Japan: The land that doesn't need Ozempic
time.com
time.com
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.
Even 3000 steps seems low on a regular day. This is what you'd get from just moving around in the house?
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 ^^
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edit: also 300/3000 numbers were from my phone, so would exclude steps when my phone wasn't on me.
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.
In my opinion, the Netherlands is definitely a car country.
And you haven't been to Los Angeles, Texas, or Florida if you call Netherlands a "car country".
[1] https://www.kimnet.nl/publicaties/publicaties/2023/11/14/mob...
https://www.bicycleretailer.com/studies-reports/2021/05/20/b...
My point is, it’s not very walkable.
Netherlands has bike lanes _everywhere_. People use it.
The cities (Randstad) encourages bike commute for everything. Driving a car around is almost cumbersome. Traffic, parking etc. Bikes are easier.
The countryside, life in farms and farmhouses are obviously more car friendly and in need of a car for better quality of life.
Food in the Netherlands has both extremes. Fried food, and pre-processed food? Check. However, you can also find healthy option almost everywhere including vegetarian/vegan options, non alcoholic beverages everywhere, and portion sizes are normal compared to American sizes.
I used to live in the US, and now in Netherlands and do own a car for those weekend trips and occasional long drives across Europe. I would not categorise NL as a car country. Majority of the times, one does not need a car to get groceries.
Are they really? Fitness socials exploded in the last 10 years, many more enthusiasts training harder/longer, but I haven't seen noticably more bodies at the gym.
One indicator is # of gym membership: ~30m->~70m in last 25 years, from 10% of population to 20%. Hard to say how much of that is due to gyms getting better at selling memberships because we know they oversubscribe. But per capita figures still suggest that vast plurarity of Americans, the average American, likely 1.5SD / 80%+ of population, probably don't have habit of regular exercise that would overcome effects of increasingly sedimentary life style. So should be ber surprising that obesity continues to increase.
I'd guess that many people going to the normal gyms aren't getting much out of it. Combined with the drive to and from the gym, and often getting a snack or something along the way, I have doubts that going to the gym is an efficient use of their time.
(the expensive, specialized gyms like Crossfit or climbing that cost much more are completely different)
> The drugs work by activating GLP-1 receptors in the body in a way that reduces appetite, alters gut function, and may impact addiction pathways.[2] However, adherence to the drugs long-term is a challenge, as many people stop taking them after some time.
So the question is whether there are other substances in our diet that are also affecting this system. This isn’t crazy: various gut bacteria produce proteins that increase natural GLP-1 in the body. So any substance that disrupts these bacteria could easily have this sort of effect. https://www.nature.com/articles/s41564-021-00880-5
most americans who go to the gym spend 60 ish minutes there. they also usually eat something after.
i don't think it's food additives, because japanese are no stranger to mass produced food and beverages from food conglomerates. it's the country that gave us instant noodles.
And packaged convenience store food of all kinds.
As a proxy, 47.7% of children walked or biked to school in 1969, and that fell to 12.7% by 2009. https://archive.cdc.gov/#/details?url=https://www.cdc.gov/po...
This mirrors general commuting changes in the Census.
People are always going on about walking, but I have a very hard time believing that the lack of low-intensity walking is a major contributing factor for the 250-pound bodies that are so common in the US (especially south and midwest). When you're overwhelming your body with fried food every day and coke at every meal, you ain't gonna keep up with those calories by getting in more steps.
A lot of steps for a pittance of calories [based on whatever hand-wavy math it's doing, admittedly]. We're frustratingly efficient. I forget exactly, it was something dumb like half a candy bar.
I've heard people say "you won't outrun your mouth", in this context... and others.
It's true. I've managed to drop my body weight ~half, it happened by controlling what I ate; not how I exercised. When I stopped skateboarding due to an injury, I ballooned. I stopped eating like that over a decade later, I shrunk.
In that time I also got older, moved, and went to college. It's worth considering what's easier/more likely/realistic to maintain
We can be remarkably efficient with the right conditioning. I eat once/day and would do less if not for literally boredom.
I do next to nothing physically all day. I'm fine, I just don't need a lot of upkeep. I have all the metabolism I need!
My health may be suffering for it, but I enjoy getting back a solid chunk of the day. Eating is such a time sink... now it's exercise too?!
I know it's nuts, I have an unhealthy relationship with food lol. Even the social side, it's hard to explain but people get mad when you don't want to eat with them.
Comment sections summarized excellently in four words. None of this was presented as universal truth, so I'd appreciate some leniency like I'm giving to you
My post provided a personal anecdote. What does yours have? Criticism we'd all be better off without.
It's clear the effect exercise had on me, it was keeping my eating in check. I can do that too at intake. I didn't even need a miracle drug.
I just stopped eating so much, but here I go slipping into moral judgement. I'm trying to help people, not reinforce a lifestyle.
In my opinion, these sorts of observations are uninteresting at best, and misinformative at worst. Hacker News, as you may well know from your nearly three year comment history here, is a place where detail and nuance are roundly appreciated.
I have three kids, and after each one of them, I tend to put on 10-15kg of body mass, mostly the wrong kind. So I have three experiences of "fixing it".
The first two times, I ran, lifted weights, ate salads and dropped alcohol, all that shit... it worked, but it was hard. Hard like when I quit smoking cigarettes (before the first kid). I was hungry. Irritable. Sometimes, I'd be like "oh, fuck it!" at 1AM and make a big ass instant Japanese ramen with scrambled eggs on the side, I was so hungry.
The third time, I eventually bought one of those under-desk treadmills, because despite my vows to walk 10km per day I just "don't have time".
It took about a day to acclimate. After that, and forever more, I can easily do computer work (writing code, reading code, architecture diagrams, writing docs) while walking 3kph (slow). When I am just reading stuff, I ramp it up to 4-5kph.
There are a bunch of other things that made me feel dumb for not doing it years earlier, which one day I might blog about or something. I suspect it actually helps my productivity — including learning rate and retention — for some reason (bleeding off extra energy that my mind might otherwise use to poke me with small, fascinating distractions?). But sticking to this topic, the main point is this: I was no longer super hungry with only 2000 kcal a day.
When I would run 750kcal off, sure I burned the calories, but I was soo hungry later that I would override my caloric restriction plan, and often end up eating more extra than I'd burned off.
Not at all the case with walking, either on the desk treadmill, or in the relatively uncommon case that I get to walk 10km in the real world (maybe once a week I will walk to/from work and take some detours).
My weight dropped steadily — which, of course, it does any time I manage to consistentely burn ~500kcal per day more than I consume — but the point is it dropped easily. Walking 10km/day, I can eat at a deficit without it being so... annoying. Eating to maintain weight is also easy.
And unlike lifting weights, or HIIT, or running hard — you can literally walk 10km every single day. You can take a day off if you want, but you don't need to[1]. Your muscles don't need rest. Your joints don't wear out. It's literally the activity your body was designed for. You can do it every single day for 10 years if you want.
I should really write that blog post.
I suspect some science-type should dig into it more and write a whole book.
[1]: the only real worry is that if you have already gotten super out of shape (very fat, very low cardio fitness, etc) then you should start with less walking per day, and work your way up gradually.
The appetite starts to come back around day six. Normally I've lost about two kg by then, after allowing for trail dehydration. After two weeks or so, I'm down about 4 kg.
Let's say that's 10,0000 days. Because I'm Australian and like round numbers and am lazy (these numbers are all very rounded), call 250lb 100kg. 1,0000 steps a day consumes about 20 kiljoule. If those kilojoules come from eating fat, you either add 1/2 a gram of fat or walk those 1,000 steps.
I know, 1/2 a gram, 0.02oz - almost insignificant, right? Now multiply it by 10,000 and see that over those decades it contributed 50kg of the 100kg we are talking about.
For the same reason exercise doesn't make a lot off difference to a 6 month or even 2 year diet. But when you are trying to explain to difference between trim Koreans and 250lb Americans those extra 3,000 steps a day explain the entire difference, then some.
I mean, it's obviously better to walk than to not, but I'm claiming the dominant factor is sugar-bomb drinks and fatty foods (which isn't at all a novel claim anyway). Walking only barely chips away at that.
When you look at ingredient labels in Japan or Germany, you see a short list of what you would expect, plus maybe a preservative.
In the US, you see an entire chemistry lab: artificial colors and flavors, bizarre substitutes for real sugar, oils that a hundred years ago would not be considered fit for human consumption, and so on.
Only 25% of Americans are getting the recommended aerobic activity. Which is 20 minutes per day of moderate activity (walking).
It is difficult to comprehend how little most Americans walk. In many suburbs, the local store is more than a mile, which would equate to a 40 minute round trip walk. How often do you walk for 40 minutes when you can drive in 8 minutes. Of course, delivery services only exacerbate the issue, as you're not even walking through the parking lot now.
Its also not really magical, they didn't just add sugar, they added meat, sugar, grains and oil (replacing butter mostly) - all together it adds up to 720 kcal extra per day per capita.
Koreans eat about 1500 kcal less per day (they are also quite a bit smaller on average so it's not 1 ot 1 of course.) Japanese eat even less (like 200 kcal less) but are also even a bit smaller on average. Both countries happily eat terrible food just as much as Americans do these days, they just eat a lot less food in total.
There's an idea that American eat out more and that the calories at dining establishments about increased about 35%.
Americans are also, on the whole, gigantic people. Tall, wide, huge frames and/or a lot of meat on the bone. Only some of that is accounted for by diet.
I think there's more to do in Japan locally, or at least more general social/physical freedom, which I attribute to low costs and high mobility. Nature in the US is generally privatized, far out of the way, or has limited access or parking. If you travel by walking in the US, middle class people think you're poor or your car has broken down. There's a bit of a stigma in some cases and places against not being sedentary and large (or, having to move and sweat for anyone).
In Japan a mindset of just enough seems to be prevalent. They do not seem to be as prone to glorifying excess in all ways like us Americans tend to be. I think this is a / the key aspect which is supported by these:
Americans are not active. Japanese people tend to be active and walking absolutely contributes to this.
Americans eat low quality food. We eat a lot of food with added sugar. We feed candy to children in sugary water-fat for breakfast. We eat processed and ultra processed foods regularly even when we primarily prepare meals at home.
Americans are anti-conformist. Japan is very conformist. This relates to social pressure(fat shaming, diet) and social activity cohesion (exercise, dieting).
It seems quite evident at even a glance why one country would be overweight while the other tends to be fit. In the US our culture rewards excess. We value cars more than people. We care about profits over people, too, really. Things like healthcare and food come to mind here.
It 100% has to do with walking/biking and portion sizes. Low intensity exercise throughout the day is as if not more effective than high intensity exercise for burning calories and keeping your metabolism from crashing.
Whatever the cause, there seems to be a causal relationship with brisk walking and lower blood sugar the following day.
https://pubmed.ncbi.nlm.nih.gov/30933002/
Americans and Indians just need to move more, weather it’s walking in a city or on a treadmill.
You’re pretty much on track until this. The idea that a specific subtype of sugar has slightly different effects on the body might technically be true, but it’s a small drop in the bucket when compared to the huge increase in calorie intake in general. When this idea started circulating, it seemed like a food company misinformation campaign.
I strive for 7k steps per day since Covid hit March 2020. Some days I may fall a little short if really tired or sore from golf or coaching little league the previous day, but most days I easily achieve it or go well over. I surely don't think 7k is an unreasonable goal for ANYONE - it just takes a little bit of mentality change and effort that just seem taken for granted in the USA from what I have observed last few years.
Things like parking near the rear of parking lots when going to stores. I am amazed now at how often I see people wasting many minutes in their cars just to wait or "hunt" for closer spots when they could have just parked in back and be walking into the store already. Or parents at the park sitting and reading their phones for an hour while their kids play in playground. Teenagers riding electric scooters/ebikes instead of walking or regular bikes, etc.
I was at my in-laws over Christmas and everyone sitting around eating one of the many appetizers to choose from and drinking alcohol, I decided I wanted to go for a quick mid-afternoon walk just for some fresh air. I remember sort of being giggled at when I asked if anyone wanted to go, with a few bewildered looks on some faces. Again it is a change of mentality that needs to happen if obesity is going to be addressed in the US anytime soon. Now, with these drugs available, I'm afraid it will be even harder to get to the root of the problem.
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.
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.
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.
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.
the food subsidy probably makes sense but not to the degree and bluntness of american policy. one of the instigations of nationwide school lunch was actually to provide a baseline level of demand for farmers and make cycles less severe.
But exercise has very little effect on weight compared to diet. It's a known fact, even for the fans of counting calories. Just see the tables of inputs and outputs.
Eating less and avoiding sugar and processed food is mostly enough, if not to be slim, at least to keep you reasonable healthy.
Also, some studies suggest that up to some threshold, exercise reallocates those calories from autonomic functions rather than actually adding to total expenditure [1]. It's been further speculated based on this that some of the health benefit of exercise might simply be a result of taking energy away from anxiety/stress responses.
It reduces the weight of all the fat you're carrying around. Even if exercise doesn't make you lighter it still makes you leaner.
I recognize that this is conventional wisdom, but it hasn't been borne out by my own results losing well over 100 pounds / roughly 40% of my body weight over the course of several years.
I've counted calories strictly, with the same methodology and same limit, and documented weight regularly, both during low-activity low-altitude winters and medium-activity, high-altitude summers. The results I got, over the major windows in which I got them, were as follows:
altitude | activity | loss | weeks | lbs/week | implicit daily caloric deficit @ 3500 cal/lb
high | high | 60 | 14 | 4.28 | 2140
low | medium | 0 | 6 | 0.00 | 0
low | low | 17 | 22 | 0.76 | 381
high | low-med | 47 | 30 | 1.57 | 783
low | low | -2 | 22 | -0.09 | - 45
high | medium | 10 | 4 | 2.50 | 1250
This is now data collected over years of weight loss and multiple seasonal changes in location and activity, and I find it difficult to explain this within the context of standard weight loss advice. Exercise at altitude seems to burn far more calories than it "should", by a factor of four or five times.
I walked a mile or two every other day on average across this period, meaning the only difference is a roughly 15 to 30-minute walk up a steep slope roughly every other day. A typical calculator will tell you this "should" burn on the order of 100-150 calories, but the data suggests it's closer to 500-1000.
I'm not a doctor, so I don't know why this is. I've largely ruled out:
- Diet, which is conserved across locations fairly well (I cook most of my own food using widely-available ingredients)
- Seasonal effects, unless they happen to produce very sharp discontinuities at the exact time I relocate each year
- Emotional state, since these results have been robust to both positive and negative emotional states in both locations
- Temperature, which is near-constant year round (because I live in warm places in winter and cold places in summer)
- Groundwater, because I drink almost entirely bottled water and not local water supplies
- Major underlying medical causes (my bloodwork is great and I don't have any reason to think I'm sick)
I have a working hypothesis that the studies that established calorie burn from exercise (which I believe largely did it by measuring CO2 exhalation) were missing a great deal of the actual energy cost, because the costs of anaerobic respiration take place over hours following exercise and not just during it. But I also can't imagine people with actual medical expertise haven't thought of this before. A negative correlation between altitude and obesity rates is well-established, so something is going on.
In any case, the data is the data, and it points very strongly towards altitude and exercise, synergistically, being almost exclusively the source of my own weight loss.
I dont get the point of saying excercise doesnt make you lose weight. It increases your caloric need, so if you dont eat to make up for it, then ya it absolutely helps.
I struggle greatly to diet hard enough to lose weight if im sedentary. Its extremely easy when doing 3 1hr strength workouts a week, and lik 20 mins of cardio a day. Like its a struggle to eat enough to maintain weight.
Locals would say matter of factly “you only order the large when you want more.”
Also many restaurants offer Tabehoudai and Nomihoudai, “all you can eat and drink” respectively.
All the servers would come to see when the Americans would order nomihoudai and request a pitcher of beer.
“Okay, one pitcher for the table.”
We’d always get a laugh when we’d say, “Actually, one pitcher for each of us.”
It would interesting to see the effect of that here in Australia. Imagine the Homer Simpson at the seafood buffet episode but an entire country.
Japan does have a “drink to excess” culture too, but it largely seems to be more with intent. (Also, in my travels I have found harder alcohols, 35%+, and shots culture are mostly a US characteristic.)
If I’d eat out with only my Japanese friends and we’d get a tabehoudai/nomihoudai we would only consume until sated, usually only ordering about the same amount as a normal menu item, but take advantage of the “all you can” to try new foods and drinks we were unsure if we’d like.
With my fellow American friends we would certainly abuse the privilege by drinking and eating beyond excess without necessarily even setting out to do so.
So what is your point?
So you think life style choices/abuse/etc is not a result of body chemistry? You know, that thing that drugs change:)
Intelligent people have died from diabetes and other obesity related illnesses, not because they couldn't understand calorie math or what carbohydrates are, but because they couldn't or wouldn't change their eating habits in the long term.
But I guess taking a medicine forever instead of not stuffing your face is easier because it requires zero user effort.
And Italian diet has a similar simplistic philosophy. French food does not. Both can keep you slim.
“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
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.
All true for Japan though?
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.
It clearly wasn't the mere existence of unhealthy foods, the Japanese have tons of unhealthy food as well. You can get a burger there without any issue.
If you saw a population of people injecting heroin into their veins and getting frail, would you say you have a frail ness epidemic? No. What you have now is a food addiction epidemic. You should treat it as you treat any other addiction.
>Combining that with an individualistic culture
So that is the only change since the 50s? Seems like a very weak explanation.
I agree that overeating should be shamed, but was that needed 70 years ago? To be honest I don't believe the cultural issue. Which percentage of US citizens believe that they should loose weight? Likely a very large proportion.
The stereotype of Japanese food abroad is it's all just grilled fish and sushi but there is a LOT of fried food involved.
I'll say US portions are absolutely out of control though, I think that's the biggest thing. When my Swedish friends went to visit the US they ended up just ordering one thing at every restaurant and sharing it, and the waiters would just laugh at them.
Japan has those in vending machines. That can't be the deciding factor.
>Also, Americans don't do walking. Walking is a very low effort activity. Good infrastructure usually means that you do little walking and a lot of standing around, this can't account for such a massive difference.
Did people 70 years ago in the West just happen to eat smaller portions?
>eating sugar in huge quantities.
But sugar consumption, per capital, is decreasing. And has done so for decades, when will obesity rates follow?
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.
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.
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).
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.
I agree too many non-Japanese who just visit judge the whole country by Tokyo which is a mistake. But there's a much bigger culture of walking and standing in Japan than there is in the US. Heck, the US has a culture of parking as close to the store/restaurant as possible in the parking lot of any commercial area to minimize walking. It's hard to beat culture. Of course Japan is also a culture where obesity is a lot more frowned upon, the doctors chastise you much harder for it, and as a collective society people feel much more pressured to stay skinny. Japanese also eat much smaller portions and find that acceptable. And Japanese in rural, more car centric, areas often are heavier than urban Japanese.
I really don't think the small lot sizes are causal for Japanese not having kids, rather I think it's the other way around. Fewer folks in urban areas are having kids, dropping demand for anything larger than a 2LDK, so the market is responding in kind.
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.
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.
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.
And the USA is eating less and less sugar since around 30 years.
I think you're missing the point of the article. It's not claiming that the mere existance of unhealthy food is what's causing obesity; it's the societal norms and behaviors developed around food (and exercise).
Of course ultra-processed food also exists in Japan. Same for sugary drinks, sugars and sweets. But it's undeniable that there's a culture of acceptance of junk food in the US, and a confusion that some of it "must be good for you" -- e.g., fruit juices, cereals.
There's so many historical differences between Japanese and American societies that could be part of the cause -- many of them listed in this thread.
To give you one example: breakfast in the US is typically full of carbs, sugars and fructose: cereals, fruit juices, bread, honey, maple syrup. There's a common belief that they're healthy, and you need that "energy punch early in the day to keep you going".
That couldn't be further from the truth. All this carb and sugar-heavy meal does to your body is to give your metabolism a glucose spike, followed by a rush of insulin, and eventually a crash [1]. This roller coaster leaves you hungry and craving soon after. Rinse and repeat for 30 years (together with other bad habits), and you're one stop closer to obesity and diabetes.
The American culture of "snacks" is another example: we're inundated with granola bars, dried fruit, veggie chips -- all "organic", "natural", "full of vitamin". Portion size is another one; go compare to portion sizes in the US vs. Japan. Or the common habit of eating fast and until full, while in Japan is 'eat slow, until 80%'. The list goes on.
Now, you need a social scientist to understand WHY it happened this way over the past 70 years. It may have been the food scarcity during WWII, or how baby boomers grew up, the rapid industrialization of American society, or a myriad of other confounding factors.
Whatever the case, it's clear that this is wrecking the metabolism of millions of Americans, and it'll get worse before it gets better.
ps: I'm using Americans instead of Western society, because 1) that's the reality I'm familiar with, and 2) I think this is more prominent in the US than in the Western societies at large.
Source: born and raised abroad, but living in the US for the past 20 years, with a Japanese-descent spouse. This gave me some perspective on how different cultures develop a relationship with food.
[1] Glucose Revolution, https://www.amazon.com/Glucose-Revolution-Life-Changing-Powe...
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.
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).
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.
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.
[1]https://www.express.co.uk/life-style/health/1733624/obesity-...
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.
As someone with a couple doctors in my family, that's BS if talking about any competent doctor. No, doctors may not say "You're super fat and better eat less", but that's because they're generally not assholes, not because they're "tip-toeing" around obesity. On the contrary, for many decades most doctors would say the same thing: "You're overweight. You have bad lab numbers (e.g. high A1C, high cholesterol, etc.) You need to diet and exercise."
Of course, that advice obviously made no difference at a societal level (Americans only got more obese) largely because of things pointed out in this article: cultural impacts of things like standard portion sizes, favored cuisines, ease of walking instead of needing to take a car everywhere, etc. swamped any once or twice a year advice of "you're overweight and need to diet and exercise more".
This would be reasonable advice for most people, but falls flat when a doctor completely ignores a patients circumstances.
This kind of lazy advice is commonly given to women, and more so to women of color. As a result, I’m very leery of describing all cases of disgruntled patients “sensitivity”.
The thing that you are misunderstanding is that people don’t want to be humiliated about their weight. It isn’t that they want to be fat, but that they don’t want to be thought of as disgusting or “less than human” for being fat.
In fact, most people who struggle with their weight have worked harder to try to lose it than you can imagine. If you think “just eat less and move more” is something they’ve never heard before, you’re living in an alternate universe. It’s not always quite that simple; people have baggage, trauma, genetics, and so on.
It’s not that they’re proud of being fat. It’s that they’re proud of who they are despite their weight, not because of it.
The issue with doctors isn’t that they can’t tell patients they are obese and need to make dietary changes or lose weight; it’s that people will come in with unrelated issues and doctors will refuse to look past their weight to diagnose what the underlying issue might be, using weight as an easy answer to blame it on. Sometimes it’s weight; but sometimes it isn’t.
The goal of those ads (which I agree there are too many of today) is to help people hate themselves a little bit less. There’s a reason obesity is often comorbid with suicide.
But shaming is effective. There are of course fat Japanese people, but for the average person, shame is an effective deterrent against weight gain. That makes sense. Food doesn’t act on people’s rational senses. It targets pleasure centers. The cold logic of non-judgmental medical advice is powerless to do anything against that. Medical professionals, after all, are nearly as likely to be overweight or obese as the general population. Shaming, by contrast, targets a different, more primitive part of the brain. People will change their behavior in an effort to avoid shame in a way they won’t for abstract good advice.
So you’re right, shame works. But, for the sake of argument, if it leads people to suicide, eating disorders, or depression, while obesity is no longer technically the problem, you’ve just created another problem.
Shame works for Japan (for now, at least) because they are a wholly different society than ours, based on a wholly different set of morals and upbringing.
But is a Japanese salaryman happier than an obese American? Most are miserable, for most of their lives, and simply don’t talk about it to anyone outside their close circle, if at all. Remember that mental health in Japan isn’t really a thing that gets discussed very much, by doctors or anyone else.
It’s just trading one thing for another.
We’ve learned a lot about reinforcement learning from training animals, and specifically that positive feedback tends to lead to better results long-term, even if negative reinforcement may lead to quicker changes in the short-term.
I’m not convinced the same ideas don’t apply to mammals like us.
Moreover, what gets lost in the shame / blame game is the concept that people can work really hard at changing themselves and still have a long way to go. That is, if someone is 200 lbs overweight and has spent the last two years losing 100 of those lbs… someone who sees them in a “shame” society would still shame them, with zero context given to the fact that they’ve had a massive success over the last twelve months that should be celebrated even if they’re not where they want to be yet.
Without positive feedback, it’s exceptionally difficult to “stay the course,” and that is the point. Shame only gets you so far.
Supporting someone on their journey to a healthy weight gets them much further, and if you genuinely care about someone, that should generally extend to their mental health as much as their weight, imho.
Part of the problem with discussions in many societies now is this false equivalency. Yes, some people might be driven to suicide due to shaming, but this is not the vast majority of people. However, NOT shaming people about their weight leads to a much larger portion of the population being fat and unhealthy, which has incredible downstream health and societal impacts.
So I disagree with your equivalency here - shame is a good social tool for the majority, and while we should certainly be on the lookout for the extreme minority who have mental health issues, we should not be throwing out good general social tools just because of a few edge cases.
What you're calling "thought police society" is basically another way of saying that "there are social norms in a particular society". This is true anywhere.
You may not like the social norms of a particular place and time, or think your rival political tribe is from the dark ages (I recommend going outside to touch grass if you're in a Western country and believe this), but the base point is that any group of people that has any sort of group cohesion has preferred social behaviours and disliked antisocial behaviours.
But do those hurt the median person, or does that social policy just increase those problems at the margin? If the median person is made better off overall then it’s worth the trade off.
And is the Japanese salaryman more or less happy than the obese American service worker?
This also ignores a very basic premise in medicine: nobody will willingly go to a doctor they do not believe has their best interests in mind. It’s one of the reasons the Hippocratic oath exists.
This is basically my point. A lot of the policies the writer points to arent transferrable to the west imo because they rely on eastern values that wouldnt fly here. In some ways the estern values are better, in some ways the western ones are, nothing wrong with that.
(I know that these are complex and wicked problems, and using the word “translating” might sound like an oversimplification, but humans are incredibly adaptable)
That's almost bordering on orientalism. The fact that everything you do has a social dimension, that the way you live impacts the people around you is a true fact, not an eastern value. It's simply that we in the West ignore this at our own peril because we ideologically pretend that every man and woman is an island. That what any individual does has no impact on their surroundings, and for that reason that society cannot impose on our "private decisions". You can actually map out obesity spreading within families and communities like a viral disease.
That's why they have a 4% obesity rate spending almost nothing, why over here half the nations are obese despite spending hundreds of billions on individual livestyle fixes. They have a correct understanding of how societies work in this regard at least, we've given up on it. This is not about subjective cultural values.
I’m older, less stressed and (hopefully) wiser than I used to be but still: I stop, but keep coming back to it for a couple of months after a longer break, because this behaviour is so deeply ingrained in my upbringing and in the culture of my new home. And there are so many socially accepted triggers. I am aware that ultimately this is my own responsibility but it’s hard.
I know that I can’t fully compare obesity to nicotine addiction, these are all complex states/behaviours but I feel like the social and cultural aspect is similar in some ways.
Familiarity with the environment matters so much. An example would be the percentage of Vietnam war veterans who suffered from heroin addiction during deployment but ceased using after coming back home (it was ridiculously low compared to people who lived and used in the same country.
[0] https://www.niddk.nih.gov/health-information/health-statisti...
So the costs are ones we as a society are putting on individuals are coming back to bite everyone in the ass.
> 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/
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.
That is my interpretation of why the semaglutide budget effects are dire etc - well, Medicare doesn't spend anything on the fatty who dies at 50, and if they live to 80 and get cancer it's a lot more expensive for Medicare in the long-run actually. The proximal cost of the drug almost doesn't matter itself ($700/mo is w/e in terms of what we spend on seniors, and obesity is expensive both short-term and long, right?) it's more the long-run budget effects.
It's already generally a shift upwards in Euro societies with more egalitarian age distribution of spending. Then you consider the US's favoritism for seniors... and the fact that ultimately Medicare foots a lot of it (minus the substantial amounts they can claw back ofc). They are the ultimate "sick pool"/adverse selection, right? Yeah, the USG's budget numbers probably look really bad if we cure obesity actually, even if it wasn't expensive.
Thanks for your disarming attitude.
What about dumb people? Or people with Down syndrome? Or people who use a wheelchair? Or people who were born with a missing limb? Or spina bifida?
Why limit it to “fat people,” other than because society says it’s simply okay to shame them more than others?
And before you say it’s a choice: it isn’t always. Kids don’t get to pick what their parents feed them, and while you can make changes in adulthood, if you don’t have the tools or skills, good parents (or any at all), and so on, you’re in for a rough time.
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
> 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/3ksqebx...
The key is walking distance. The Japanese live in their cities, we Americans live in our cars.
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.
Portions are way smaller though.