Mandatory Waistline Measurement in Japan: Good Public Health Social Policy? Or Genetic Discrimination Against Fat People?

The NY Times has a really interesting piece on a new policy of mandatory waistline measurement in Japan.  With a goal of improving the public health, the government has established a state prescribed limit on male waistlines of 33.5 inches along with a limit of 35.4 inches for women...

No...I'm really not kidding.

Companies and local governments will apparently be required - under this new national law - to measure waistlines of those 40-74 years old during annual checkups.  Apparently, those not meeting the country's standard will be given dieting guidance if they do not meet the standard and do not lose the weight over 3 months (with subsequent escalation of the scrutiny and advice if folks are still too rotund at 6 months). 

Interestingly, the Japanese government intends to impose monetary penalties on entities (local governments and companies that fail to meet specific targets).

Although I am sure that the Japanese government has good intentions, this is a very interesting policy in light of the fact that obesity is a trait that can only be partially modified by behavioral change.  In other words, it is clear that obesity risk is to some extent a heritable trait, determined to some extent by one's genetic background, that can be difficult for some individuals to overcome.

Although this is an interesting and aggressive experiment aimed at reducing healthcare costs, it has the potential to result in further stigmatization of those affected by the obesity epidemic (something that is, no doubt, intended by the rule since it may result in public health benefits).  By imposing penalties on local governments and companies, the government is avoiding the appearance of discriminating against those with generous waistlines; however, this will create tremendous incentives on these entities to exert considerable pressure on individuals whose waists are over the limits. 

In sum, it's a bold social policy.  It may help with healthcare costs in the long-run, but is it genetic discrimination? 

What do you think?

Comments

[razib]

Although I am sure that the Japanese government has good intentions, this is a very interesting policy in light of the fact that obesity is a trait that can only be partially modified by behavioral change. In other words, it is clear that obesity risk is to some extent a heritable trait, determined to some extent by one's genetic background, that can be difficult for some individuals to overcome.

it's a trait that can be totally modified by behavioral change, it just doesn't seem that many people in a modern affluent society are willing to burn as much energy as a pre-modern peasant, or reduce their food intake enough. if you go around vietnam you'll see very few obese people, and that's not due to different genetics, but a different environment. the variation within the population might still be due to genetics, but the median weight is lower and those predisposed toward obesity in an affluent society might just be a bit plumper-than-average.

this is a good first step because you increase the number of priors in any system of personal healthcare. if someone has the obesity prone alleles they know they are at risk and have to modify their behavior accordingly to a far greater extent.