The population in Japan has long been considered one of the healthiest in the world. The Japanese have the lowest obesity rates in the world, at only 3.6 percent (compared to 32 percent in the US). With diets rich in fresh foods like vegetables and oily fish, paired with appropriately compact serving portions, people in Japan consume about 25 percent fewer calories a day than those in the US. This, combined with the physically active Japanese lifestyle, has created a population of people naturally thin and fit in physique.
Despite all of these factors, health concerns have reached a nationally concerning level over the past several decades in Japan, with the number of people - young women, in particular - suffering from eating disorders such as anorexia nervosa and bulimia nervosa at a rate which has risen dramatically since the 1980s. While eating disorders are by no means unfamiliar concerns of modern healthcare in a country like the US, this is still unfamiliar territory in Japan.
Navigating in unfamiliar territory
Many doctors currently practicing in Japan grew up not even knowing what an eating disorder was. In an interview for The Japan Times, Dr. Hiroyuki Suematsu points out that food was a luxury when he was growing up, after the Pacific War, and purposefully overeating or undereating was unheard of.
Unlike the rest of the developed world’s population, which has gotten fatter since World War II, Japan’s population is actually getting skinnier. As in other countries, the most vulnerable demographic suffering from eating disorders is young women.
According to the Ministry of Health Labour and Welfare in Japan, a quarter of Japanese women in their twenties were underweight as of 2002. A government survey also found that at least 2 percent of female high school students were anorexic.
This dramatic rise in the prevalence of eating disorders in Japan is certainly cause for concern, but the underlying problem is that so few of the people suffering from eating disorders are receiving treatment. In 2014, only 10,000 people in Japan were getting treated for eating disorders, compared to 750,000 people in the UK, whose population is only about half that of Japan.
Social stigma and access to proper care
With so little public research and education on the matter, many young women in Japan don’t even recognize they have an eating disorder. More often than not, the eating disorder is hidden due to shame. While food in Japan is no longer a luxury for most people, the acts of binging as well as vomiting up food are considered extremely wasteful, and thus reason for women and girls to hide their behaviors from friends and family members. And without a family doctor referral system in Japan, even attempting to seek help on the matter can be difficult.
There are so few professionals specially trained in the field of eating disorders that the waiting list to see an official eating disorder specialist is up to seven years. Recognizing harmful behaviors is often up to the individual. Unfortunately, since treatment for eating disorders is primarily only available in Japan’s bigger cities, many patients’ conditions are so severe that by the time they seek help they are often close to death. Even those who recognize the problem early on must often wait months before they can get a consultation, which usually lasts all of 10 minutes.
Patients’ inability to seek out and receive treatment as soon as possible is an extremely important issue, according to Dr. Suematsu, who points out that the success rate for treatment is much higher when eating disorders are detected at an early stage.
A complicated solution
Although this potentially fatal health crisis is finally being acknowledged in the Japanese medical community, professionals who work with patients suffering from eating disorders claim enough progress simply is not being made to truly help the many young women in need.
The Japan Society for Eating Disorders has even put out the statement that the “health system is failing hundreds of thousands of sufferers.” And if the stigma of shame surrounding eating disorders persists, if healthcare professionals as well as laypeople are not properly educated, and if accessibility to basic medical care is not improved, the suffering is sure to only increase.