A common narrative, as I have often observed on Twitter and Hacker News, is that East Asia ought to serve as a role model for mitigating obesity in the US. The apparent success of East Asian countries at having low rates of obesity is something that can be emulated in the US, or that their lifestyles and diets are superior, as the comment below demonstrates:
Articles praising the alleged salubrity of East Asian culture not uncommonly goes viral on Western media, whether it’s about claims of superior longevity (e.g. “Blue Zones” or “Okinawan diets”) or low rates of obesity. For example, in 2024 the Time Magazine article Japan: The land that doesn’t need Ozempic, by Johann Hari, saw effusive praise in the comments and endless cultural theories, voiced with unshakable confidence, of how Japan had conquered obesity:
The actual reason is that Mounjaro was not available in Japan due to shortages arising from huge demand….whoops:
Lilly last year had to limit shipments of Mounjaro in Japan, where it’s approved for treating diabetes, amid a supply crunch. The medicine was also approved for weight loss last year in the US under the brand name Zepbound. A steady ramp up of manufacturing capacity, with investments totaling $18 billion since 2020, is starting to ease the constraint, Simone Thomsen, the company’s Japan president told Bloomberg TV on Thursday.
Second, Ozempic in Japan is ONLY limited to diabetics or patients who meet other criteria considered much more stringent compared to in the US:
In line with the drug’s market authorization, the Japanese government issued a guideline to prevent inappropriate prescription of the drug,4 restricting the number of physicians who can prescribe the drug. In the background, the authorities are afraid of issues related to overuse, which have already been reported regarding out-of-pocket diet-purposed use where patients subscribe to semaglutide online outside of universal health coverage.5 Nonetheless, the guideline shows further concern for patient access to the drug.
Moreover, Japan saw huge off-label use of the compounds of these drugs for weight loss by non-diabetics, clearly in refutation of the narrative they don’t need or want it.
So much for the narrative that such countries have no demand for these drugs due to superior lifestyles, better diets, shaming, or walkability. The actual explanation is that the drugs were not easily or readily available, or restricted to diabetics–not that they didn’t need or want them. Obesity is becoming a big problem in Asia, especially China, and many of those people still want to lose weight anyway.
I guess that makes sense, or in invoking Occam’s Razor, is a more parsimonious explanation instead of having to invent an entire cultural narrative to account for Japan not using the drug. I too was duped by Johann Hari, which does not give me much confidence in any of his other work or Time Magazine for publishing this fake news. And as for those blue zones? Recent evidence has shown that apparent longevity may be due to pension fraud, not diet. Moreover, Japanese Americans have about the same life expectancy compared to native Japanese people. When controlling for demographics and income, first and second generation immigrants live as long as their native counterparts.
True, obesity rates are lower in Japan and Asian countries overall, objectively speaking. But this not that useful for trying to fix obesity ‘here’. It also overlooks key differences and other factors. And also, many similarities; for example, Americans are also pretty active too, yet still fat. Gyms are full of Americans trying to lose weight but often failing to do so. Same for the popularity of fitness apps and calorie-tracking apps. Also, trying to make obese people lose weight by being more active has mixed to no results, suggesting the problem has more to do with overeating instead of inactivity.
Genetically speaking, regarding important differences, African Americans and ‘heritage Whites’ (whites who can trace their lineage to early American history of Northern or Western-European stock) tend to be taller and more muscular, but at the cost of also being fatter, especially later in life. How many NFL or NBA equivalents does Korea or Japan have? For American football or basketball, you got to be big to excel at those sports, generally speaking. The ‘standard American diet’ (SAD) is like miracle grow, being that it’s calorie dense, nutritionally balanced, and highly palatable, which is perfect for turning kids into athletes but not so great later in life. Trying to make people who are genetically predisposed to being big adopt a culture that may work for people who are smaller, is not going to work as well.
As for Japanese and Korean diets being healthier, I am not really buying that either, unless you’re talking a strict plant-dominated agrarian, non-industrialized diet. Otherwise, the food tends to be savory, fried , and calorie-dense and quite palatable, as opposed to bitter like soups or broths. If the goal is to lose weight, it’s hard to do worse than Asian food, sorry to say (although it’s reasonable to assume ‘Westernized’ versions may have more calories compared to native food). There are many viral videos on YouTube of Korean or Japanese convenience stores, filled with the same sort of sugary, fatty, calorie-dense food as seen in the US:
The junk food is clearly still there, and evidently it sells or else why would stores stock it? If their culture is so much better why would these stores and food exist, as no one would buy the food? Why aren’t they eating just plants, canned fish, and bread, compared to rice cakes and other tasty desserts?
And as for supposed healthier lifestyles, smoking rates are very high in those countries, which although protective against weight gain, obviously comes with the risk of cancer. South Korea’s male smoking rates is 30% versus 12% for the US. Pickled or preserved food, although much less calorie-dense compared than the SAD, comes with a significantly elevated risk of deadly stomach or esophageal cancer later in life. Some may be surprised to learn that Japan has among the highest rates of stomach cancer in the world, thanks to this diet. There is always some tradeoff. This is why you have to always be skeptical of narratives. Do your own research.