Legislated lifestyles for health

2008-05-07

Is your life healthy? So-called lifestyle diseases that result from bad habits are the bane of health officials the world around. Japan's aging population has spurred it to act. A new program prescribes that insurers screen for "metabolic syndrome" and treat lifestyles to curb the ills it can cause. Makes good sense; but it may also provoke cries of, 'physician, heal thyself!'

Life-threatening lifestyle diseases, unlike fatal communicable illnesses, plague more affluent societies whose members have more choice in matters such as diet, physical exertion and indulgence. They include coronary heart disease, strokes, type 2 diabetes, hypertension and obesity. These are the same ailments to which metabolic syndrome, a cluster of risk factors, is believed to be capable of leading.

The new program last month required corporate health insurers to start offering members regular checkups that will identify metabolic syndrome. By Japan's standards, men with waistlines that are 85 centimeter or more (90 cm or more for women) and any combination of high blood sugar levels, high blood pressure or high levels of lipid have it. Those so diagnosed between the ages of 40 and 75 are to be counseled by a health professional on diet, exercise and other lifestyle remedies. (Those whose waistlines fail the test but have just one of the three symptoms are said to be at risk of having the "risk factor" and should improve their lifestyles accordingly.)

In Japan, some 30 percent of health care spending goes toward treating lifestyle diseases. Metabolic syndrome, a condition virtually unheard of by lay persons on other shores, is all the rage here. That's largely because the Ministry of Health, Labor and Welfare, spurred concerns over what's been nicknamed "metabo" to heighten public awareness. It hopes to stave off health-care cost for a state that is estimated to see 30 percent of its population reach age 65 or older and one in 9 people age 80 or older by 2050.

The government hopes to save some 2 trillion yen in preventative-treatment cost with the new program by 2025 when the median age is slated to be 50, according to The Asahi Shimbun. Coincidently, the private sector is also eyeing that sum. Nikkei Business Online recently reported that a survey by Mitsubishi UFJ Research and Consulting Co., Ltd. showed annual sales of metabolic-syndrome-related products at the end of 2006 were also at about 2 trillion yen.

"The main feature of these products is 'visualization' of calories," reports Nikkei. They include a beer mug, soft-drink glass, rice bowl and mechanized calculator that let users see the number of calories they are about to consume. The research and consulting firm's Yumiko Arimoto told Nikkei: "The needs of such products may be created by official reforms of health-related systems and educational activities by the administrative authorities in the coming years. - As a result, the market of such products is expected to expand rapidly." It remains to be seen if metabo madness will lead to healthier living.

Only 8.2 percent of 6,016 online respondents currently used a sports or fitness club, according to a February DIMSDRIVE online survey. Fitness reasons were cited the most by 495 who did, but diet and "metabolic syndrome" were among the top at 41.6 percent. A similar survey by MyVoice of 13,158 respondents showed walking was the No. 1 method of exercise. Of 30 reasons to choose from, diet, often associated with the syndrome, ranked fifth at 38 percent.

Nearly 31 percent of men and 3.6 percent of women "can be diagnosed" with metabolic syndrome in Japan, according to an Okayama University Medical School report. An estimate often quoted in media is that one in every two middle-aged men in Japan has the fated syndrome (counting those likely to get it in the near future). If such math seems fuzzy it's most likely because it is. As elsewhere, there has been much adieu about setting official criteria for diagnosis in Japan - especially regarding waistlines.

At the start, some scientist advocated research into Japan-specific figures (pun intended) instead of merely importing criteria. Just last year, the same Okayama University researchers whose work supported current criteria released another study arguing that 75 cm for female waistlines is a more accurate benchmark; it showed 39.5 percent of women studied had metabolic syndrome instead of 3.6 percent. In the United States, it is set at 102 cm for men and 88 cm for women.

"The definition of metabolic syndrome is so slippery that at least six other organizations have their own versions, the World Health Organization (WHO) among them," notes USA Today newspaper. "The American Diabetes Association and European Association for the Study of Diabetes assert that 'too much critically important information is missing' to justify the use of (metabolic) syndrome as a measure of cardiovascular and diabetes risk."

"The new program was put together by the health ministry in a desperate response to strong pressure from the government's Council on Economic and Fiscal Policy, among others, to curb growth in snowballing health care spending," The Asahi Shimbun points out in a recent editorial that conservatively criticizes the program. "It is designed more to serve the interests of the ministry than to improve people's health. - We should pay ample attention to avoid excessive government involvement in personal health care and maintain the flexibility to review the program as necessity arises."



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