Masculinity and Body Weight in Japan

Grappling with Metabolic Syndrome

Genaro Castro-Vázquez

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000056785
• Edition: 1
• Topic: Biological Sciences
• Subtopic: Biology
• Index: Biological Sciences

Drawing on the concept of the somatic self, Castro-Vázquez explores how Japanese men think about, express and interpret their experiences concerning bodyweight control.

Based on an extensive ethnographic investigation, this book offers a compelling analysis of male obesity and overweight in Japan from a symbolic interactionism perspective to delve into structure, meaning, practice and subjectivity underpinning the experiences of a group of middle-aged, Japanese men grappling with body weight control. Castro-Vázquez frames obesity and overweight within historical and current global and sociological debates that help to highlight the significance of the Japanese case. By drawing on evidence from different locations and contexts, he sustains a comparative perspective to extend and deepen the analysis.

A valuable resource for scholars both of contemporary masculinity and of medical sociology, especially those with a particular interest in Japan.

1 From obesity and overweight to metabolic syndrome

‘Total energy consumption in Japan is not that high compared with the USA and the West in general, but the ratio of fat to total energy is quite high, especially among the young’, says Fumi Hayashi, a research assistant at the government-affiliated National Institute of Health and Nutrition. A diet higher in fat was an early side-effect of the astonishing economic growth in Japan after the war, which established itself first in urban areas and later in rural regions in the 1960s and 70s.

(McCurry 2007, 451)

Contrary to cultural stereotypes that render the Japanese self ‘fit and healthy’, and comparative international surveys that imply that obesity and overweight should not be a concern for medics and politicians in Japan (OECD 2017, 3), researchers from the National Institute of Health and Nutrition are worried about shifts in current diet patterns and an increase in the number of young people who are overweight. Obesity might be indeed a sign of growing social affluence—an originally metropolitan phenomenon that has spread out to the entire country—which although it is not a daunting matter, as it is for ‘Westerners’ and Americans for instance, has entered the current public health agenda as a ‘critical’ issue to be attended to. ‘Healthy’ traditional culinary habits have been apparently replaced by fatty and ‘unhealthy’ ones, and this has triggered the implementation of a number of programmes to help palliate the situation.

The Japanese medical approach to obesity nonetheless elicits in principle a somewhat different stance, a rather ‘unique’ perspective that has attracted the attention of local and international health-related agencies, because it revolves around the concept of ‘metabolic syndrome’—a term used to refer to obesity and overweight—which primarily suggests that an individual should lose weight only when he or she is at risk of developing metabolic-related diseases. Obesity and overweight are not an illness per se, they are both identified as lifestyle-related diseases and thus medical interventions are to be deployed accordingly. More importantly, the Japanese metabolic-syndrome-grounded approach is primarily inspired by an ethnicised viewpoint of corpulence, which mostly implies that although East Asians in general, and the Japanese in particular, do not look as ‘corpulent’ as ‘Westerners’, racial determinants make them highly vulnerable to developing metabolic-related diseases, such as diabetes and heart attacks. East Asians tend to be exceptionally predisposed to accumulate visceral fat—intra-abdominal adipose tissue—and thus although they look slimmer, it does not necessarily mean that they are healthier than Westerners.

Obesity and overweight might actually involve shifting moral values. Gaining weight could be a symptom of Japanese people not appreciating the intrinsic nutritional value of Japanese food and thus a possible ‘solution’ to metabolic syndrome could entail a moral campaign where the ‘right’ behaviour is to retrieve traditional culinary patterns that mostly entail a ‘healthy and balanced’ diet. The Japanese are supposedly healthy by ‘nature’, as long as they eat ethnic Japanese food, yet the younger generation—men in particular—relentlessly distance themselves from the archetype and this could be pathological. An element of the moral campaign might thus imply to recuperate the traditional Japanese self, which is largely equivalent to ‘healthiness’.

Interventions to thwart metabolic syndrome have been in place for approximately 20 years, yet their outcomes are largely unmeasurable. Although official surveys suggest that attitudes seemed to have changed and Japanese people’s awareness of the significance of eating healthy and doing physical exercise to reduce the risk of lifestyle-related diseases might exist, this does not mean actual behavioural changes, or clear evidence that official schemes have served to reduce the incidence of metabolic-related diseases. A proper evaluation of social impact is indeed difficult to attain as strategies are not to promote bodyweight control alone. Nonetheless, opponents of the government’s policies contend that metabolic syndrome is an ‘invented’ disease and thus it is unlikely that a perceptible change in the wellbeing of the Japanese can be attained. In this light, this chapter discusses the origin of metabolic syndrome and its connections to obesity and overweight and the different programmes that have been implemented to improve the situation. The chapter draws on the construct of biopedagogy to offer a theoretical view on strategies against obesity and overweight. Finally, the chapter highlights why the outcomes of official interventions tend to be uncertain and imperceptible.

Why metabolic syndrome?

Explicit government’s attempts to promote bodyweight control in Japan date back the 1970s, and have largely entailed an appeal to return to traditional food as a means to keep the self healthy, as Yazaki and Kadowaki elaborate

[o]ver the past 50 years, the Japanese diet has changed from traditional, natural foods to high-calorie, high-fat foods. This change in lifestyle, which has been accompanied by a reduction in the physical activity of the average person, has been associated with a considerable change in the frequency with which metabolic diseases are reported.

(2006, 74, emphasis added)

One of the first official schemes to encourage healthy diets, body fitness and proper rest, with a special emphasis on how to balance a diet was launched in 1978, and lasted for ten years. In 1988, Active 80 Health Plan was released and one of its main objectives was to raise awareness of the importance of physical exercise to become a healthy self—a largely unfulfilled objective from the previous plan. Issued in 2000, Healthy Japan 21 was a scheme that included for the first time the prevention of ‘metabolic syndrome’ through physical exercise and healthier diets (Ministry of Health Labour and Welfare 2010b). Metabolic syndrome—naizō shibō shōkōgun, visceral fat syndrome, ‘metabo’—became henceforth the Japanese official term to refer to obesity and overweight-related conditions. Metabo ‘has become a widely-used term in the mass media, featured on the ubiquitous television shows featuring health issues’ (Borovoy and Roberto 2015, 66).

Body Mass Index¹ (BMI) was not originally ‘intended to provide a measurement of health’ (Boero 2012, 10), but it is currently the most common and practical method to diagnose obesity and overweight. The World Health Organization (WHO) indicates that a person with a BMI ≥30 should be considered obese and undergo bodyweight control (World Health Organization 2016), which means that only approximately 2 to 3 per cent of the Japanese population is obese. The Japan Society for the Study of Obesity (JSSO) thus contends that the BMI alone is insufficient to estimate how obesity and overweight affect the Japanese, and highlights that obesity should not be regarded as a ‘disease’ per se. Obesity and overweight are a factor that triggers metabolic-related illnesses. Obesity and overweight both entail a ‘risk factor’ in the clustering of diseases, and consequently, irrespective of BMI, an individual should be recommended to lose weight to avert the risk of atherosclerotic diseases or diabetes mellitus, which are two of the most common metabolic disorders (Japan Society for the Study of Obesity 2002, 990).

Social scientists have challenged the concept of race, and questioned the ‘scientific’ use and validity of genetical differences and physical features such as, body sizes and shapes, as well as skin colours to substantiate the existence of three main races: Caucasoid, Africanoid and Mongoloid. Anthropologists and sociologist insist that although humans do vary and dissimilarities might matter, ‘racial divisions … do not reflect biology: they are cultural constructs (Fuentes 2012, 91), which have been largely served to justify colonialism, imperialism and the notion of ‘superior’ versus ‘inferior’ races that underpins social Darwinism.² This largely entails a ‘cognitive’ process where ‘the physical features of a group are evaluated according to their supposed social and cultural superiority or inferiority … Biological similarities are suppressed, and physical differences are highlighted and used to support racist classificatory systems’ (Shilling 2012, 109). Nonetheless, health care professionals and epidemiologists aver that an inclusive understanding of how adiposity and unhealthiness are connected could be better attained when considering ‘racial differences’.

The rationale underneath the concept of metabolic syndrome entails indeed a racialised gaze to fatness, as ‘[o]besity-related disorders occur at a much lower body mass index (BMI) in ethnic Asian populations than in ethnic Caucasian ones’ (Sakuta and Suzuki 2008, 116, emphasis added). Medical research has indicated, for instance, that non-Asian men appear ‘heavier’ in general, because they are prone to accumulate subcutaneous fat and grow larger waistlines; however, although Asian men tend to look ‘slimmer’, they are predisposed to produce larger amounts of unperceived visceral fat concentrated around internal organs, which increases their potential risk of developing metabolic-related diseases (Moon et al. 2002, McCurry 2007, 451, Li et al. 2002). The WHO Western Pacific Region underscores, in this light, the need to produce specific standards for Asian and Pacific Island regions. Whilst associated risks with obesity happen at lower BMI in Asians due to their prevalent susceptibility to ‘visceral or abdominal obesity’, Pacific Islanders tend to present larger muscle mass and lower body fat than Europids with the same BMI (World Health Organization Regional Office for the Western Pacific 2000, 5).

The WHO holds, moreover, that the occurrence of metabolic disorders increases when men and women have a waist circumference of ≥94 cm and ≥80 cm, respectively (World Health Organization 2000). Notwithstanding, the WHO Western Pacific Region holds that the standard should be adjusted; ‘Asian’ populations are at high risk of being stricken by metabolic disorders with a waistline of ≥90cm and ≥80cm for men and women, respectively. In clarifying what metabolic syndrome entails, the JSSO adduces another ethnic predisposition: Japanese people can hardly metabolise glucose and when over-nourished, they tend to develop ‘glucose intolerance and complications even with a mild excess of adiposity’ (Japan Society for the Study of Obesity 2002, 987). In addition, Yamagishi and Iso hold that when ‘considering measures of metabolic syndrome in East Asia, we should note that the aetiology of arteriosclerosis differs between East Asians and Westerners’ (Yamagishi and Iso 2017, 4, emphasis added); therefore, though not to the exclusion of other measures, the level of visceral fat together with BMI could better serve to estimate overweight-associated health hazards.

Against this backdrop, the Ministry of Health Labour and Welfare (MHLW) has promoted an ethnicised medical policy against obesity and overweight, and to prevent metabolic syndrome. Japanese people should endure bodyweight control with a BMI ≥ 25, a waist circumference ≥85 cm and ≥90 cm, for men and women respectively, and when they present high levels of at least two or three of the following items: blood pressure, glucose concentration in blood, and LDL cholesterol level³ (Ministry of Hea...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• Acknowledgements
• Introduction
• 1 From obesity and overweight to metabolic syndrome
• 2 The somatic self and the Japanese
• 3 The somatic self, metabolic syndrome and the mass media
• 4 The somatic self of some ‘chubby’ (debu) men
• 5 The somatic self of some beefy and slim-muscular Japanese men
• 6 The somatic self and culinary practices of some Japanese men
• 7 The somatic self and social class of some Japanese men
• Conclusion
• Index