a guest blog by Tessa Tricks*
We are amidst a major moment for UK food policy. The pandemic has pushed longstanding issues up the agenda; dietary ill-health has become a medical emergency, school food provision has made the PM’s radar and over five million Britons have become food insecure. Working out how to provide access to healthy and sustainable diets for all is more important than ever. It’s a time for change. A time when many, including the Government are asking about the key ingredients for a more successful food system. What I saw in Japan gives reassurance that policies which affect the dietary health of a nation can be done a radically different way. Here I discuss two health policies, the ‘Metabo’ law which aims to control the waistline of an aging population, and the Shokuiku law which gives each school child a basic food education. Will either win Japan the gold medal for dietary health?
School food matters
According to UNICEF’s 2019 report, The State of the World’s Children, Japan tops the charts for childhood health indicators and has the lowest incidence of childhood obesity among the 41 developed countries in the OECD and EU.
Kyushoku, Japan’s school lunch programme, and its supporting food education scheme Shokuiku, receive international acclaim for their contribution to such chart-topping child health. Kyushoku began in the 1950s shortly after the introduction of school food standards in the UK. While Thatcher abolished the UK System, the Japanese system remains.
The government-subsidised Kyushoku extends to all government primary schools and many junior high schools. The Basic Law of Shokuiku was introduced in 2005 to make food education a part of school curriculums. Combined, Kyushoku and Shokuiku culminate in across-curricular programme which has the long-term health and wellbeing of children at its core.
Under these programmes each school has a nutritionist who plans the meals using seasonal and fresh food, oversees the preparation, and in many cases supports the procurement of local produce. They also facilitate food learning within lessons and outside of the classroom, through activities such as local farm visits.
From their first year in school, children turn their classroom into a lunch hall for an hour a day. They take it in turns to serve food to their classmates, introduce the meal, and clear away. The process normalises a sense of shared responsibility and highlights the table manners, gratitude and community dining which are all considered essential parts of ‘teaching food.’
This is supported by a daily broadcast to explain the nutritional elements of the day’s lunch. Regular discussions around lunch and food are also part of the curriculum.
Japanese friends say pudding was not a part of Kyushoku. “Maybe jelly on special days, but not really.” My memories of UK school lunches revolve around a thick syrupy sponge drowning in custard. No complaints on my part, but it did little on the nutritional front.
On the contrary, each Kyushoku meal has 600-700 calories balanced between carbohydrates, meat or fish and vegetables. A meal might include rice with grilled fish and a spinach and sprout dish, served with miso soup with pork, alongside milk and dried prunes. A splash of custard wouldn’t go amiss but credit is due for the incorporation of at least three portions of fruit and veg into lunch alone.
There are no concessions for those who have special dietary requirements or are vegetarian, let alone vegan. Each child gets the same. This is hard to conceive of in the UK where we have a greater number of ethnicities, pressure for schools to go ‘meat-free’ during certain days of the week, and a crippling fear of allergies.
In Japan, “individual choice” (in an increasingly obesogenic environment) happens outside of the school gates. This one meal a day is seen as an opportunity to level the social determinants of diet-related health which are starker within the UK and sow the seeds of adult diseases in early childhood. “School lunch is designed to provide nutrition that tends to be lacking in meals at home. I think it contributes to the nutritional balance necessary for children.”says Education Ministry official Mayumi Ueda.
Although Japan’s childhood obesity rates are low in comparison with the international community, they have risen in recent years due to the increasing infiltration of ‘Western’ high-fat sugar salt (HFSS) foods. Recent data suggests they have begun to stabilise. While it remains to be seen if Shokuiku’s joined up approach to health and food education will help it to buck the global trend long term, these results show promise.
A weighting game
Things are also happening outside the school gates, since Japan’s diet-related adult health has equally come under strain due to a rise in Western-influenced foods. The burden that this places on national healthcare is increased by an ageing population, and a diminishing pool of young taxpayers. In response, the government has made policy moves which shape the nation’s food choices long after they leave school.
Introduced in 2008, the Metabo aims to prevent obesity in old age by penalising bulging waistlines. It requires men and women between the ages of 40 and 74, (amounting to nearly half of the population) to have their waist circumference measured annually. Men with waistlines larger than 33.5 inches and women with waistlines larger than 35.4 inches are seen as a cause for concern.
Those spilling over the threshold may be required to go to counselling sessions, converse with a dietician or attend exercise classes. Meanwhile, in the UK, the NHS advises that men with waistlines larger than 37 inches and women with waistlines larger than 31.5 inches should ‘try to lose weight’.
Japanese citizens aren’t penalised if their weight loss efforts go awry. The companies and local government who have such citizens in their charge are. At the time of Metabo’s introduction, NEC, Japan’s largest maker of PCs, told the New York Times that it could incur as much as $19 million in penalties if it failed to meet its targets.
‘Metabolic syndrome’ is a collection of factors that heighten the risk of developing vascular disease and diabetes, including abdominal obesity, high blood pressure and cholesterol. Shortening technical and potentially alienating terminology to the jovial ‘Metabo’, has worked wonders. The term has entered daily conversation as shorthand for both ‘overweight; and ‘body fat’.
Witty advertising campaigns compliment up-beat ‘Metabo’ music played at specific exercise classed. The lyrics joke about the prospect of buttons flying off trousers and invoke camaraderie as the nation fights the pesky Metabo together.
“Goodbye, Metabo. Let’s get our check-ups together. Go! Go! Go! Goodbye, Metabo. Don’t wait till you get sick. No! No! No!” (When sung to the tune of Amy Winehouse’s Rehab, this really has the potential to stick).
It’s an understatement to say the social disapproval is stronger in Japan than in the UK. The number of Japanese who are afraid to say that they do not want to eat meat for fear of going against the grain serves as one example.
As such, many people felt the approach would have legs. “It’ll have the same effect as non-smoking campaigns where smokers are now looked at disapprovingly,” a company nurse Kimiko Shigeno, told the New York Times.
A decade on Tokyo university worker, Makiko, has mixed feelings about the scheme. “Measuring waistlines isn’t enough to prevent lifestyle related diseases and I’m not sure what impact it’s had. However, Government intervention has made Japanese people more aware of lifestyle diseases. We are all aware of Metabo.”
Official studies on the success of the law have yet to be published. However, Metabo is not just a paternalistic strategy. It highlights an understanding of the role of government in personal health, but also an appreciation of the role of social pressures and norms in shaping dietary behaviour.
Whether or not you agree with Japan’s strategy for obesity management, their approach to education on the health risks associated with modern food, combined with a healthy food culture from childhood is worth watching. Will it keep them in the running for global health leader? Stay tuned.
In this guest blog, Tessa Tricks, Creative Partner at Environmental Charity Hubbub, reflects on her recent time in Japan, before it was cut short by Covid-19.