December 13, 2022

The Health and Global Policy Institute (HGPI) Obesity Control Promotion Project“The Next Steps for Engaging and Cooperating with Patients, Citizens, and Communities
for Obesity Control”
Discussion points
Background to this compilation of discussion points
Compounded factors like lifestyle changes and urbanization have led to the growing prevalence of obesity, chronic diseases,
and non-communicable diseases (NCDs) in developed and developing societies. For many years, this transformation has beencalled a “Silent Pandemic.” In Japan, a number of measures have been implemented to prevent obesity, a known factor for
many chronic diseases. Since 2008, all insurers have been obligated to conduct specific medical checkups and provide specifichealth guidance for obesity. In addition, health examinations called “metabolic checkups” have made the technical term
“metabolic syndrome” widely understood among the Japanese public. This has elevated public awareness toward the healthhazards of obesity and can be considered a symbolic paradigm shift in policy.
However, methods for approaching cases of obesity that require medical intervention are different from those for general
obesity, so various types of interventions including prevention should be discussed. In prevention and intervention for general
obesity, it is crucial for there to be a social environment that facilitates lifestyle habit management in terms of nutrition andphysical activity and that has fewer of the psychological stress factors that cause obesity. Correlations have also been
established among health and conditions like income and living environment, which are known as Social Determinants ofHealth (SDH). Society must avoid resorting to the concept of personal responsibility and cooperate to encourage better healthto prevent income and education disparities from becoming health disparities. Globally, there are various scientificapproaches to providing medical and pharmaceutical interventions for obesity and expectations are high for clinical guidelines
to be formulated or updated to meet the needs of Japan today.
In light of these circumstances, Health and Global Policy Institute (HGPI) launched the Obesity Control Promotion Project in
2022 with the objectives of heightening interest in general obesity and obesity requiring medical intervention throughout
society and building momentum for more effective, organic measures for obesity control. As our first initiative for this project,
we gathered an advisory board representing specialists in various fields who exchanged opinions and identified the discussion
points described below.
Discussion point 1: The definition of obesity that requires medical intervention must be broadly disseminated throughout
society, people living with obesity of the type that necessitates medical intervention must be identified, and ongoing
efforts to establish all types of relevant guidelines based on scientific evidence must continue.
There are differences between society’s conventional image of obesity and obesity that constitutes a health hazard, butsociety’s recognition of this fact is insufficient. As it is likely that progress will be made in pharmaceutical and surgicaltreatments for obesity in the future, the medical definition of obesity must be disseminated throughout Japanese society sothe people who truly need medical interventions can arrive at treatments that are appropriate for them. It is also desirable
that we continue ongoing efforts to establish guidelines and principles of all types and that are based on scientific evidence,starting with treatment guidelines that help people select appropriate treatment methods and make similar decisions.
Expectations are high for support from the Government and each stakeholder for this objective. These efforts to defineobesity and address it from a medical perspective will also be extremely important in the context of preventing excessive
caution toward weight among groups who do not require weight loss, such as women and young people. There is anincreasing number of people whose body mass index (BMI) is 30 or above, which is a level that is hazardous to one’s health,while the average BMI among women is decreasing. These are signs of what is known as the “Double Burden of Malnutrition,”
which is the coexistence of undernutrition (due to factors like unnecessary weight loss) and overweight or obesity. For young
women, insufficient nutrition can lead to increased future risk for conditions like infertility and osteoporosis, so this is a subject
that will require special attention when advancing policies.
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Discussion point 2: When treating cases of obesity that require medical intervention, in addition to involving physiciansand healthcare institutions specializing in obesity, it will also be necessary to promote multidisciplinary cooperation andcollaboration with family doctors and occupational physicians.
People with obesity of the type that demands medical intervention need their treatments to be led by medical specialists andto be based on various guidelines. Those treatments can be made more effective through multidisciplinary collaboration atmedical institutions that involves medical specialists, dietitians, nurses, physical therapists, clinical psychologists, and publichealth nurses. Before and after medical examinations are provided at specialized institutions, steps to collaborate with family
doctors and occupational physicians must also be taken. A system must be established that includes the steady
implementation of specific health guidance consultations, the utilization of Integrated Occupational Health Support Centers(“Sanpo” Centers), and the provision of collaborative support involving occupational physicians, family doctors, and publichealth centers to such patients. Expectations are high for policy support that facilitates cross-disciplinary collaboration among
healthcare providers throughout various phases. It will also be necessary to continuously provide family doctors andoccupational physicians with opportunities to undergo training on obesity.
Discussion point 3: The causative factors of obesity are diverse and complex. Rather than limiting ourselves to the conceptof personal responsibility and only viewing obesity as the result of overeating and physical inactivity, we must reaffirm theissues that create factors for obesity for the parties most affected and in society as a whole with a perspective thatencompasses the Social Determinants of Health.
The factors and underlying causes that can result in obesity are diverse. There are also cases in which the burdens of social
factors can lead to obesity among children. For example, there may be insufficient educational opportunities for people tolearn about nutrition and health in households or in society, which may lead to cases of childhood obesity. For obesity inadulthood, many cases are affected by factors related to mental health and the social environment, such as isolation, poverty,and stress. Among such cases, there are times when even repeated interventions, like nutritional guidance, do not result inimprovement because these underlying factors remain in place. There are also cases in which people living with mental
disorders develop severe obesity. The Government and related stakeholders must reaffirm the fact that obesity is caused byunderlying SDH and not a lack of personal responsibility among people with obesity.
Discussion point 4: Based on the diversity and complexity of the causative factors of obesity, collaboration with andinvolvement from broad stakeholders must be expanded so a greater variety of obesity interventions can be provided.
Given the diversity and complexity of the causative factors of obesity, medical intervention methods that are closer to theneeds of people living with obesity must be examined. In addition to pharmaceutical and surgical interventions, these include
utilizing cognitive-behavioral therapy or collaborating with specialists in psychiatry. There are a number of non-medical
interventions that are also effective for preventing and improving obesity, including what are known as “social prescriptions.”Collaboration with and involvement from diverse stakeholders outside of the health sector must be promoted and be basedon a systems approach perspective that aims to generate solutions while taking into account the environments surrounding
the parties most affected and their interactions. Good examples of such solutions are starting to emerge in Japan and abroad.
These include joint efforts to promote sports and physical activity through collaborative efforts among local governments,communities, social welfare councils, and key people in communities; introducing community development measures that
implement exercise as a natural part of daily life or that facilitate commuting by bicycle; introducing programs that aim toexpand nutrition education for children; and collaborating with integrated community support centers for parents. While
taking the characteristics of each community into account, steps should be taken to expand these good examples laterally
across Japan. Introducing good examples from overseas should also be given active consideration. There are also highexpectations for steps to establish evaluation indicators in economic systems. This may include systems to commend
companies that are proactive about promoting health and well-being or that are working to improve obesity.

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Discussion point 5: The prevalence of general obesity and obesity requiring medical intervention vary among countries andregions, so research in Japan must be enhanced and evidence- and data-based policies must be expanded.
Prospective cohort studies on the relationships between obesity and various health effects have been conducted in Japan andcomparisons have been conducted using both domestic data and data from prospective cohort studies in Asia, Europe, andthe U.S. They have found that general obesity and obesity requiring medical intervention are factors for a variety of diseases
and health effects regardless of race or region. We also know that obesity’s impact differs by underlying disease. For example,
the risk of type 2 diabetes rises with increasing BMI, and people whose BMI is 30 or above and 21 or below face increased
risks of cancer and cardiovascular disease. In terms of age demographics, it has also been found that obesity in younger
generations can significantly impact life expectancies. Another trend that has been observed is an increase in obesity-related
complications and mortality among people whose BMI is above 27. At the same time, detailed epidemiological analyses haveshown that there are also intervening differences by country, region, and race. Expectations are high for the introduction ofevidence- and data-based policies that take differences in country, region, and race into account. To that end, it will benecessary to expand research on general obesity and obesity requiring medical intervention in Japan.
Discussion point 6: Health promotion measures that affected parties consider harmonious must be promoted by building
health information networks and health data systems that encompass obesity control and the entire health system.
To promote efforts to treat and improve obesity as well as advance overall health promotion measures, it will be essential toestablish medical information networks and health data systems that take into account the perspectives of the parties mostaffected. If every citizen maintains a Personal Health Record (PHR) and shares data from specific health checkups or their
medical and examination histories with family doctors, occupational physicians, and specialized medical institutions asneeded, it will enable the provision of high-quality, efficient healthcare and health consultations to the parties most affected.
The Government and related stakeholders must recognize there is an urgent need to establish medical information networks
and health data systems to enable multi-disciplinary, multi-institutional collaboration in obesity control.
Acknowledgements
When compiling the discussion points described above, we conducted hearings with the experts who participated on ouradvisory board and are listed below. We would like to express our deepest gratitude for their input. Please note that therecommendations in this document were compiled by HGPI in its capacity as an independent health policy think tank basedon those hearings and should not be taken to represent the opinions of any advisory board member, related party, or anyorganization to which they are affiliated.
The Obesity Control Promotion Project Advisory Board (Titles omitted; in Japanese syllabary order)
Kyoko Ama
(Representative, Children and Healthcare Project)
Yuko Oguma(Associate Professor, Sports Medicine Research Center, Graduate School of Health Management, KeioUniversity)
Iwao Kurose(Executive Director, Japan Medical Association)
Naoki Kondo(Professor, Chairperson, Department of Social Epidemiology, Global Health Course, School of Public Health,Graduate School of Medicine and Faculty of Medicine, Kyoto University)
Ichiro Tatsuno(Chairman, Japanese Society for Treatment of Obesity; President, Chiba Prefectural University Of HealthSciences)
Shoichiro Tsugane (President, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Healthand Nutrition)
Koutaro Yokote (President, Japan Society for the Study of Obesity; Director General, Chiba University Hospital)
About Health and Global Policy Institute (HGPI)
Health and Global Policy Institute (HGPI) is a non-profit, independent, non-partisan health policy think tank established in

Health and Global Policy InstituteOtemachi Financial City Grand Cube 3F 1-9-2, Otemachi Chiyoda-ku, Tokyo 100-0004 JAPAN
Tel: +81-3-4243-7156 Fax: +81-3-4243-7378 E-mail: info@hgpi.org

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2004. In its capacity as a neutral think tank, HGPI involves stakeholders from wide-ranging fields of expertise to provide policy
options to the public to create citizen-focused healthcare policies. Looking to the future, HGPI produces novel ideas andvalues from a standpoint that offers a wide perspective. It aims to realize a healthy and fair society while holding fast to its
independence to avoid being bound to the specific interests of political parties and other organizations. HGPI looks forward tocontinuing our work with partners around the world to develop effective health policy solutions to resolve domestic andglobal issues. HGPI’s efforts have earned high global recognition. In the Global Go To Think Tank Index Report presented by
the Think Tanks and Civil Societies Program (TTCSP) of the Lauder Institute at the University of Pennsylvania, HGPI ranked
second in the “Domestic Health Policy Think Tanks” category and third in the “Global Health Policy Think Tanks” category (asof January 2021, the most recent data).

Health and Global Policy InstituteOtemachi Financial City Grand Cube 3F 1-9-2, Otemachi Chiyoda-ku, Tokyo 100-0004 JAPAN
Tel: +81-3-4243-7156 Fax: +81-3-4243-7378 E-mail: info@hgpi.org