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Japan: The land that doesn't need Ozempic

90 points by throw0101c 2y ago

HDThoreaun 2y ago
Japan is an incredibly paternalistic society that makes heavy use of peer pressure to enforce social norms. As the writer notes the government literally taxes all your coworkers if you are fat. It sounds unbelievably humiliating. Im happy this works for the japanese but personally have zero desire to live a society like that.
- lagrange77 2y ago
  I think drill sergeants use the same technique.
- slothtrop 2y ago
  I don't think you can make the case that nations' BMI is inversely correlated with peer pressure. For one it's difficult to measure, and that tax for example is a new phenomenon. The US has been an early leader in obesity trends, by way of pioneering mass produced junk foods / fast foods and seeing mass adoption early (and you can make the case for other environmental influences like being a nation that began to be built for driving rather than walking). Other countries who clung on to "old ways" longer had the benefit of seeing the outcome of US approach in this respect and there is little resistance/pushback to both cultural trends and policies meant to deter obesity. All of which to say I don't think Japan's relatively better health outcomes has to do with exceptional peer pressure. Many European countries are more culturally individualist (though less than the US) and still come out better than the US. The other point I would argue is that there are social pressures everywhere, the expectations are merely different. You can also distinguish some by political divide.
  - WalterBright 2y ago
    I doubt junk food is the cause. More like eating massive amounts of sugar.
    - slothtrop 2y ago
      > I doubt junk food is the cause Why? > sugar. By way of junk food (sweetened drinks are junk, boxed cookies are junk). Added sugar is one way to facilitate consumption of excess calories, the other is flour + added fat + salt, absent fiber and protein. (and also deep frying).
      - WalterBright 2y ago
        > Why? Because I run a lot, and was steadily gaining weight. Stopping eating all desserts, pies, boxes of cookies, candy, soda, etc. resulted in slowly losing weight. I still eat high fat foods, chips, cheese, etc.
        slothtrop 2y ago
        High fat foods aren't necessarily junk foods, and presumably your intake of chips is moderate/low. They are not satiating and calorie dense, but of course drinks are the worst for that, they offer nearly 0 satiety for the price of calories. Cheese is relatively satiating, milk protein and animal proteins are in general.
- feyman_r 2y ago
  I think the intent of the article is to express that the obesity epidemic should be treated like a problem of culture and society and not an individual. Eastern societies have different ways of dealing with things than Western, and that’s ok. A person should not feel humiliated, but that’s a relative feeling by culture - the law seems to be working for them. I am obese myself - whenever I visit Asia (China, Japan, Vietnam, India etc.), the difference in diet and daily walking lingers on for a bit back here in the US but I regress to the ‘cultural mean’ here very soon. At least I know I can change my habits when the right support system is around me.
  - mc32 2y ago
    In the west it’s becoming frowned upon to observe that someone is fat (obese). Doctors have to tip-toe around the issue lest some patients become offended[1]. Some patients take it as fat (obesity)-shaming rather than what it is advice to seek being healthier. Some see being fat as something to celebrate. I don’t think I would celebrate any medical condition I had, be it fat, skinny, one-eyed, one-legged, etc. We can of course learn to cope and live with the conditions, but celebrate? That’s backwards to me. [1]https://www.express.co.uk/life-style/health/1733624/obesity-fat-shaming-patients-nhs https://www.express.co.uk/life-style/health/1733624/obesity-...
    - pwdisswordfishc 2y ago
      In the USA, you mean.
    - Dalewyn 2y ago
      I think it's just the pendulum swinging back the other way after it swung this way during the 19th to 20th centuries. Being fat was considered appealing in ye olde times, because it indicated to your peers that you had more access to food. Being lean became popular (again) in more recent times, especially with advances in entertainment like cinema and fashion magazines. Now that entertainment is lambasted for seeding unrealistic (and in some cases even harmful) expectations, so too has popularity for leanness waned. The pendulum will swing back again, of course. Before being fat became appealing, the ancient Greeks and Romans certainly preferred lean figures, judging by all their marble statues and other cultural artifacts.
- InstantOats 2y ago
  Maybe there's a reason why these social pressures exist? I'd MUCH rather live in a society that shames people for being fat than one that bends over backwards to accommodate obesity. The social and financial cost of 42% of all adults being obese in the US[0] must be so high as to be incalculable. [0] https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity https://www.niddk.nih.gov/health-information/health-statisti...
  - HDThoreaun 2y ago
    Id be happy to see a tax on fat people due to the externalities they place on the healthcare system. Im not happy to see policy that uses peer pressure though. I dont think the government should be shaming people for questionable activities that arent illegal. I really dont think the government should be in the business of shame at all.
    - brohoolio 2y ago
      I'd argue the way American culture is constructed (drive everywhere, less opportunities to walk, folks are socially isolated) in a way that actually puts people in a situation where they are much more likely to be overweight. So the costs are ones we as a society are putting on individuals are coming back to bite everyone in the ass.
      - HDThoreaun 2y ago
        Of course there are tons of other ways that Japanese society makes it easier to be skinny than American society does. Im just saying that some portion is the shame culture, not sure how much and not sure if its possible to figure that out, but I do know that Im not interested in trying that method.
    - paulmd 2y ago
      There’s pretty solid evidence that lifetime healthcare spending is actually lower for obese people, even in European countries with better allocation towards younger populations. In the US, it’s definitely cheaper to have people dying young before they get that third hip replacement and two rounds of chemo. > one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from -€1563 to +€4832. https://pubmed.ncbi.nlm.nih.gov/37222003/ https://pubmed.ncbi.nlm.nih.gov/37222003/ You should at least consider the possibility that you’ve unfairly jumped to assertions about “cost” out of another layer of paternalism that is not warranted by the facts. Like the whole “muh tax/healthcare dollars” may actually be backwards and having them live longer might well end up costing you more. That is the essence of the CBO paper that was discussed yesterday too: curing the obese doesn’t really reduce lifetime healthcare spending, because the US healthcare system barely spends anything on anyone who isn’t an AARP member anyway, and reducing obesity is going to lead to a lot more AARP members in 10-20 years. Which is a good thing, but also not going to be a net financial benefit, especially when you only are paying for seniors to begin with and don’t see any of the healthy-population benefits. This is the problem with all these discussions around obesity, everyone treats it as a moral failing and automatically assumes every other factor falls into line backing their ideal moral stance etc. And money doesn’t really care about morality, it’s quite cheap to have people die early before they get the third knee replacement and the second round of chemo. People have been doing the “ugly people = worse/morally inferior/less deserving” since the dawn of time and people today have somehow convinced themselves they’re immune. But morality doesn’t necessarily line up with practical reality, in this case finances.
- lozenge 2y ago
  It is not the cause of their slimness. There isn't any country which has successfully reduced its obesity. The trend has only been in one direction.
- ClimaxGravely 2y ago
  Are you referring to the Metabo law section? I'm not sure if I overlooked something but I don't see anything about co-workers paying a tax. Are you referring to the potential fine the company pays? For what it's worth. I've worked at a Japanese company since the program was introduced in 2008 and don't recall that happening. I'll have to ask some of my former co-workers about it next time I see them. upon further investigation I might not have experienced it because I was under the ago of 40 when I worked in Japan https://en.wikipedia.org/wiki/Fat_tax https://en.wikipedia.org/wiki/Fat_tax
- analog31 2y ago
  We are taxed for obesity through our health insurance premiums.
- consumer451 2y ago
  Related to your comment, I read a post today from an apparently over-weight person who has lived in Japan for a while. > I've been in Japan for 15 years (visiting for 20) and for most of this time, doctors had no problems calling patients "fat" right to their faces. Now things have changed, though, and doctors are coming up with a bunch of diff. euphemisms. Last week, one hit me w/ "You're... blessed with size." https://bsky.app/profile/ostrichson.bsky.social/post/3ksqebxkmoz2z https://bsky.app/profile/ostrichson.bsky.social/post/3ksqebx...
deleted 2y ago
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jfim 2y ago
Realistically, if you eat smaller servings and walk more, it's easier to have a healthy weight. The last time I went to Japan with an American friend, she commented that the portion sizes in Japan were so small. Combined with all the walking from using trains (we'd easily get more than 10k steps per day), we both lost weight during that trip.
- hn_throwaway_99 2y ago
  > Realistically, if you eat smaller servings and walk more, it's easier to have a healthy weight. Yeah, many years ago as a student I spent a summer in Manhattan. The diet probably couldn't have been more different than Japan, but the combination of walking a ton compared to the suburbs where I grew up, and the fact that as a poor student in a very expensive city my portions were smaller out of necessity (e.g. my snacks were usually fresh fruit sold outside of a store/bodega) I got much healthier.
- voisin 2y ago
  > Combined with all the walking from using trains This is a stark contrast to North America where there are generally no trains to walk to catch, but rather simply a few steps from your door to your car. My point being that the design of our society right down to the topography of our physical spaces is not set up to encourage walking. We can’t even agree that obesity is a problem, instead choosing to talk about beauty in all shapes and sizes and other woke nonsense (to be clear: I consider myself a liberal) that masks true objective facts about health. If we could agree on a goal, perhaps we could then have real conversations about how to get there. But instead we are so fractured and our governments so inept and conflicted that we subsidize the food that makes us sickest.
  - jfim 2y ago
    > My point being that the design of our society right down to the topography of our physical spaces is not set up to encourage walking. There are places where it's downright hostile, with areas with no sidewalks or crossings. > But instead we are so fractured and our governments so inept and conflicted that we subsidize the food that makes us sickest. There's actually a somewhat sane rationale for the agricultural subsidies. For the longest time in human history, famine was always looming, and the best policy to avoid it was to store excess calories in case of a bad harvest year. Whether or not that still applies in the US can be debated though.
m3kw9 2y ago
They don’t really eat those tv nugget trash quickies meals you put in the microwave or air frier
- omegaworks 2y ago
  Ridiculous. They have plenty of their own quick and convenient food readily available in convenience stores. Lawson, Family Mart or 7-11 are walking distance everywhere. A significant number of (typically underpaid, overworked) people don't cook for themselves in their tiny apartments and rely on these for basic needs. The key is walking distance. The Japanese live in their cities, we Americans live in our cars.
- csa 2y ago
  > They don’t really eat those tv nugget trash quickies meals you put in the microwave or air frier There is an ample variety of absolute shit food in Japan. It just tends to be eaten in smaller quantities. There are also a truckload of Japanese people who have good or decent looking BMI numbers while being fat (relatively little muscle). The weight situation Japan is nowhere near as bad as the US, but it is not the panacea some folks make it out to be.
- Ekaros 2y ago
  I have understood that there is lot of not exactly healthy food available in Japan. Including fried chicken. Portion size is probably smaller in general with offset lot of this.
- kalleboo 2y ago
  They absolutely do. The freezer section of a supermarket in Japan is full of frozen kara-age, tempura, croquettes, fried spring rolls etc so that the overworked housewife can just reheat them quickly in the morning and pop them in the bentos for their kids/husbands along with a generous heaping of white rice. Portions are way smaller though.
Leftium 2y ago
Korea has a similar lack of obesity. It's not just genetics because Koreans tend to become overweight when living in the US. I think it comes down to two major factors: 1. Koreans tend to walk (exercise) more. Walk (partway) during commute, walk to lunch, walk to do errands, etc. In the US people just sit in their cars. I personally find I get 3000+ daily steps in Korea without even trying, while in the US I only get about 300 daily steps or so. 2. Diet + portions. My Korean friend was astounded by the amount of fries that came with every meal in the USA and Canada. The US is the only place where fructose is substituted for sugar in most processed food. I've heard fructose inhibits the sense of satiation after eating. So walkable cities and better food options would probably reduce US obesity.
- fifilura 2y ago
  I am not in the USA, but 300 steps raised my eyebrows! Even 3000 steps seems low on a regular day. This is what you'd get from just moving around in the house?
  - Leftium 2y ago
    I noticed 1,000 steps is about 10min of walking. (I used a Fitbit for 6+ months). So 300 steps is about 3 minutes of walking. If I sit at the computer most of the day and don't leave the house, I might get even fewer steps. 3,000 steps would be about 30min of walking. Perhaps I'm more sedentary than average. Sometimes the only steps I get are walking to lunch and back. But I got 15,000+ steps a few days ago because I went out dancing ^^ --- edit: also 300/3000 numbers were from my phone, so would exclude steps when my phone wasn't on me.
    - brianwawok 2y ago
      100 steps a minute is a comical pace. 20-25 is a more reasonable rate.
      - fifilura 2y ago
        100 steps a minute sounds like normal walking speed. With 70 cm step length it means 4 km/h, which is slow walking. 20-25 steps/minute, with 70cm step length will take you to the toilet in one minute.
aficiomaquinas 2y ago
GLP-1 Agonists are very interesting drugs. There are ongoing clinical trials for their application in neurodegenerative diseases because they seem to have, among others, excellent neuroprotective effects, they are great at lowering inflammation. There is a good paper about that. I think it's misleading and ridiculous to say that Japan does not need Ozempic. Not all obesity is simply caused by eating habits. There is a very important factor that has to do with oxidative/nitrosative stress and inflammation that may as well have to do with other underlying diseases, syndromes, etc. and that we are just starting to understand. The science is not "settled" with obesity, as much as we've progressed with understanding it, and it's really weird to me for someone to use such a clickbait title... [0] https://doi.org/10.1177/20420188231222367 https://doi.org/10.1177/20420188231222367
- thefz 2y ago
  To me it is insane we are even talking about a drug to solve the obesity problem when there is hard evidence that it is a lifestyle issue mostly.
  - aficiomaquinas 2y ago
    If by lifestyle you mean behavioral disorder, It seems to me that the science from the last 10 years is starting to point in the opposite direction. If I may recommend, there is a great presentation by Dr. Robert Lustig called "Fat Chance: Fructose 2.0". [0]: https://www.youtube.com/watch?v=ceFyF9px20Y https://www.youtube.com/watch?v=ceFyF9px20Y
  - throwaway290 2y ago
    you think lifestyle choices are somehow not fully influenced by body chemistry?
    - thefz 2y ago
      Nobody is born obese so it takes years of abuse to get there. So what is your point?
tjpnz 2y ago
I need it but my doctor cannot write me a prescription for it unless I get diabetes. The joke is that I'll probably end up with it at this rate, and the absurdity of my situation isn't lost of them either. My options are to visit a weight loss clinic importing it (legally) from the US and pay out of pocket, look into Xenical which has only recently been approved in Japan or re-evaluate my diet + exercise routine for the hundredth time.
- aficiomaquinas 2y ago
  This is exactly my point. There are many patients that do require GLP-1 agonists to realistically lose weight. It's ridiculous to say that a country doesn't need it just because fewer people are obese.
- deleted 2y ago
  [deleted]
ck2 2y ago
It's not the genetics or food, it's the culture. ie. Japanese take their trash home from stadium and theaters. Meanwhile in America we throw the trash out of the window of their car into the parking lot while parked 10 feet away from a dumpster. I am sure somewhere in Japan there are obese people and those who throw their trash into the parking lot but they are the exception not the norm where it is reverse in America. But if it takes a drug to help drive down obesity I have no problem with people taking it, but we've got to address the cost which is ridiculous and unacceptable.
banish-m4 2y ago
There are many reasons including prevalence of fast food locations, ultraprocessed foods, food marketing, car culture, social tolerance, and sedentary lifestyles. So much would have to change in America, including attitudes, to make a dent. PS: Ozempic is not for weight management, it's for blood sugar control. Wegovy is a higher dose for weight management and not covered by Medicare discriminating against all causes of obesity without nuance.
- constantcrying 2y ago
  >There are many reasons including prevalence of fast food locations, ultraprocessed foods, food marketing, car culture, social tolerance, and sedentary lifestyles All true for Japan though?
  - banish-m4 2y ago
    Japan doesn't have carb-heavy ultraprocessed foods, social tolerance of obesity, or massive quantities.
    - constantcrying 2y ago
      >Japan doesn't have carb-heavy ultraprocessed foods Without a doubt they do. One of their most important foods is rice, I don't think there are many cultures eating more carb heavy. For the processing, maybe, what is the actual difference to the US or Europe? >social tolerance of obesit Maybe? Although hard to quantify, certainly many Americans want to loose weight. >or massive quantities Japan certainly is not suffering from any food shortages and surely you can eat however much you want there.
      - banish-m4 2y ago
        You're tilting at windmills if you think Japanese foods approach the level of caloric density and unhealthiness of burgers, burritos, french fries, Doritos, and other shit Americans eat.
constantcrying 2y ago
The article seems to suggest that low obesity rates are the result of a particular style in Food, compared with western foods. This is obviously not true. Mass obesity was something also not known in western countries before the 50s, so western food before that behaved similarly. If you are looking for the cause of mass obesity it can only be in the divergence that happened in the mean time.
- kurnik 2y ago
  I wouldn’t say so. Article shows that the biggest factor are your eating habits. In case of Japan they are engrained in school, with methods formalized by law.
  - constantcrying 2y ago
    How have the eating habits in the West change over the last 70 years?
    - goosedragons 2y ago
      More and more ultraprocessed foods. We never had such ready access to food filled with sugar/fat/salt and engineered to taste maximally good. Stuff like soda, potato chips and chocolate bars are barely 150 years old. Frozen foods are basically 70 years old.
      - constantcrying 2y ago
        How does this not apply to Japan as well? Surely soda and candy exists in Japan, they are even internationally known for having a diverse candy industry. And the USA is eating less and less sugar since around 30 years.
        1ark 2y ago
        Candy bags in Japan are small, 50g. Drink vending machines contain 50% green tea of different varieties. Domestically sweets are big, usually with sweet bean paste and so on.
VeejayRampay 2y ago
the world needs ozempic because of the garbage diet that has been pushed through American soft power in the past 50 years
- borski 2y ago
  You’re right; it can’t possibly be due to multiple causes. That would be absurd.
ec109685 2y ago
It’s dangerous and misleading when reporters conflate controlled scientific studies with anecdotes that haven’t proven true when properly studied: “I had learned there are massive health benefits to reversing obesity with these drugs: for example, Novo Nordisk ran a trial that found weekly injections reduced the risk of heart attack or stroke by 20% for participants with a BMI over 27 and a history of cardiac events. But I also saw there are significant risks. I interviewed prestigious French scientists who worry the drugs could cause an increase in thyroid cancer, and eating disorders experts who worry it will cause a rise in this problem. Other experts fear it may cause depression or suicidal thoughts. These claims are all fiercely disputed and debated. I felt trapped between two risky choices—ongoing obesity, or drugs with lots of unknowns.” The suicidal thoughts have been studied: https://www.nbcnews.com/news/amp/rcna147578 https://www.nbcnews.com/news/amp/rcna147578
- saurik 2y ago
  So, I know this isn't the point you were making--and I also certainly am not saying this correlation could mean what it would look to imply--but a little part of me read your comment and went "huh: so if the Japanese people 'don't need Ozempic', are they also already experiencing the side effects?"... and, I correctly hazily remembered, they are: "In 2017, the country had the seventh highest suicide rate in the OECD, at 14.9 per 100,000 persons, and in 2019 the country had the second highest suicide rate among the G7 developed nations." (per Wikipedia).
  - solidsnack9000 2y ago
    The USA also has a relatively high suicide rate for a developed country, though. The USA is closing the gap and recent data puts the USA at a higher rate than Japan: https://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...
brcmthrowaway 2y ago
[flagged]
snowpid 2y ago
I am very annoyed that even a food scientist put very different food cultures into 'western' food then he meant American diet . European food cultures are way too diverse to even combine it. And Italian diet has a similar simplistic philosophy. French food does not. Both can keep you slim.
rmanolis 2y ago
We are getting fat because we stopped eating legumes and whole grains like we used to. 100 grams of uncooked lentils is 300 cal only and will make you feel full for 12 hours
- zagrebian 2y ago
  There are many options: couscous, rice, air-fried potatoes, even pure popcorn (raw corn + vegetable oil) is healthy and very filling.
nikolay 2y ago
Ozempic and its popularity is a clear proof what's wrong in the West! Not only Japan doesn't need it, most of the world doesn't, but in the West, we treat symptoms, not root causes!
rychco 2y ago
Of course they’re more healthy, they eat less & walk more. I just returned from Japan, and the difference in quality of life due to urban density, reliable public transit, and walkability of every city I visited is staggering. There really is no comparison to the United States. Everything you could ever need to live is within walking distance - seriously. This is the way people are meant to live.
- donw 2y ago
  Except for the minor issue that this density plays a significant part in Japan's well-below-replacement-popluation birthrate. You may have noticed, walking around Tokyo, the lack of children. I certainly do every time I'm there -- I live about two hours away in a bedroom community, where you absolutely do need a car to get around. Most Tokyo families have one and only one child. Out where I live, where 1000sqft+ houses are the norm, three or more is not uncommon.
  - rychco 2y ago
    That's a fair point. I hadn't considered it from the perspective of having space for children, though I don't personally think the density of Tokyo is prohibitive. I'm curious about another thing: You mention 1000sqft+ homes being the norm where you're located, is that considered a larger than average home in Japan? I can't find a recent figure for average dimensions of a Japanese home. The average in the United States, by comparison, is apparently 2273sqft (reported in 2021).
    - donw 2y ago
      For a single-family dwelling, 1000 sqft seems fairly normal in Japan. It’s also fair to mention that the lot sizes are drastically smaller: 1/16 of an acre is on the larger size here, and you’d be hard-pressed to find anything bigger that isn't in the middle of nowhere. For context, 1/16 of an acre is around 2500 sqft, so that's smaller than the average American house. And, if you have kids and move to the middle of nowhere... great, now your kids have nobody else their age to play with. Japanese homes typically don't have backyards, and the small yard you do have is typically not fenced-in, which kinda sucks with young kids.
bcherny 2y ago
(American that has been living in Japan for a number of years here.) There are a few factors that make Japanese people skinnier on average: 1. Genetics (compared to westerners, not to Hawaiians like the article said) 2. A culture of fat shaming. My brother in law often pinches my belly publicly whenever he sees I gained a few pounds. Others enforce this through other means: calling out your friends, creating social pressure, your doctor pointing out you gained a pound. 3. Diet, in the sense of diet, not cuisine. People very much watch what they eat. It’s easy nowadays to eat super high calorie foods (rice, ramen, etc.), but most people either don’t eat these every day, or eat in small portions. There is also less fat and sugar than the US, offset by more salt. 4. Small portions. Portions are generally like 2x less than what you’d find in the US. 5. Exercise is built-in, at least in the cities. In big cities (not just Tokyo) people use public transportation, go out for lunch, walk to the grocery store. If you don’t drive, you exercise.
Tiktaalik 2y ago
The significant thing I see here in this article is that eating and food is part of the education system, with children having good, healthy meals prepared for them at school that everyone eats, including the teachers. This has a lot of advantages beyond ensuring kids are eating healthy food and healthy and able to learn at school, it also teaches kids how to eat well, and gives a big helping hand to lower income parents that might not be able to afford to feed their children well. This is something that I would love to see my country adopt.

90 points by throw0101c 2y ago

Japan is an incredibly paternalistic society that makes heavy use of peer pressure to enforce social norms. As the writer notes the government literally taxes all your coworkers if you are fat. It sounds unbelievably humiliating. Im happy this works for the japanese but personally have zero desire to live a society like that.

lagrange77 2y ago
I think drill sergeants use the same technique.
slothtrop 2y ago
I don't think you can make the case that nations' BMI is inversely correlated with peer pressure. For one it's difficult to measure, and that tax for example is a new phenomenon. The US has been an early leader in obesity trends, by way of pioneering mass produced junk foods / fast foods and seeing mass adoption early (and you can make the case for other environmental influences like being a nation that began to be built for driving rather than walking). Other countries who clung on to "old ways" longer had the benefit of seeing the outcome of US approach in this respect and there is little resistance/pushback to both cultural trends and policies meant to deter obesity. All of which to say I don't think Japan's relatively better health outcomes has to do with exceptional peer pressure. Many European countries are more culturally individualist (though less than the US) and still come out better than the US. The other point I would argue is that there are social pressures everywhere, the expectations are merely different. You can also distinguish some by political divide.
- WalterBright 2y ago
  I doubt junk food is the cause. More like eating massive amounts of sugar.
  - slothtrop 2y ago
    > I doubt junk food is the cause Why? > sugar. By way of junk food (sweetened drinks are junk, boxed cookies are junk). Added sugar is one way to facilitate consumption of excess calories, the other is flour + added fat + salt, absent fiber and protein. (and also deep frying).
    - WalterBright 2y ago
      > Why? Because I run a lot, and was steadily gaining weight. Stopping eating all desserts, pies, boxes of cookies, candy, soda, etc. resulted in slowly losing weight. I still eat high fat foods, chips, cheese, etc.
      - slothtrop 2y ago
        High fat foods aren't necessarily junk foods, and presumably your intake of chips is moderate/low. They are not satiating and calorie dense, but of course drinks are the worst for that, they offer nearly 0 satiety for the price of calories. Cheese is relatively satiating, milk protein and animal proteins are in general.
feyman_r 2y ago
I think the intent of the article is to express that the obesity epidemic should be treated like a problem of culture and society and not an individual. Eastern societies have different ways of dealing with things than Western, and that’s ok. A person should not feel humiliated, but that’s a relative feeling by culture - the law seems to be working for them. I am obese myself - whenever I visit Asia (China, Japan, Vietnam, India etc.), the difference in diet and daily walking lingers on for a bit back here in the US but I regress to the ‘cultural mean’ here very soon. At least I know I can change my habits when the right support system is around me.
- mc32 2y ago
  In the west it’s becoming frowned upon to observe that someone is fat (obese). Doctors have to tip-toe around the issue lest some patients become offended[1]. Some patients take it as fat (obesity)-shaming rather than what it is advice to seek being healthier. Some see being fat as something to celebrate. I don’t think I would celebrate any medical condition I had, be it fat, skinny, one-eyed, one-legged, etc. We can of course learn to cope and live with the conditions, but celebrate? That’s backwards to me. [1]https://www.express.co.uk/life-style/health/1733624/obesity-fat-shaming-patients-nhs https://www.express.co.uk/life-style/health/1733624/obesity-...
  - pwdisswordfishc 2y ago
    In the USA, you mean.
  - Dalewyn 2y ago
    I think it's just the pendulum swinging back the other way after it swung this way during the 19th to 20th centuries. Being fat was considered appealing in ye olde times, because it indicated to your peers that you had more access to food. Being lean became popular (again) in more recent times, especially with advances in entertainment like cinema and fashion magazines. Now that entertainment is lambasted for seeding unrealistic (and in some cases even harmful) expectations, so too has popularity for leanness waned. The pendulum will swing back again, of course. Before being fat became appealing, the ancient Greeks and Romans certainly preferred lean figures, judging by all their marble statues and other cultural artifacts.
InstantOats 2y ago
Maybe there's a reason why these social pressures exist? I'd MUCH rather live in a society that shames people for being fat than one that bends over backwards to accommodate obesity. The social and financial cost of 42% of all adults being obese in the US[0] must be so high as to be incalculable. [0] https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity https://www.niddk.nih.gov/health-information/health-statisti...
- HDThoreaun 2y ago
  Id be happy to see a tax on fat people due to the externalities they place on the healthcare system. Im not happy to see policy that uses peer pressure though. I dont think the government should be shaming people for questionable activities that arent illegal. I really dont think the government should be in the business of shame at all.
  - brohoolio 2y ago
    I'd argue the way American culture is constructed (drive everywhere, less opportunities to walk, folks are socially isolated) in a way that actually puts people in a situation where they are much more likely to be overweight. So the costs are ones we as a society are putting on individuals are coming back to bite everyone in the ass.
    - HDThoreaun 2y ago
      Of course there are tons of other ways that Japanese society makes it easier to be skinny than American society does. Im just saying that some portion is the shame culture, not sure how much and not sure if its possible to figure that out, but I do know that Im not interested in trying that method.
  - paulmd 2y ago
    There’s pretty solid evidence that lifetime healthcare spending is actually lower for obese people, even in European countries with better allocation towards younger populations. In the US, it’s definitely cheaper to have people dying young before they get that third hip replacement and two rounds of chemo. > one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from -€1563 to +€4832. https://pubmed.ncbi.nlm.nih.gov/37222003/ https://pubmed.ncbi.nlm.nih.gov/37222003/ You should at least consider the possibility that you’ve unfairly jumped to assertions about “cost” out of another layer of paternalism that is not warranted by the facts. Like the whole “muh tax/healthcare dollars” may actually be backwards and having them live longer might well end up costing you more. That is the essence of the CBO paper that was discussed yesterday too: curing the obese doesn’t really reduce lifetime healthcare spending, because the US healthcare system barely spends anything on anyone who isn’t an AARP member anyway, and reducing obesity is going to lead to a lot more AARP members in 10-20 years. Which is a good thing, but also not going to be a net financial benefit, especially when you only are paying for seniors to begin with and don’t see any of the healthy-population benefits. This is the problem with all these discussions around obesity, everyone treats it as a moral failing and automatically assumes every other factor falls into line backing their ideal moral stance etc. And money doesn’t really care about morality, it’s quite cheap to have people die early before they get the third knee replacement and the second round of chemo. People have been doing the “ugly people = worse/morally inferior/less deserving” since the dawn of time and people today have somehow convinced themselves they’re immune. But morality doesn’t necessarily line up with practical reality, in this case finances.
lozenge 2y ago
It is not the cause of their slimness. There isn't any country which has successfully reduced its obesity. The trend has only been in one direction.
ClimaxGravely 2y ago
Are you referring to the Metabo law section? I'm not sure if I overlooked something but I don't see anything about co-workers paying a tax. Are you referring to the potential fine the company pays? For what it's worth. I've worked at a Japanese company since the program was introduced in 2008 and don't recall that happening. I'll have to ask some of my former co-workers about it next time I see them. upon further investigation I might not have experienced it because I was under the ago of 40 when I worked in Japan https://en.wikipedia.org/wiki/Fat_tax https://en.wikipedia.org/wiki/Fat_tax
analog31 2y ago
We are taxed for obesity through our health insurance premiums.
consumer451 2y ago
Related to your comment, I read a post today from an apparently over-weight person who has lived in Japan for a while. > I've been in Japan for 15 years (visiting for 20) and for most of this time, doctors had no problems calling patients "fat" right to their faces. Now things have changed, though, and doctors are coming up with a bunch of diff. euphemisms. Last week, one hit me w/ "You're... blessed with size." https://bsky.app/profile/ostrichson.bsky.social/post/3ksqebxkmoz2z https://bsky.app/profile/ostrichson.bsky.social/post/3ksqebx...

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jfim 2y ago

Realistically, if you eat smaller servings and walk more, it's easier to have a healthy weight. The last time I went to Japan with an American friend, she commented that the portion sizes in Japan were so small. Combined with all the walking from using trains (we'd easily get more than 10k steps per day), we both lost weight during that trip.

hn_throwaway_99 2y ago
> Realistically, if you eat smaller servings and walk more, it's easier to have a healthy weight. Yeah, many years ago as a student I spent a summer in Manhattan. The diet probably couldn't have been more different than Japan, but the combination of walking a ton compared to the suburbs where I grew up, and the fact that as a poor student in a very expensive city my portions were smaller out of necessity (e.g. my snacks were usually fresh fruit sold outside of a store/bodega) I got much healthier.
voisin 2y ago
> Combined with all the walking from using trains This is a stark contrast to North America where there are generally no trains to walk to catch, but rather simply a few steps from your door to your car. My point being that the design of our society right down to the topography of our physical spaces is not set up to encourage walking. We can’t even agree that obesity is a problem, instead choosing to talk about beauty in all shapes and sizes and other woke nonsense (to be clear: I consider myself a liberal) that masks true objective facts about health. If we could agree on a goal, perhaps we could then have real conversations about how to get there. But instead we are so fractured and our governments so inept and conflicted that we subsidize the food that makes us sickest.
- jfim 2y ago
  > My point being that the design of our society right down to the topography of our physical spaces is not set up to encourage walking. There are places where it's downright hostile, with areas with no sidewalks or crossings. > But instead we are so fractured and our governments so inept and conflicted that we subsidize the food that makes us sickest. There's actually a somewhat sane rationale for the agricultural subsidies. For the longest time in human history, famine was always looming, and the best policy to avoid it was to store excess calories in case of a bad harvest year. Whether or not that still applies in the US can be debated though.

m3kw9 2y ago

They don’t really eat those tv nugget trash quickies meals you put in the microwave or air frier

omegaworks 2y ago
Ridiculous. They have plenty of their own quick and convenient food readily available in convenience stores. Lawson, Family Mart or 7-11 are walking distance everywhere. A significant number of (typically underpaid, overworked) people don't cook for themselves in their tiny apartments and rely on these for basic needs. The key is walking distance. The Japanese live in their cities, we Americans live in our cars.
csa 2y ago
> They don’t really eat those tv nugget trash quickies meals you put in the microwave or air frier There is an ample variety of absolute shit food in Japan. It just tends to be eaten in smaller quantities. There are also a truckload of Japanese people who have good or decent looking BMI numbers while being fat (relatively little muscle). The weight situation Japan is nowhere near as bad as the US, but it is not the panacea some folks make it out to be.
Ekaros 2y ago
I have understood that there is lot of not exactly healthy food available in Japan. Including fried chicken. Portion size is probably smaller in general with offset lot of this.
kalleboo 2y ago
They absolutely do. The freezer section of a supermarket in Japan is full of frozen kara-age, tempura, croquettes, fried spring rolls etc so that the overworked housewife can just reheat them quickly in the morning and pop them in the bentos for their kids/husbands along with a generous heaping of white rice. Portions are way smaller though.

Leftium 2y ago

Korea has a similar lack of obesity. It's not just genetics because Koreans tend to become overweight when living in the US. I think it comes down to two major factors: 1. Koreans tend to walk (exercise) more. Walk (partway) during commute, walk to lunch, walk to do errands, etc. In the US people just sit in their cars. I personally find I get 3000+ daily steps in Korea without even trying, while in the US I only get about 300 daily steps or so. 2. Diet + portions. My Korean friend was astounded by the amount of fries that came with every meal in the USA and Canada. The US is the only place where fructose is substituted for sugar in most processed food. I've heard fructose inhibits the sense of satiation after eating. So walkable cities and better food options would probably reduce US obesity.

fifilura 2y ago
I am not in the USA, but 300 steps raised my eyebrows! Even 3000 steps seems low on a regular day. This is what you'd get from just moving around in the house?
- Leftium 2y ago
  I noticed 1,000 steps is about 10min of walking. (I used a Fitbit for 6+ months). So 300 steps is about 3 minutes of walking. If I sit at the computer most of the day and don't leave the house, I might get even fewer steps. 3,000 steps would be about 30min of walking. Perhaps I'm more sedentary than average. Sometimes the only steps I get are walking to lunch and back. But I got 15,000+ steps a few days ago because I went out dancing ^^ --- edit: also 300/3000 numbers were from my phone, so would exclude steps when my phone wasn't on me.
  - brianwawok 2y ago
    100 steps a minute is a comical pace. 20-25 is a more reasonable rate.
    - fifilura 2y ago
      100 steps a minute sounds like normal walking speed. With 70 cm step length it means 4 km/h, which is slow walking. 20-25 steps/minute, with 70cm step length will take you to the toilet in one minute.

aficiomaquinas 2y ago

GLP-1 Agonists are very interesting drugs. There are ongoing clinical trials for their application in neurodegenerative diseases because they seem to have, among others, excellent neuroprotective effects, they are great at lowering inflammation. There is a good paper about that. I think it's misleading and ridiculous to say that Japan does not need Ozempic. Not all obesity is simply caused by eating habits. There is a very important factor that has to do with oxidative/nitrosative stress and inflammation that may as well have to do with other underlying diseases, syndromes, etc. and that we are just starting to understand. The science is not "settled" with obesity, as much as we've progressed with understanding it, and it's really weird to me for someone to use such a clickbait title... [0] https://doi.org/10.1177/20420188231222367 https://doi.org/10.1177/20420188231222367

thefz 2y ago
To me it is insane we are even talking about a drug to solve the obesity problem when there is hard evidence that it is a lifestyle issue mostly.
- aficiomaquinas 2y ago
  If by lifestyle you mean behavioral disorder, It seems to me that the science from the last 10 years is starting to point in the opposite direction. If I may recommend, there is a great presentation by Dr. Robert Lustig called "Fat Chance: Fructose 2.0". [0]: https://www.youtube.com/watch?v=ceFyF9px20Y https://www.youtube.com/watch?v=ceFyF9px20Y
- throwaway290 2y ago
  you think lifestyle choices are somehow not fully influenced by body chemistry?
  - thefz 2y ago
    Nobody is born obese so it takes years of abuse to get there. So what is your point?

tjpnz 2y ago

I need it but my doctor cannot write me a prescription for it unless I get diabetes. The joke is that I'll probably end up with it at this rate, and the absurdity of my situation isn't lost of them either. My options are to visit a weight loss clinic importing it (legally) from the US and pay out of pocket, look into Xenical which has only recently been approved in Japan or re-evaluate my diet + exercise routine for the hundredth time.

aficiomaquinas 2y ago
This is exactly my point. There are many patients that do require GLP-1 agonists to realistically lose weight. It's ridiculous to say that a country doesn't need it just because fewer people are obese.
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ck2 2y ago

It's not the genetics or food, it's the culture. ie. Japanese take their trash home from stadium and theaters. Meanwhile in America we throw the trash out of the window of their car into the parking lot while parked 10 feet away from a dumpster. I am sure somewhere in Japan there are obese people and those who throw their trash into the parking lot but they are the exception not the norm where it is reverse in America. But if it takes a drug to help drive down obesity I have no problem with people taking it, but we've got to address the cost which is ridiculous and unacceptable.

banish-m4 2y ago

There are many reasons including prevalence of fast food locations, ultraprocessed foods, food marketing, car culture, social tolerance, and sedentary lifestyles. So much would have to change in America, including attitudes, to make a dent. PS: Ozempic is not for weight management, it's for blood sugar control. Wegovy is a higher dose for weight management and not covered by Medicare discriminating against all causes of obesity without nuance.

constantcrying 2y ago
>There are many reasons including prevalence of fast food locations, ultraprocessed foods, food marketing, car culture, social tolerance, and sedentary lifestyles All true for Japan though?
- banish-m4 2y ago
  Japan doesn't have carb-heavy ultraprocessed foods, social tolerance of obesity, or massive quantities.
  - constantcrying 2y ago
    >Japan doesn't have carb-heavy ultraprocessed foods Without a doubt they do. One of their most important foods is rice, I don't think there are many cultures eating more carb heavy. For the processing, maybe, what is the actual difference to the US or Europe? >social tolerance of obesit Maybe? Although hard to quantify, certainly many Americans want to loose weight. >or massive quantities Japan certainly is not suffering from any food shortages and surely you can eat however much you want there.
    - banish-m4 2y ago
      You're tilting at windmills if you think Japanese foods approach the level of caloric density and unhealthiness of burgers, burritos, french fries, Doritos, and other shit Americans eat.

constantcrying 2y ago

The article seems to suggest that low obesity rates are the result of a particular style in Food, compared with western foods. This is obviously not true. Mass obesity was something also not known in western countries before the 50s, so western food before that behaved similarly. If you are looking for the cause of mass obesity it can only be in the divergence that happened in the mean time.

kurnik 2y ago
I wouldn’t say so. Article shows that the biggest factor are your eating habits. In case of Japan they are engrained in school, with methods formalized by law.
- constantcrying 2y ago
  How have the eating habits in the West change over the last 70 years?
  - goosedragons 2y ago
    More and more ultraprocessed foods. We never had such ready access to food filled with sugar/fat/salt and engineered to taste maximally good. Stuff like soda, potato chips and chocolate bars are barely 150 years old. Frozen foods are basically 70 years old.
    - constantcrying 2y ago
      How does this not apply to Japan as well? Surely soda and candy exists in Japan, they are even internationally known for having a diverse candy industry. And the USA is eating less and less sugar since around 30 years.
      - 1ark 2y ago
        Candy bags in Japan are small, 50g. Drink vending machines contain 50% green tea of different varieties. Domestically sweets are big, usually with sweet bean paste and so on.

VeejayRampay 2y ago

the world needs ozempic because of the garbage diet that has been pushed through American soft power in the past 50 years

borski 2y ago
You’re right; it can’t possibly be due to multiple causes. That would be absurd.

ec109685 2y ago

It’s dangerous and misleading when reporters conflate controlled scientific studies with anecdotes that haven’t proven true when properly studied: “I had learned there are massive health benefits to reversing obesity with these drugs: for example, Novo Nordisk ran a trial that found weekly injections reduced the risk of heart attack or stroke by 20% for participants with a BMI over 27 and a history of cardiac events. But I also saw there are significant risks. I interviewed prestigious French scientists who worry the drugs could cause an increase in thyroid cancer, and eating disorders experts who worry it will cause a rise in this problem. Other experts fear it may cause depression or suicidal thoughts. These claims are all fiercely disputed and debated. I felt trapped between two risky choices—ongoing obesity, or drugs with lots of unknowns.” The suicidal thoughts have been studied: https://www.nbcnews.com/news/amp/rcna147578 https://www.nbcnews.com/news/amp/rcna147578

saurik 2y ago
So, I know this isn't the point you were making--and I also certainly am not saying this correlation could mean what it would look to imply--but a little part of me read your comment and went "huh: so if the Japanese people 'don't need Ozempic', are they also already experiencing the side effects?"... and, I correctly hazily remembered, they are: "In 2017, the country had the seventh highest suicide rate in the OECD, at 14.9 per 100,000 persons, and in 2019 the country had the second highest suicide rate among the G7 developed nations." (per Wikipedia).
- solidsnack9000 2y ago
  The USA also has a relatively high suicide rate for a developed country, though. The USA is closing the gap and recent data puts the USA at a higher rate than Japan: https://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...

brcmthrowaway 2y ago

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snowpid 2y ago

I am very annoyed that even a food scientist put very different food cultures into 'western' food then he meant American diet . European food cultures are way too diverse to even combine it. And Italian diet has a similar simplistic philosophy. French food does not. Both can keep you slim.

rmanolis 2y ago

We are getting fat because we stopped eating legumes and whole grains like we used to. 100 grams of uncooked lentils is 300 cal only and will make you feel full for 12 hours

zagrebian 2y ago
There are many options: couscous, rice, air-fried potatoes, even pure popcorn (raw corn + vegetable oil) is healthy and very filling.

nikolay 2y ago

Ozempic and its popularity is a clear proof what's wrong in the West! Not only Japan doesn't need it, most of the world doesn't, but in the West, we treat symptoms, not root causes!

rychco 2y ago

Of course they’re more healthy, they eat less & walk more. I just returned from Japan, and the difference in quality of life due to urban density, reliable public transit, and walkability of every city I visited is staggering. There really is no comparison to the United States. Everything you could ever need to live is within walking distance - seriously. This is the way people are meant to live.

donw 2y ago
Except for the minor issue that this density plays a significant part in Japan's well-below-replacement-popluation birthrate. You may have noticed, walking around Tokyo, the lack of children. I certainly do every time I'm there -- I live about two hours away in a bedroom community, where you absolutely do need a car to get around. Most Tokyo families have one and only one child. Out where I live, where 1000sqft+ houses are the norm, three or more is not uncommon.
- rychco 2y ago
  That's a fair point. I hadn't considered it from the perspective of having space for children, though I don't personally think the density of Tokyo is prohibitive. I'm curious about another thing: You mention 1000sqft+ homes being the norm where you're located, is that considered a larger than average home in Japan? I can't find a recent figure for average dimensions of a Japanese home. The average in the United States, by comparison, is apparently 2273sqft (reported in 2021).
  - donw 2y ago
    For a single-family dwelling, 1000 sqft seems fairly normal in Japan. It’s also fair to mention that the lot sizes are drastically smaller: 1/16 of an acre is on the larger size here, and you’d be hard-pressed to find anything bigger that isn't in the middle of nowhere. For context, 1/16 of an acre is around 2500 sqft, so that's smaller than the average American house. And, if you have kids and move to the middle of nowhere... great, now your kids have nobody else their age to play with. Japanese homes typically don't have backyards, and the small yard you do have is typically not fenced-in, which kinda sucks with young kids.

bcherny 2y ago

(American that has been living in Japan for a number of years here.) There are a few factors that make Japanese people skinnier on average: 1. Genetics (compared to westerners, not to Hawaiians like the article said) 2. A culture of fat shaming. My brother in law often pinches my belly publicly whenever he sees I gained a few pounds. Others enforce this through other means: calling out your friends, creating social pressure, your doctor pointing out you gained a pound. 3. Diet, in the sense of diet, not cuisine. People very much watch what they eat. It’s easy nowadays to eat super high calorie foods (rice, ramen, etc.), but most people either don’t eat these every day, or eat in small portions. There is also less fat and sugar than the US, offset by more salt. 4. Small portions. Portions are generally like 2x less than what you’d find in the US. 5. Exercise is built-in, at least in the cities. In big cities (not just Tokyo) people use public transportation, go out for lunch, walk to the grocery store. If you don’t drive, you exercise.

Tiktaalik 2y ago

The significant thing I see here in this article is that eating and food is part of the education system, with children having good, healthy meals prepared for them at school that everyone eats, including the teachers. This has a lot of advantages beyond ensuring kids are eating healthy food and healthy and able to learn at school, it also teaches kids how to eat well, and gives a big helping hand to lower income parents that might not be able to afford to feed their children well. This is something that I would love to see my country adopt.