Your waistline may be the best barometer of your health. (Susan Farley for The New York Times)Imagine if your employer started measuring your waist as a measure of your health.
That’s what’s happening in Japan. As my colleague Norimitsu Onishi explains in today’s Times, a Japanese law that came into effect two months ago requires companies and local governments to measure the waistlines of Japanese adults. The government limits are 33.5 inches for men and 35.4 inches for women. Those who exceed the standard and also have another weight-related health concern are given “dieting guidance” to drop weight. (To read the full story, click here.)
While the Japanese plan seems onerous, it’s not without scientific basis. Studies clearly show a person’s health risks increase as waist size grows.
In March, an analysis in The Journal of Clinical Epidemiology showed that body mass index is the ”poorest” indicator of cardiovascular health, and that waist size is a much better way to determine, for both sexes, who is at a higher risk for hypertension, diabetes and elevated cholesterol.
Studies suggest that health risks begin to increase when a woman’s waist reaches 31.5 inches, and her risk jumps substantially once her waist expands to 35 inches or more. For a man, risk starts to climb at 37 inches, but it becomes a bigger worry once his waist reaches or exceeds 40 inches.
Last month, The International Journal of Obesity suggested that, particularly for young people, the waist-to-height ratio might be a better indicator of overall health risks. Put simply, your waist should be less than half your height.
To read more about health and waist size, click here. And click here to check out whether your body shape is an apple or a pear.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
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Perhaps the numbers are stricter than they should be, but I am sure the practice, if implemented in the United States, would would be beneficial. It will never take root here because we care about “self-esteem” and “freedom of choice” more than we do about not living to see our grandchildren.
— YuliaOften in this blog, the subject for a politically correct or polite term for corpulence comes into question including terms such as obese, overweight, and fat.
My nomination goes to the Japanese term described in the article, “metabo.”
To answer you blog article question:
Sex: Male
Age: 31
Height: 6 ft 2 in (74 in)
Weight: 190
BMI: 24.4 (Normal)
Waist (at navel): 31 in
I’m no metabo!
— Lexingtonhow do you measure your waist for health risk? do you measure your ‘natural’ waist (which is a lot smaller), or around the biggest part of your stomach?
— katherineFROM TPP — According to the National Institute of Diabetes and Digestive and Kidney Diseases, measure your waist circumference, place a tape measure around your bare abdomen just above your hip bone. Be sure that the tape is snug, but does not compress your skin, and is parallel to the floor. Relax, exhale, and measure your waist. Here’s a link.
Why don’t the airlines do a sliding-scale fare system based on BMI? They weigh everything else. I’d love to have to get in-shape for my flight.
— JonesIt will be interesting to see how this program will do. Will people be healthier because the entire nation is focused on not being “metabo”, the preferred Japanese word for overweight? Will companies and local governments, who are responsible for measuring waist lines and ultimately financial penalties if their population, help change the lifestyle in Japan to be more healthful? For example, if your company produces food for the nation, do you promote smaller serving sizes? If you are a local government, do you greenlight more parks and neighborhoods that promote physical activity? Measuring waistlines gives us a starting point and a proxy of the health of a nation. What will be fascinating to see is what they do with that data. It will be more, however, than simply re-educating people. We all should know that being overweight or obese, which is the status of 2/3 adult Americans, is not healthy, but the challenge is how do we make our increasingly hectic 24/7 lifestyle more supportive for staying active and eating well?
Davis Liu, M.D.
— Davis Liu, M.D.Author of Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America’s Healthcare System
http://www.davisliumd.com
As tough as it is to imagine a practice like thisto take place within our oversensitive culture, I do believe setting standards and expectations on day one would be a great practice. After all, in our military today if a new recruit does not pass the standard regarding his or her weight and ability to move (strength)they get sent off for special training and with that comes a closely regulated diet. Now what would happen if we were able to implement this today in more of our work culture of today? I am all for it!
Call it metabolic syndrome or what ever you please but it comes down to more people taking ownership for their health by making wiser and more healthier choices each day!
Male
36
6 ft
183
Normal BMI range
Waist 32
Posted from MPLS
— Coach EichersActually, my U.S. university employer already does this. It’s not required, but it’s tied to a $40/month insurance premium discount.
— uni workerIt might be a little strict and is unlikely to change anything for overweight people who continue to insist on making poor choices, but at least Japan is making an effort. The obesity problem in the US is huge!! I hope our country gets up the nerve to address it in a stricter manner soon.
— MegSounds like a great way to make employees feel insecure and inadequate, and potentially distract them from concentrating on their work, at least in the weeks leading up to their physical. It’s one thing to check on a person’s health, but to judge an entire diverse (or not so diverse, as the case may be in Japan) population against a predetermined “average” seems like a laughable proposition at best.
— mbIf you go to the “are you an apple or pear?” website, they note both that “apple” people have higher waist to hip ratios, and that higher waist to hip ratios are troublesome, ie could put the apples at higher risk for certain diseases.
Does that mean that if an apple and a pear had the same height, weight, and BMI, but due to the specific fruit storage patters the apple’s waist to hip ratio is higher, the apple is at a greater risk? Are apples naturally predisposed more to metabo associated diseases? And if so, does that just mean that they need to have lower weights and BMIs than fellow pears in order to be equally healthy? Seems a little strange to me (not that I buy into the whole BMI is a great indicator of health nonsense necessarily, either)
— confusedFROM TPP — People with an apple shape collect fat around their waist. People with a “pear” tend to gain fat around their hips. Being an apple shape puts you at higher risk for metabolic syndrome, diabetes, heart disease and a number of other health problems. If you have an apple shape, that means visceral fat is wrapped around your important organs.
The US Air Force currently uses waist measurement as part of its fitness assessment for its military members. Airmen are also assessed on their ability to run 1.5 miles and do push-ups and sit-ups. The leadership decided to use waist measurement when the doctors presented information directly tying waist circumference with morbidity. The standards apply to all. “Self-esteem” is less of a concern for the Air Force than military readiness and general fitness.
— AlisonWaist circumference is most reliable as a predictor of risk in normal weight people. This is because it tells us whether or not a person has central obesity (apple shape). Using this measure in the obese population is less reliabe as an indicator of central obesity because obese people are larger overall–so the measure does not really discriminate shape.
Incidentally, the picture you display highlights another important point. Whoever isdoingthe measuring has to know how–your picture shows this being done wrong, wrong, wrong.
As far as letting employers do it–ok by me if they are going to pay for nutrition counseling for me:)
— ChrisMaybe it’d be the motivation I need to get myself in gear, if they did it in the U.S., lol. Getting measured at work is no fun.
— DakotaFrom what I have read, there are two kinds of fat: abdominal fat, and subcutaneous (below the skin) fat. It is the abdominal fat which is worse, it surrounds your internal organs and leads to many health problems. Subcutaneous fat is not as bad.
What they are getting at with “apple” versus “pear” shapes, and with focusing on waist sizes, is this difference. Apple shapes and people with large waists are assumed to be so because they have a lot of abdominal fat. If your waist is smaller, or at least your waist to hip ratio is smaller and you are more pear shaped, that means you have more subcutaneous fat and relatively less abdominal fat.
One problem with this is that some people may have large waists but their fat may be more subcutaneous than abdominal. The difference is that subcutaneous fat is above (outside of) the muscle, while abdominal fat is beneath the muscle. If you have a big “spare tire” or “beer belly” and it is superficial fat, that is presumably not as bad as if the reason for the extra size there is because of deep, abdominal fat.
— HalThat means that if you’re apple-shaped, your ’safe’ zone is quite a bit thinner than if you have large hips. With my hip width the way it is (36″), I am in the dangerous ratio range of >0.8 once I have a waistline of 29″ (resulting in 0.81). That’s over 5 inches less than what is advised in general for women.
Interesting, I didn’t realize that being predisposed to store fat this way is a health risk of its own. (not being sarcastic, really). “visceral fat near the organs” - yikes! Quite a visual.
— an appleAmericans would never allow this to happen. Please, they are defensive about their weight problems, quick to blame someone else and don’t take responsibility for the poor choices they make- be it nutritional, or lack of exercise, etc…. It’s the “it’s my right to eat what I want, exercise when and if I want, and it sure isn’t your right to tell me what to do” argument. I was raised in middle America and it seems like it’s a pervasive attitude that isn’t going to change until Darwinism starts to work. And, I’ll be damned if I am going to pay for the medical care for individuals who don’t take personal responsibility for his/her health.
— susanthe problem is, susan, the weight control advice the government has doled out to americans has very likely directly led to the “obesity epidemic”. since officially endorsing low-fat diets in mid 1970s (based on very little evidence, i might add) americans have exploded. “low-fat” has meant “more sugar” (particularly high fructose corn syrup) and the results have been disastrous.
i am interested to see what kind of nutritional advice the japanese will be giving violators and if it has any effect in reducing the “metabo” rates.
— paul bowersThis sounds like a great way for weight discrimination to start. Don’t hire/let go of your fat employees so you don’t aquire a financial penalty. I won’t say that waist measurement has little effect on one’s health but it is certainly not the way to judge the overall health of an individual.
— LauraI guess I’ll never get a job in Japan. Kinda glad we don’t do this here - I like being employed.
— JenKOh Crap. I’m a goner.
— Adrienne ZurubWhat I’m wondering is this: is it an employer’s responsibility to monitor an employee’s weight? I want my supervisors etc, to monitor my performace at work, but I don’t want them measuring my waist or my hair or my fashion sense. Unless my employer is also my physician, it’s none of their business.
— EmmaThere’s a racial element to ‘metabo’ in the United States. Any attempt by authorities to do something similar will be a political nightmare. Also, shame has a big cultural influence in Japan (elsewhere in Asia as well) but in the US, lawsuits will arise if somebody’s self-esteem is slighted.
— H TranAre these employers also screening/fining/re-educating for other health risks such as stress, poor eating, no exercise, smoking, drinking, lack of social supports, driving without a seatbelt, overuse of rx drugs…you get the idea.
Weight (or, in this case, waistlines) get targeted not because they pose a greater threat to health but because they are visible. It’s a slender (!) thread on which to pin an assumption of health or illness.
Japan’s move is wrong-headed–and terrifying.
— WeebittyIt is true that your body-fat distribution shape (apple v.s. pear) is determined initially by genetics (post explaining how and why is here - http://healthhabits.wordpress.com/2008/06/13/the-science-behind-spare-tires-and-thunder-thighs/ )we also need to know that low calorie diets make this situation worse by increasing the number of fat receptors responsible for storing fat in our problem areas. These same hormone receptors interfere with our bodies ability to release fat for energy from those problem areas.
It’s boring and old fashioned, but a healthy lifestyle of sensible eating and exercise is still the way to go.
It’s just not sexy enough to turn into a reality tv show or a best selling diet book.
— DRI was initially surprised that most of the comments to this article didn’t seem concerned of the possibility that their government would consider legislating just how fat they are allowed to get before being sent to a body fat re-education camp.
But then I realized that most of TPP’s readers have already decided to take responsibility for their own health and fitness.
Bravo.
But don’t be surprised if the U.S. gov’t doesn’t come up with a similar program.
Just the other day, Rear Admiral Steven Galson, the U.S. acting Surgeon General, called on the nation’s doctors to prescribe exercise to patients who would benefit from being more physically active.
Thanks to the support of the California Governor’s Council on Physical Fitness and Sports, over 2,000 doctors immediately signed up to support this new initiative.
link to the full article - http://healthhabits.wordpress.com/2008/06/02/us-surgeon-general-issues-exercise-prescription/
How novel - Doctor’s prescribing lunges instead of Lipitor, Healthy food instead of hospitals.
— DR