6th International Symposium on Wellness, Healthy Lifestyle & Nutrition,
University Sains Malaysia
November 25 to 27, 2015

Japanese school lunch has prevented obesity
Shigeru Yamamoto, Ph.D., RD

Director, Asian Nutrition & Food Culture Research Center
Professor, Jumonji University Graduate School,
Honorary Professor, Hanoi Medical University
Professor Emeritus, Tokushima University,
Professor Emeritus, Ochanomizu University

Japanese
86:61
FemaleJapanese
80.21

Male

Life-expectancy for Japanese at birth is long; the mean for womenis 87 and for men 80 . It has been increasing and Japanese women
have the longest life-expectancy in the world and Japanese men are
one of the top groups.
図録主要先進国の平均寿命の推移 http://www2.ttcn.ne.jp/honkawa/1610.html

Japanese Ministry of Health,
Labor and Welfare

Japanese Cancer Research Center「主要死因別年齢調整死亡率年次推移」
Stroke (male)

Cancer
29.5%

MaleFemaleStroke (female)
Cancer (male)Heart disease (male)Heart
disease15.8%
Pneumonia
9.9%

Cancer (female)Heart disease (female)

Stroke10.3%

Leading causes of death in Japan (left) andAge-adjusted changes since 1950 (right)
Leading causes of death in Japan are cancer (30%), heart disease (16%) and stroke(10%). Death rate from stroke was the highest in Japan until 1980 but has dropped
dramatically. Cancer and heart disease have been increasing in total number: however,
the age-adjusted death rates for them have been quite constant, indicating the increase
was due to the increase in the elderly population.

USA

EnglandJapan

Secular changes in obesity in USA, England and Japan (BMI over 30)
Prevalence of obesity in the last 40 years has increased in USA from
15% to 33%, in England from 7% to 25%. In Japan it has also
increased from 2% to 3.4%, but the increase has been small.

Obesity ratio is decreasing in Japanese children
Boy

17 years
11 years
14 years
1977

Girl

1990

2000

2006

2010

5 years

11 years
17 years
14 years
5 years

1977
1990
2000
2006
2010
The prevalence of obesity in Japanese children has been decreasing in the last decade.
At present it is about 10% if we define obesity as over 120% of standard body/height.

Washington Post : January 28, 2013
How Japan’s revolutionary school lunches helped slow the rise of child obesity
By Max Fisher

http://www.washingtonp
ost.com/blogs/worldvie
ws/wp/2013/01/28…..But the world’s children are increasingly
overweight and obese, a problem with global
health and thus economic implications. A
National Institute of Healthstudy characterized the global rise in childobesity over the last three decades as an“epidemic.” According to the Centers for Disease
Control and Prevention, the prevalence ofchildhood obesity in the United States has
tripled over that period.
Japan hasn’t solved childhood obesity, but it
has achieved some of the developed world’s
greatest successes in keeping children healthy.
…………………………… Japanese school
lunches tend to be planned by a nutritionist,
include locally grown and fresh ingredients andtend to be dominated by rice, vegetables,
soups and fish. The Japanese program is both
impressively successful and surprisingly cheapat about $2 per meal.

Resumption of School Lunch• 1946 After theSecond World War,
the Ministries of
Education, Healthand Agriculture
recommended aschool lunch program.
It was supported by
LARA (Licensed
Agency for Relief inAsia)

Beginning of Full School Lunch
1950 Full school
lunch wasserved when
wheat flour
from the USA
was supplied.

School Meal Law was established in
1954
Government Appropriation for Reliefin Occupied Area Fund (GARIOA )was ended on June 30, 1951 by thePeace Treaty between Japan andUSA.

Due to the financial burden, many
schools could not continue school
lunch.
Teachers of schools and parents
demanded the establishment of
the School Meal Law.
People taking to the streets demanding
the establishment of the School Meal Law

Present Japanese school lunch

Influences of school lunch for industries• Most of Japanese children have school lunch.
• Basically there is a dietitian at each school.
• About half of them are now nutrition teachers.
• They make different menus almost every day.
• They try to use locally available foods (promotionof local industries)• They use only foods supplied by known foodproducers ( safe food supply).
• They try to use natural foods but not supplements
and nutrients.

Establishment of
NUTRITION TEACHERThe Central Education Council proposed
implementing a system of nutrition teachers in schools.

This law was adopted on May 14, 2005.
Under the proposed system, school dietitians become
the chief person responsible for nutrition education as
well as food management.

Basic Law on Shokuiku
It is a Japanese NEW BASIC LAW established in 2006 .
Shokuiku is defined as acquisition of knowledge about food andnutrition, as well as the ability to make appropriate food choices
through various experiences related to food, in order to develop
people’s ability to follow a healthy diet.
In addition, the law calls for promotion of SHOKUIKU for a richer
lifestyle based on life-long cultivation of a healthy mind in ahealthy body.
www.maff.go.jp/english_p/shokuiku.pdf

School lunch influences agriculture and other food industries.
Fresh local vegetables are used for school lunch. Farmers
harvest vegetables very early in the morning and bring themto school. Of course it is tasty and children are happy andsend massages of appreciation to food producers. Food
producers are encouraged and try to supply better products.
By these efforts, good relation is established between foodproducers and children.

Farmers are introduced in the “School Lunch Newsletter”

Strawberries from the Izumida
familyEggplants from Ms Aoki

Tomatoes from the Iitsuka
familyLeeks from Mr. Yasuo

Children make fertilizer from their waste of school lunch. The
fertilizer is given to the farmers free. Children see the growth andharvesting of foods.

http://www.city.kochi.kochi.jp/2005/kyushoku/index_1.html

Farmers use the fertilizer made by children.
Children: I don’t like potatoes, but I will eat this potato.

Sugar and obesity
Sugar rich beverages are abundant.

Sugar intakes in various countries
Country

Intake (g./day)

USA*1

124-142

UK *2

84

Holland *3

135South Africa *4

42－59

Vietnamese, Japanese andCambodians *5

25-30

Taiwan *550

Source：* 1
National Health and Nutrition Examination Survey 2005-2006*2
Family Food 2007
*3 Dutch National Food Consumption Survey-Young children2005/2006*4 The National Food Consumption Survey; children aged 1-9years1999*5 From our present study•Amazon.com Review•Marion Nestle, nutrition chair at New York University.
• The book argues that the food industry has intimidated and silenced critics ofthe food industry.
•Someone or some organization/group with power and money is able to gain
the support or at least the silence of potential critics by supporting their‘Research', which of course will have favorable results.
•Similarly, powerful industries may use donations to politicians to make surethat government regulatory agencies won't be too hard on a given industry. -Arthur Boehm

Sugars: Mono- and Di-saccharides
Mono- and Di-saccharides:

glucosefructosesucroselactosemaltose

Isomerized sugar ; made from starch thathas undergone enzymological procedures toconvert to glucose and continuously someof it is converted into fructose. It is also
called High Fructose Corn Syrup (HFCS).
Isomerized sugar is almost 1:1 ratio of
glucose and fructose in liquid form.
labaq.com/archives/51197015.html

22

Taste of fructose is sharp and sweetness is about
50% higher than sucrose in low temperature

S
w
e
e
t
n
e
s
s

fructosesucroseGlucose

Time

S
w
e
e
t
n
e
s
s
Temperature

Energy drinks in Vietnam
330mL about 260kcal
Glu
(g)

Fru
(g)

Suc
(g)

Lac
(g)

Mal Tổng số
(g)
(g)

30 33

1.7

0

0

260 kcal,21.5 sugar cubes

64.7

1bowl of rice 220kcal,
about l8 sugar cubes

Fructose, compared with sucrose 1;• Taste: Fructose is sweeter about 1.5 times when it iscold, however, less sweeter than sucrose at higher
temperature. Taste of glucose is sharp. We canfeel sweetness very quickly and disappear quickly
than sucrose.
• Appetite: Compared with consumption of highglucose beverages, drinking high-fructose beverages
with meals results in lower circulating insulin andleptin levels, and higher ghrelin levels after the meal.
Since leptin and insulin decrease appetite and ghrelin
increases appetite, some researchers suspect thateating large amounts of fructose increases thelikelihood of weight gain.

We have made a sugar composition table (mono- and di-saccharides) ofJapanese snacks and beverages.

Concentrations of sugars (sucrose, glucose, fructose and lactose)in 135 sugar rich foods and beverages
1. Yamamoto S, Taniguchi H, Sarukura N, Tseng AT, Wong UY, Takeichi H. 2009. Developmentof food composition database monosaccharide and disaccharides in sweet snacks andbeverages J Jpn Diet Assoc 52: 22-25(in Japanese)
2. Takeichi H, Wakaikawa N,Taniguchi H,Sarukura N, Tseng AT, Wong UY, Yamamoto S. 2010
Concentration of monosaccharide and disaccharides in commercial sweet snacks.
J JpnDiet Assoc 5：23-26 (in Japanese)
Concentrations of sugars (sucrose, glucose, fructose and lactose) in 135 sugar rich foods and beverages
No. Food
1 Soy milk
2 Soy and milk coffee
3 Carrot juice
4 10% Acerola juice
5 20% Japanese apricot juice
6 Mandarin orange juice from concentrate
7 50% Mandarin orange juice
8 Reconstituted orange juice
930% Orange juice

Glucose－0.06±0.02
3.16±1.15
2.09±1.52
1.43±1.09
1.94±0.07
2.89±0.70
2.24±0.09
3.82±2.70

Sucrose1.45±0.91
6.05±1.39
0.02±0.01－－
5.38±0.38
1.67±0.41
3.58±0.23
0.69±0.21

Fructose
LactoseTotal－
0.01±0.01 1.46
0.03±0.03－
6.14
3.39±0.92
－
6.57
3.82
1.73±1.21－
2.00±1.22－
3.43
2.19±0.12－9.51
3.80±0.82－
8.36
2.46±0.08－
8.28
5.20±0.21－
9.71

Nutrition Survey in Japanese Children-Food, energy and nutrient intakesAbout 1,000 school children aged 7, 10 and 13 y old
In areas throughout the country for a 3 non-consecutive day survey

Sites of survey

We studied the intakes of energy and nutrient intakes by a 3-day nutrition survey
in children and found that energy and lipid intakes were lower than the RDAs.

Sugar intakes from beverages and snacks

We studied the intakes by a 3 day nutrition survey in children and foundthat the total intake was only about 25g, which is much lower than that ofchildren in Western countries (about 100g).
[g/day]
Age

Years
7
10

13
Mean

gendern(A)sucrose(B)
glucose(C)
fructose(D)lactose(A)+(B)+(C)+(D)
total

boy

33 15.9 ± 9.4

3.1 ± 2.6 a b c 3.5 ± 3.3 a b c 2.5 ± 2.3

25.1 ± 14.6 a bgirl

42 17.7 ± 11.7

3.5 ± 3.0 a b c 3.8 ± 3.6 a b c 2.4 ± 1.6

27.4 ± 15.9 aboy

64 16.8 ± 9.8

3.2 ± 3.4 a b c 3.4 ± 3.7 a b c 2.2 ± 1.9

25.7 ± 14.2 a b

girl

64 16.6 ± 9.5

3.4 ± 2.4 a b c 3.6 ± 2.8 a b c 2.4 ± 1.9

26.0 ± 12.7 a bboy

42 14.6 ± 12.7

4.0 ± 4.2 b

4.4 ± 4.6 b

2.1 ± 3.1

25.0 ± 20.7 a bgirl

38 12.0 ± 11.2

2.0 ± 2.4 c

2.1 ± 2.7 c

1.4 ± 1.7

17.5 ± 14.3 b

15.8 ± 10.7

3.2 ± 3.1

3.5 ± 3.5

2.2 ± 2.1

24.7 ± 15.5

Values are mean ±SD.
Figures with different superscript alphabet in the same column are significantly different assessedby one-way ANOVA and then Tukey’s multiple comparison test
(p＜0.05).

Energy from sugar expressed percentage of totalenergy inake （%）

Relationship between sugar intake and18 body weightin Japanese children
16

Old WHO recommendtion<10% total energy (about 50g)

14
12
10
8

New WHO recommendation<5% total energy (about 25g)

6
42

y = -0.0386x + 6.2297
p=0.013
R² = 0.0302

0
-40

-20
0
20
40
60
Body weight/standard body weight %）80

Tapioca milk tea (bubble tea) was born in Taiwan.
It is two times sweeter than cola drinks.
Size is jumbo ( regular size is 700mL)
Tapioca milk tea

Cola

700ｍL

700ｍL

Energy550(kcal)

296(kcal)sugar cubes
（3g）

46

25
30

Taiwanese children take about 2 times moresugar than Japanese children
TaiwanJapan

Former President Bill Clinton backs school soft-drink ban –says sugar adds up to fat kids
Sugary soda has no place inschools, former President Bill
Clinton said Monday.
"We wanted to stop and thenreverse the epidemic of childhood
obesity, which I believe is the No.1
public health problem in the UnitedStates today,“

Sourcehttp://www.nydailynews.com/news/politics/
president-bill-clinton-backs-school-softdrink-ban-sugar-adds-fat-kids-article1.174157

Clinton said. As a result, thenation's 54 million students will
have access to low energy
beverages such as diet soda, lowcalorie fruit drinks and bottled
water instead.

Effect of Tapioca-milk ban
on sugar intake in Taiwan• Following the strategy of Clinton, we studied In
Taiwan whether tapioca-milk ban decreases sugar
intake.
• Subjects:
From 341
1. Sugary beverage more than 4 times/week
2. Sweet cake etc more than 2 times/week
3. Like Tapioca milk tea
4. Age（20－２４ years old）
5. Willing to join the study

Final number 40

Crossover-design study
Food intake was recorded every day
Group A20

1 weekGroup B
20

Tapioca milk tea available

No tapioca milk tea

Tapioca milk tea available

1

Washout
1 week

1 week
No tapioca milk tea

2
3
Measurements of Ht, Wt and body fat

4

Subjects were allowed to take foods freely except tapioca milktea
34

Sugar intake with and without tapioca milk tea
week of consuming Tapioca milk tea
week of not consuming Tapioca milk tea
120

100
80

66.2

52

68.8

63.2
56.1

49.3

58.5
56.2

58.9

65.7
55.9

50.9

53.7

49

58.4 56.5

60
40
20
0
Saturday

SundayMondayTuesday

Wednesday Thursday

FridayMean

 No effects were observed without tapioca milk.

 Maybe the sugar intake level has become habitual.
To reduce sugar intake, we have to find the time before it
becomes a habit.
35

Without proper school lunch, what happens tochildren? They get hungry and may eat cheap but
tasty food with sugar rich beverages.

Sugar-free beverage is a big business

Bottled green tea is popular in Japan (left). Many companies sell
it but all brands are sugar-free. Picture in center is the label ofgreen tea sold in Thailand. Sugar-free is written on it because mostof the tea sold is sugar-added. Sugar-free coffee is also popular inJapan.

Japanese children do not bring money to school• It is surprising for me, too, that Japanese
school children basically do not bring moneywith them to school.
• It means that they can not buy soda drinks orother beverages and foods.
• For this to work, there must be a proper school
lunch and proper breakfast at home.

Japanese have maintained their lipid intake
at about 55g/day for more than 40 years

20.3

From Japanese National Nutrition Survey

Lipid intake (g/person/day) and GDP per Capita in 162 countries (2000-2003).
The higher theLipid
income,the higher thein
fat162
intake.
However, Japan was
intake/capita
countries
exceptional. We do not know the reason.

Japan 55g/37,9700

Modern Economic Growth and Quality of Life: Cross Sectional and Time Series Evidence by Richard A.
Easterlin and Laura Angelescu, University of Southern California Discussion Paper No. 2755 April 2007

Lipid intake
13 years 男子
中学校2年生

135～

120～

110～

100～

90～

80～

70～

60～

50～

20～

120～

110～

100～

90～

80～

70～

60～

全国 66.1g

全国 70.9g

40～

66.1g

DRI;60~85g 70.9

30～

35
30
25
20
15
10
5
0

DRI;55～75g

50～

35
30
25
20
15
10
5
0

40～

全国 61.0g

10 years男子
小学校5年生30～

DRI;40～55g

30～
35～
40～
45～
50～
55～
60～
65～
70～
75～
80～
85～
90～
95～
100～
105～

35
30
25
20
15
10
5
0

7 years 男子
小学校2年生

20～（人数）（エネルギー摂取量）

小学校5年生 女子

135～

120～

This graphs show the distribution of lipid intake. Red
color square is DRI. Orange vertical line is the averageintake. Lipid intake was normal in 10 and 13 y children.

110～

100～

90～

80～

70～

60～

50～

120～

110～

100～

90～

80～

70～

60～

50～

40～

全国 61.5g

全国 54.5g

40～

61.5g

DRI;55～75g

30～

35
30
25
20
15
10
5
0

DRI;50～70g

30～

全国 53.2g

35
30
25
20
15
10
5
0

20～

DRI;35～45g

30～
35～
40～
45～
50～
55～
60～
65～
70～
75～
80～
85～
90～
95～
100～
105～

35
30
25
20
15
10
5
0

中学校2年生 女子

20～

小学校2年生 女子

Energy intake (kcal）（人数）

7 years 男子
boy
小学校2年生25

DRI;1650

20
15

Sruvey1765

13 years男子
中学校2年生小学校5年生男子
10 years25
20
15

Survey2096

DRI;2300

25
20
15

10

10

10

5

5

5

0

0

0

Survey2290

DRI;2650（エネルギー摂取量）

7 years 生girl
小学校2年
女子
25

25

DRI;1450201595

中学校2年生
13 years女子
小学校5年生女子

10 years
小学校5年生
女子
20

1822

25

DRI;2150

20

15

15

15

10

10

10

5

5

5

0

0

0

1765

This graphs show the distribution of energy intake in 7, 10 and 13 y old.
Vertical lines show DRI (red line) and mean intake (orange line).
Energy intake was lower than DRI in older children, especially girls.

DRI;2300

Protein intake (g)
小学校5年生 男子

DRI

135～

115～

105～

95～

85～

75～

55～

45～

65～

135～

115～

105～

95～

85～

75～

65～

135～

120～

110～

100～

0
90～

0

調査66.1g

DRI;55.0
g

55～

20
10

80～

35～

25～

135～

120～

110～

30

10
40～

0

DRI;50.0
g 20
70～

DRI;30.0g
1020

中学校2年生 女子

調査
68.4g

30

60～

調査 63.1g

30

小学校5年生 女子

45～

小学校2年生 女子

100～（エネルギー摂取量）

90～

0
80～

0
70～

10
50～

0

20

10

87.9g

DRI;60.0
g

30

35～

20

10

調査77.8g

DRI;50.0
g

30

60～

調査67.0g

50～

20DRI;35.0
g

40～

30

中学校2年生 男子

25～

小学校2年生 男子（人数）Protein intake was sufficient for most of the children.

SurveySmall portion foods are popular in Japan(source: Nikkei Women on Line)•Are large portions good? The portion size of foods also influences energy intake andbody weight. At stores, cooked side dishes are sold usually in small portions. This isgood in the present society, with an increased elderly population that tends to eat small
portions of food. Small portion size is also good for saving food and money.

Conclusion
Good school lunch may prevent consuming fast foods
with sweet beverages, and obesity.
This encourages new industries such as reliable foods,
no- or low-sugar beverages and snacks.
Small portion of foods may be good for saving foodand money and for preventing obesity in children andthe elderly in various countries.