on the take or when the state response to disasters — notably the earthquake, tsunami and nuclear meltdown of March 2011 — is exposed as inadequate. But the Japanese state has proven resilient over the years, notably in responding to public disquiet about environmental pollution in the Sixties and Seventies by advising big businesses to salvage their reputations and protect themselves against legal action by agreeing to stringent environmental and health and safety legislation. This included workplace health checks like the ones that Labour are considering for the UK: these have been happening in Japan for more than 50 years.
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Subscribethe idea takes root that physical health is a communal rather than just a personal good, not least because it eases pressure on the NHS.
What an extraordinary story and proposition. My physical health, and presumably my mental health, because both are interactive, are communal affairs, ultimately controlled, not by “the community” because it doesn’t exist, but by the government. Not least because it impacts on the NHS. (But as we know the government collects huge taxes on alcohol and cigarettes and yet the NHS wobbles). Just like the war on misinformation, who is going to determine what ideal health is? And what are the consequences for poor health; social ostracising? Just how extreme could that get; inability to get a job because you don’t meet communal standards?
The annual health checks you get in Japan are free, and if there’s something amiss you get a letter to take to a doctor where you will be seen immediately by the efficient and inexpensive health system. It’s eminently sensible, as is teaching kids properly about nutrition. Basically the state has made the effort to try and keep its people healthy.
The consequences for poor health are the same as everywhere. Feeling crap and heightened risk of an early grave.
We seemed happy to accept extreme restrictions on our movement to save the NHS during the covid pandemic. Why not enforced slimming to save the NHS!
The idea that we are proud independent people who “never shall be slaves” took a bit of a knock during the covid era.
Why should the fit, slim and virtuous have to pay for NHS services to the fatties, the cigarette smokers and assorted alcohol and drug takers?
Virtuous? What does being fit or slim have to do with virtue? You’re being a bit shifty lumping drinkers and smokers in with drug takers. From what I understand 80% of the cost of cigarettes go to the government. Nor does everyone that smokes require hospital treatment. Nor does every drinker need hospital care. Being fit and slim doesn’t mean you’ll never need care from the NHS. It’s there for everyone financed by everyone. Who knows when you might need it. But you’re right about the NHS, good health begins at home.
Having just come from reading articles on Starmer’s insulting hypocrisy and DEI harassment of yoga I was in a somewhat cynical mood regarding interference by politicians in the citizens daily life. What next? Mandated attendance at two hour sessions of fat and exercise awareness courses perhaps to show something has been done.
I believe Singapore has or had regular fitness requirements for its citizens and I can see that if you are running a ‘free” health service there is an argument for requiring those who might need its services to look after themselves properly so that the service does not collapse and/or become unaffordable. My reference to virtue was anything that saved the state a medical cost. The difficulty is deciding where interference ceases to be reasonable and becomes oppressive. Politicians are probably the last people you want deciding this as they are usually inveterate meddlers.
My reference to virtue was anything that saved the state a medical cost.
Yes, I can see that it was the way I read it and not necessarily connected to fitness. Apologies are rare here, so …
I intend to live forever and expect government healthcare to get me there. Whatever the cost.
That’s what the promise was. I kept my word, I expect them to as well.
Well, alcohol and nicotine are actually drugs! The issue of the net cost of smoking is a tricky one because of course people tend to die much younger when they are heavy smokers and most of the cost of the NHS derive from the much higher health needs of older people.
I love social drinking but there’s no doubt that the excessive use of alcohol causes very high social costs to others. Whether or not a particular drug is legal or not seems to be a matter of arbitrary history and contingency – who got there first – rather than often in any rational assessment of harm. But I certainly don’t want the state controlling what we do that is the way to an even less free society than it already is. However helping people to make better choices doesn’t seem to be unreasonable
Believe me, you can’t win this one. Fat people are not fat, they are heavy or well-built.
We discuss these things at home. Strangers in the street can be fat but family or friends “Have problems. You wouldn’t understand.” There are two meanings to ‘fat’ when applied to people. One is a description, which is for strangers; the other is an insult, which can’t be used for anyone you know well.
An increasing proportion of health service costs go on the ailments and management of old age. Ditto social care. They are delayed but not avoided entirely by living a healthy lifestyle. In fact old age can result in multiple hospitalisations, multiple medication management and pressure on social services. Why thus should the alcoholic, tab smoking fatty who’s going to die younger and not generate those costs help pay for them?
The moral judgments are much more difficult once you get into them and even the economic calculations fraught with complexity. We need personal responsibility of course, but there will be v few of us reaching perfection.
Some lines can be drawn when considering a free health service. If your BMI is between 25 and 30 American doctors would caution you. If over 30 you are in disease territory. Due to the use of DEI extended to weight now doctors cannot even safely weigh a patient in the USA without fat shaming and being called a fatphobic
Surgically such high BMI can mean you don’t get listed as you are too high an anaesthetic risk. You have to go and lose some weight.
Lots of patients get weighed for clinical reasons – to track hydration levels or gut function etc. It’s a basic observation for many conditions. Be careful you don’t drink the Kool-Aid on all your hear about weighing patients.
BMI can play a role in some clinical rationing, but would you deny someone a cataract op on account of BMI?
Not so straightforward in reality.
Longevity and healthy life expetency for a North Western European peak at a BMI of 26.5. Carrying slightly extra fat (and muscle mass) is a risk reducer for this ethnicity. Surely knowing this we should set the BMI benchmark higher?
But wait, people from some parts of Oceania have significantly worse health prospects with a BMI above 23. Where exactly should this “ideal” benchmark be set?
To ignore genetic differences is to ignore the often very stark differences in health outcomes genetic inheritance causes individuals. And we are all individuals.
For exampe, 70% of the surge in diabetes under 40s in the UK is driven by genetic shifts towards those from South Asia, who are significantly more predisposed to the condition. BMI has an effect but other factors are far more important.
When you drill into BMI it is an arbitrary number at population-level when populations are not homogeneous. It becomes extremely fuzzy when we consider individuals. And becomes irrelevant with age.
Well, for all the faults of the British state and the NHS, this is certainly not the case here!
I wonder whether it might be possible for once to keep the American culture wars out of an argument mainly about Britain?!
“Why should the fit, slim and virtuous have to pay for NHS services to the fatties, the cigarette smokers and assorted alcohol and drug takers?”
We don’t (I speak as a slim, fit person myself). The overweight, the drinkers and especially the smokers pay far more into the system than they take out in healthcare and social care costs. It is in fact these people who subsidise the rest of us so that we can burden the NHS in our 80s instead of our 60s like they do.
That was always my best friends comment. Then he had a serious illness and moderated his drinking eating and gave up smoking.
I’m not quite sure the numbers work though. Smokers dropping dead in their 50s is a huge loss for society.
Unhealthy lifestyles do kill people younger than they would otherwise live. The fact that this is a bad choice personally doesn’t alter the actuarials I’m describing.
People dying in their 50s is a personal tragedy for themselves and their loved ones and there are therefore good reasons to recommend healthier living to such people on that basis. What isn’t a good argument is to say that these people cost society more than others, because they don’t.
Why should the childless pay for midwife services? Why should the gender normal pay for transgender procedures? Why should I pay for treatment of musculoskeletal issues commonly found in runners and tennis players? This approach is utterly reductive and leads only to a society that is unable to provide social security of any kind.
But yes, let’s turn it into purely economics. Smokers die early and quickly. Smokers are, all else being equal, net contributors. Indeed, it is those that live the longest and healthiest lives that are the largest societal burden in economic terms. And children are pretty expensive too, perhaps we should curtail having them and import fully grown adults raised elsewhere… oh, wait a minute.
The problem with this economic analysis is it is the tail wagging the dog. We are not servants of the NHS or government. We are not economic units to be ordered and managed.
Like most things governments do competing priorities need to be taken into account. And one is always economics. What are the others?
It’s an important point. The question is what is healthcare and what should the governments role in it should be limited to.
Whether workplace health checks the way to go (and I’d favour them if optional) two key questions prompted by Article – with costs of health and social care rising exponentially with an aging population how do we best manage demand and what is the role of personal responsibility within this?
One can be a bit yah-boo and place more emphasis on the latter. Trouble is it’s not as straight-forward when you get below the surface. Poor health can impact on others, esp family and carers generating an economic impact well beyond the individual. Anyone beginning to face the reality of aging, frail parents needing increasing support that is not available will know this. And then there is who makes the judgment on to what degree the individual failed to better look after themselves and what criteria used? Few of of us have led the life of a trappist Monk.
Nonetheless social policy debates will have no choice but to consider the balance in coming decades.
All of these health checks and discussion of fat people would give me mental problems ………….
It astonishes me that this discussion takes place with no reference to the horribly fattening foods junked onto our people by US profit centres, like KFC and McDonalds. Not forgetting that large mouthsful of the UK food market is owned by US companies. It is the pernicious influence of US profiteering that leads Britons to shape themselves like citizens of the US.
KFC and McDonalds are also in Japan. No one is forced to buy or eat their stuff. So no good trying to blame the Yanks for our poor choices and lack of self-discipline.
Chip shops and canned vegetables are back on the menu baby!
They always have a choice though.
That’s not actually true often, eg in Manchester Piccadilly Gardens, US fast food chains have swamped the shops and you would have to travel some distance on foot to find healthier options. Pedro is bang on. Its similar with the out of town shopping centres and driving your kids everywhere that has been largely inherited by the UK.
Do you mean travel some distance for eating out options (which is a choice) or supermarkets where we buy our necessities.
It astonishes me that you don’t seem to recognize the term ‘junk food’ includes these items! But singling out McDonald’s and KFC would be missing the wider point. I’m not sure that McDonald’s is particularly bad (posh burgers costing £25, natch, are fine!), and occasional eating of it isn’t a problem. It is the fact that a lot of people eat a lot of this processed food and more importantly, soft drinks, much of the time. And of course get very little exercise – the recent craze for e scooters is going to be a disaster for public health – no longer even necessary to walk from the car parking space to the office or school!
Quite true. The offerings at expensive restaurants are extremely fat laden. French cooking means “add butter”.
Nobody forces anyone to eat junk food.
Japan has its own version of McDonalds called MOS Burger, which is really tasty.
Japan has its own problems with their traditional diet, which tends to be very salty, high in carcinogens (from salted pickles and bracken), is full of carbohydrates, and high in mercury from tuna. It’s not just fat people who are shamed – it’s anyone whose looks or behaviour depart even slightly from the mainstream
I have lived in Japan and yes, their diet, though less weight-induing than in US/Europe, causes a much higher rate of stomach cancer. What really keeps the Japanese skinny is the amount of walking that their transit systems require. Not many Japanese own cars; you walk from home to a subway station and then from another subway station to the office. Japanese cities are so safe that people walk everywhere, at any time of day or night, for any errand.
In your time off, you walk to a vast railroad station that can be multiple levels deep and mostly served by stairways. At country stations, it is common to ride to a destination by bicycle.
In my first year there, I lost thirty pounds.
There’s plenty of obese people working in the NHS. During my career, i can recall occasions when very fat frontline healthcare staff approaching down a hospital corridor required a bit of “space negotiation” to get past them (i’m not exaggerating here.)
I can just imagine one of those obese people heading into a place of employment to conduct healthcare checks and proffer dietary advice to a much healthier and fitter workforce!
I’d like to see some stats on this, because I have often noticed that NHS staff aren’t merely a bit overweight, but sometimes even almost spectacularly fat.
I suspect it’s because in addition to the fact that people aren’t going to adopt the difficult choice of a healthy diet just because they happen to work for the NHS, the job is usually stressful, badly-paid and involves non-standard hours and shift work. All these factors interfere with sleep and the regular daily rhythms that make healthy eating easy.
I also like to see some statistics on this, but I doubt they exist. A couple of anecdotal comments from people who are quite hostile to the NHS (and I agree overall it’s in mediocre system) isn’t evidence. In my view doctors and nurses are a bit better on average in terms of how overweight they are. Since the British population is pretty unhealthy as a whole, it’s not surprising that this is represented in the huge NHS workforce
I see that our wonderful caring government is about to offer the fat jab on the NHS. No need to diet, no need to take any personal responsibility when we can help big pharma to make excessive profits on the backs of the tax payer.
Horrible picture! Totally agree!
We should just be honest. When “Big is beautiful” caught on no one had the guts to say “No, it isn’t. It’s unhealthy.”
And it’s not beautiful, except to those who like the heavy figure.
Our communities need less government not more. And it’s not just because they do a shite job and their unions create a voting block to control the democracy.
It’s because personal development requires people to figure things out for themselves.
Without hard lessons you are still a child.
And yes shame away.
“The result of all this has been that people in Japan accept a degree of paternalism and official cajolery from their leaders that would feel culturally alien in the UK.”
Were it so. See the counter-examples of COVID, “vaccines,” Tavistock, the war in Ukraine, climate change …
Urine tests in the workplace can’t be a good thing! Our employers would find out about all the recreational drugs we take!
I love Japan and Japanese people but seriously, ifind the food dreadful. I cannot stand it. And Harding’s comment about sauces? Weird, when opening any one of a thousand daily packaged meals one emcouters liquid accessories the nature of which is beyond anyone’s real ken – such as, say, the sachet’s worth of clear fluid with which one brings instantly lubricated life to otherwise inert noodles…
The fatties owe society a huge debt. We endured the stringent COVID measures to protect the vulnerable (a nice way of saying fatties of all ages who didn’t take care of their health). Further, a huge part of health expenditures is for illnesses caused by obesity or more prevalent among the obese – diabetes, cancers, liver and kidney diseases, joint disorders and even Alzheimer’s.