Japan’s Fat Tax

This has been going on for three years, yet I just learned of it:

In 2008, Japan’s Ministry of Health passed the ‘metabo’ law and declared war against obesity. …

Japanese people are normally envied for their lean physiques. In fact, the OECD ranks them, with only 3% population obesity, one of the least obese developed countries. … Comparing the time periods 1976-1980 and 1996-2000, prevalence of obese boys and girls increased from 6.1% and 7.1% to 11.1% and 10.2%. …

The law mandates that local governments and employers add a waist measurement test to the annual mandatory check up of 40-75 year olds. For men and women who fail the test and exceed the maximum allowed waist length of 33.5 and 35.4 inches, they are required to attend a combination of counseling sessions, monitoring through phone and email correspondence, and motivational support. …

Employers or local government … are required to ensure a minimum of 65% participation, with an overall goal to cut the country’s obesity rates by 25% by year 2015. Failure to meet these goals results in fines of almost 10% of current health payments. (more)

Even before Japanese lawmakers set the waistline limits last year, the International Diabetes Federation (IDF) amended its recommended guidelines for the Japanese. The new IDF standard is 90 centimeters (35.4 inches) for men and 80 centimeters (31.5 inches) for women. But the Japanese government has yet to modify its limits. (more; HT Melanie Meng Xue)

Two interesting patterns:

  1. Japanese waist limits are stricter on men, yet since men are taller health-based rules would be stricter on women.
  2. The thinnest rich nation (Japan) passed a big law to make itself thinner just as the biggest medical spending nation (USA) debated a big law (Obamacare) ensuring it would spend more on medicine.

My tentative explanations:

  1. Most societies find it easier to disrespect/mistreat/etc. low status men than low status women.
  2. National policy is more about reaffirming and supporting symbols of national pride than about addressing national needs. The USA is proud of its medicine and Japan is proud of its thinness.

Note that that if you want to regulate health it makes far more sense to regulate weight than medicine, since weight is far more related to health than medicine.

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  • http://www.gwern.net gwern

    > Most societies find it easier to disrespect/mistreat/etc. low status men than low status women.

    Ran into a cute example of this today while working on http://www.gwern.net/Notes#the-morality-of-sperm-donationhttp://www.sciencedaily.com/releases/2007/05/070525204143.htm discusses how low-status men are treated compared to the women (many of whom are students).

  • Albert Ling

    1. I have a sense that Japan is much more patriarchal and male-dominated than western society. I have some friends who live in Japan who say it’s common for businessmen to get drunk, go to strip clubs, hire prostitutes and even “grope” random women in the subways and its overlooked/tolerated by society.

    Also this:

    Just 3% of Japanese companies have a woman on their boards, vs. more than 86% for U.S. companies, according to Corporate Women Directors International, a non-profit organization dedicated to getting more women on corporate boards. The 27 Japanese companies in the Fortune Global 200 last year had just three female directors — 0.7% of their total directors, lowest in the world.

    But yeah, maybe the low-status men phenomenon (which is global) is so large that it trumps all that.

    2. And is the U.S really so proud of it’s medicine and japan proud of it’s thinness?
    Maybe the prior distribution of women’s waistlines is larger than men’s so the change is still proportional? Just a guess…

  • Dan Hill

    Really bizarre in a country where the most popular sport is very large very obese guys wrestling…

    • PA

      I had similar concerns…

      I suppose they might get a license though which allows them to do as much.

      Besides, there’s a pointed difference between a glutton who can barely get up off the couch, and 300lbs of primed meat + muscle…

  • Kelley

    Given the blog title, I am surprised to read this:

    “Note that that if you want to regulate health it makes far more sense to regulate weight than medicine, since weight is far more related to health than medicine.”

    It turns out that neither is particularly related to health outcomes. Although, you might make the point that more medicine can be negatively correlated to outcomes, it is almost certainly the case that government regulation of weight will have no effect, either on weight or on health, not to mention that government regulation of weight will mostly lead to more medical intervention.

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  • Jon

    Wow Kelley you are pretty off here.

    In fact I was just reading thisabout an hour ago:
    http://jama.ama-assn.org/content/291/10/1238.abstract

    Looks like weight is number two behind tobacco.

    Also I think weight has a lot to do with wages which has some to do with outcomes:
    http://www.ppge.ufrgs.br/giacomo/arquivos/eco02072/cawley-2004.pdf

    And for good measure it seems that employers don’t have much impact on weight either:
    http://ideas.repec.org/h/nbr/nberch/11816.html

    By the wa

  • carl213

    Just further proof that it sucks to be a low status male. At a family gathering recently, while flipping between college football games, I passed over a pro wrestling show. It was interesting how vocal the women were in expressing loathing for the type of people who would watch pro wrestling — especially those in the crowd.

    Now the activity we were engaging in, gorging on food and college football, wasn’t especially upper class, but it was solidly middle class. The women in the room were immediately vocal about how low class and white trash pro wrestling is, especially the fans.

  • Colin

    I guess it’s cheaper this way, but body fat % is a much better indicator of health than waist size.

  • Unnamed

    Does Obamacare increase total medical spending?

    A little bit of googling turned up this post about the estimates by the Center for Medicaid and Medicare Services, which project that total medical spending will be 2% higher in 2016 than it would’ve been without Obamacare (meaning that the US will spend 102% of what it otherwise would’ve spent). After that, total medical spending under Obamacare will grow more slowly than it would have without the law, so by 2019 it will only be 1% higher than it would’ve been. So it’s just slightly more total medical spending, for a little while.

    The law has a much bigger impact on other metrics, like the number of people without health insurance (which it will reduce by 30 million or more).

    • http://hanson.gmu.edu Robin Hanson

      The law had some parts that clearly increase costs, by increasing the number of folks covered by insurance and the treatments to which covered folks are entitled. The law also included a cost control panel that would lower unspecified costs, even though previous similar panels have done no such thing. That allowed the claim of lowered future costs.

      • Damien RS

        OTOH, if health care insurance reform shifts health care delivery from high cost and last minute ER care to regularly scheduled and preventive care, it can reduce overall spending.

        And while I know you’ve long had a thing about aggregate medical spending not being well-correlated with outcomes, I’d expect more spending on people who’ve been unable to afford health care to be more productive than spending at other margins.

      • Unnamed

        It’s true that providing insurance to people who would otherwise be uninsured involves a significant increase in medical spending, and that (according to projections by the CMS and the CBO) this increase is largely offset by other aspects of the law that are expected to cut medical spending. But that seems to go against your story that the policy is meant to reaffirm national pride in the country’s strengths. Leaving lots of people uninsured was a big weakness of America’s medical system – it’s one way in which the USA stuck out as being worse than its peer countries at medicine – which means that the new spending is going to fix a weakness rather than further glorify a strength.

  • Miley Cyrax

    “Most societies find it easier to disrespect/mistreat/etc. low status men than low status women.”

    What? That’s impossible! Things like sending men off to war, men working more dangerous jobs, and “women and children first” are just emblems of male privilege!!111

  • Jeff

    Seriously? I realize your readers are entirely male, and echo chambers make for poor thinking environments, but the whole low-status-male argument is pretty disassociated from reality outside the chauvinist blogosphere. Counterexamples abound: treatment of single mothers, attempts to end all reproductive choice, even birth control, etc. I think you need a more sophisticated framework for explaining how we treat low status people, unless this is just fanservice.

    • PA

      I agree that asserting that women are on the whole better treated than men is, to say the least, shortsighted.

      But I don’t think he’s (it doesn’t matter what gender the author is ;) :P ) wrong with his assertion, which is not that men are unilaterally treated worse than women, far from it. Men happen to enjoy many positions of power or superiority over women, but amongst men, the drawback is the game is rougher. Since men don’t have the same classical issues as women to deal with, they also receive much less sympathy than they would if they were female, if and when the luck of the draw isn’t quite in their favor. Women, on the other hand, while quite deservedly receiving much sympathy and political support for their hardships, are at the same time not missing out on sympathy that their less fortunate male counterparts may or may not be receiving. Of course…one might argue this skewed perspective is very much the product of a male dominated scene (which I’d agree with)…

      The bottom line is that, due to a happy medium truly not being yet decided upon, there is most definitely undeserved bias both ways. There are feminist pigs just as much as their are chauvinist pigs.

      I will say his line here about men being mistreated is a bit hazy…but you can’t refute the fact that there is self-induced backlash against males, amongst a male-dominated society. In an equal gender society, of course, there’d be no bias either way, because there’d be no dominant male bias. Your “women are also mistreated” falls just short of refuting his premise/conclusion.

      And, if this blog predominantly male-biased, why aren’t you inviting more of your female friends to partake in the conversation? I challenge you to actually do something about it, if gender is really such a big role.

    • carl213

      Wow, Are you being serious? When you find yourself using bizarre talking points like “end all reproductive choice” … you should realize you fallen into cliched talking points and stopped actually thinking. Males vary more than females. The commanding heights are dominated by males, but so are the grinding depths.

      Most Senators are male. So are most homeless bums. And prisoners. And victims of murder, etc, etc.

      Facts are those things about the world that, even if you don’t believe them, won’t go away.

    • http://hertzlinger.blogspot.com Joseph Hertzlinger

      “end all reproductive choice”

      You mean licensing parenthood?

    • David C

      It’s just his best guess as to why men are treated more harshly than women according to the law. Robin Hanson didn’t state any level of certainty about his best guess. Do you have a better explanation?

  • http://hertzlinger.blogspot.com Joseph Hertzlinger

    You can think of Japan’s fat tax as an example of banning rare vices. For example, in the U.S. we persecute users of rare mind-altering drugs, tolerate users of occasionally-used drugs, and ignore users of common drugs.

    The problem with this policy is that it gives anybody with a vice an incentive to get others to use it.

    • Doc Merlin

      The purpose of the state (to first order) is to take from the politically weak and give to the politically powerful. (As far as I can tell.) Your observation fits this.

    • http://un-thought.blogspot.com/ Floccina

      Yes it has been my observation that something has to become unpopular before it is banned. As fewer and fewer people smoke that stronger that laws against it become and the higher we tax it. Majority rule would logically lead in this direction.

      • Doug S.

        It’s certainly a lot easier to ban something that’s unpopular, that’s for sure. Or, at least, to ban it effectively.

        (For a counterexample, consider all the various times and places in which there are, or were, legal bans on sex with anyone other than a legally wedded spouse.)

    • http://www.gwern.net gwern

      > and ignore users of common drugs.

      Tobacco smokers beg to differ – or at least they would, if they hadn’t ceased to be a majority. (And aren’t drugs like marijuana pretty common, according to the high school surveys…)

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  • Beleaguer’d

    Your tentative explanations make no sense. At all. In any way. I would try to explain how and why, but they make too little sense to even go there. Sorry dude, I can’t follow.

  • The woman boss

    I know why the limit is lower for men. Women have big hips. That’s why. Ever think of that?

    • Macy

      That would be why they are measuring the waist.

  • Jana Lybarger

    Japan doesn’t even consider genetics to be a factor. Not all overweight or obese people get that way from eating too much. There are loads of factors that simply cannot be monitored or regulated. Genetics is one of those factors. This makes the fat tax ultimately meaningless.

    • IMASBA

      That must be some new American gene then… Nobody becomes obese because of genes (at least no more than people become lazy or arrogant because of their genes: you can be too lazy to exercise or be addicted to sugar and genetics will play some role in that but no matter the genes you do not become obese with healthy calorie intake and burning). The genetic excuse is a straw man and it’s completely disingenuous to use it to block measures that could help large numbers of people.

      The people with slow metabolism? They need to eat less (having a slow metablosim means you can survive on less calories) and/or expose themselves to colder temperatures to force their bodies to burn more calories. It’s that simple.