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TOKYO, Japan — In Japan, being thin isn’t just the price you pay for fashion or social acceptance. It’s the law.

So before the fat police could throw her in pudgy purgatory, Miki Yabe, 39, a manager at a major transportation corporation, went on a crash diet last month. In the week before her company’s annual health check-up, Yabe ate 21 consecutive meals of vegetable soup and hit the gym for 30 minutes a day of running and swimming.

“It’s scary,” said Yabe, who is 5 feet 3 inches and 133 pounds. “I gained 2 kilos [4.5 pounds] this year.”

In Japan, already the slimmest industrialized nation, people are fighting fat to ward off dreaded metabolic syndrome and comply with a government-imposed waistline standard. Metabolic syndrome, known here simply as “metabo,” is a combination of health risks, including stomach flab, high blood pressure and high cholesterol, that can lead to cardiovascular disease and diabetes.

Concerned about rising rates of both in a graying nation, Japanese lawmakers last year set a maximum waistline size for anyone age 40 and older: 85 centimeters (33.5 inches) for men and 90 centimeters (35.4 inches) for women.

In the United States, the Senate and House health care reform bills have included the so-called “Safeway Amendment,” which would offer reductions in insurance premiums to people who lead fitter lives. The experience of the Japanese offers lessons in how complicated it is to legislate good health.

Though Japan’s “metabo law” aims to save money by heading off health risks related to obesity, there is no consensus that it will. Doctors and health experts have said the waistline limits conflict with the International Diabetes Federation’s recommended guidelines for Japan. Meantime, ordinary residents have been buying fitness equipment, joining gyms and popping herbal pills in an effort to lose weight, even though some doctors warn that they are already too thin to begin with.

The amount of “food calories which the Japanese intake is decreasing from 10 years ago,” said Yoichi Ogushi, professor of medicine at Tokai University and one of the leading critics of the law. “So there is no obesity problem as in the USA. To the contrary, there is a problem of leanness in young females.”

One thing’s certain: Most Japanese aren’t taking any chances.

Companies are offering discounted gym memberships and developing special diet plans for employees. Residents are buying new products touted as fighting metabo, including a $1,400 machine called the Joba that imitates a bucking bronco. The convenience store chain Lawson has opened healthier food stores called Natural Lawson, featuring fresh fruits and vegetables.

Under Japan’s health care coverage, companies administer check-ups to employees once a year. Those who fail to meet the waistline requirement must undergo counseling. If companies do not reduce the number of overweight employees by 10 percent by 2012 and 25 percent by 2015, they could be required to pay more money into a health care program for the elderly. An estimated 56 million Japanese will have their waists measured this year.

Though Japan has some of the world’s lowest rates of obesity — less than 5 percent, compared to nearly 35 percent for the United States — people here on average have gotten heavier in the past three decades, according to government statistics. More worrisome, in a nation that is aging faster than any other because of long life spans and low birth rates, the number of people with diabetes has risen from 6.9 million in 1997 to 8.9 million last year.

Health care costs here are projected to double by 2020 and represent 11.5 percent of gross domestic product. That’s why some health experts support the metabo law.

“Due to the check up, there is increased public awareness on the issue of obesity and metabolic syndrome,” said James Kondo, president of the Health Policy Institute Japan, an independent think tank. “Since fighting obesity is a habit underlined by heightened awareness, this is a good thing. The program is also revolutionary in that incentivizes [companies] to reduce obesity.”

Though the health exams for metabolic syndrome factor in blood pressure, cholesterol, blood sugar, weight and smoking, waist size is the most critical element in the Japanese law — and perhaps the most humiliating.

The hesitancy of some Japanese to expose their bare stomachs to the tape measure has led the government to allow the tape measures to be administered to clothed patients. Those who elect not to strip down are permitted to deduct 1.5 centimeters from their results.

The crudeness of the system has alarmed some doctors. Satoru Yamada, a doctor at Kitasato Institute Hospital in Tokyo, published a study two years ago in which several doctors measured the waist of the same person. Their results varied by as much as 7.8 centimeters.

“I cannot agree with waist size being the essential element,” Yamada said.

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

On the day of her exam, Yabe arrived at the clinic at 8:30 in the morning. The battery of tests lasted an hour. The result: her waist was 84 centimeters — safely under the limit. She had shed 6.5 pounds thanks to her diet and exercise.

A week later, however, Yabe was back to eating pasta and other favorite foods.

“I want to keep healthy now, but I don’t know,” she said. “Maybe in December, I will have many bonenkai [year-end parties]. And next summer I will drink beer, almost every day.”

I thought it was bad enough when Nigel Savage, who presented the Jewish seven-year plan for responding to climate change at the at the "Many Heavens, One Earth" conference in England, pledged to cut meat eating in the Jewish community by 50 percent by 2015. But actual legislation, likely based on the same shoddy science exposed by Taubes, Groves, Kendrick, Rasknov, et. al?! Hasn't anybody in the Japanese government heard of the word "hormones?"

Presumably there's a get-out clause for sumo wrestlers...

Problem is, they're probably counseling people there to eat the same sort of food sumo wrestlers would to fatten up--lots of low fat rice and veggies?

In the people I know, waist size is greatly dependent NOT just on fat. My friend L is built like a refrigerator, not from fat, just from having very wide bone structure, her hands are very big and wide, her shoulders, etc. My friend C is built like a bird, she may seem thinner but she carries probably 50% more fat, because naturally she is, like her daughter, so "bird-boned" that she is super-duper thin. I don't really understand the "fixed number" for waistline. Shouldn't this at LEAST be measured "in the context of" the rest of the person's body? Isn't it a much bigger deal to have a waist X" around if you are 5'1 than if you are 5'11?? That seems absurd.

I agree with you! My sister is also built the same way, very large frame, but not an ounce of fat. It sounds very extreme and harsh. I can't begin to imagine people that are worried about losing their job due to not fitting the size range. I know that there are certain requirements for military, and police (here), but in the private sector?

Interesting how the new, not-yet-implemented guidelines let men be a bit heavier but require women to be 10% smaller. Pretty obvious the gender of the decision makers here . . .

The standards as are when applied to Asians allows for a bit of heft. I'm am 5'7, large framed, over weight, naturally thick waisted and gain my weight in my upper body and my waist is smaller than that.

However, I hope this does not spread to anywhere else. Gah.

The article has a stupid and misleading headline.