Nutrition in Japan from an International Perspective

Abstract

International Congress of Dietetics: ICD was born in 1950 in Amsterdam, and was held every four years during the Olympic year. International Congress of Nutrition (ICN) which is a congress on basic research in nutrition, and the ICD which is a congress on practical research in nutrition and dietetics. We holded the 15th ICD in Yokohama (photo). What I wanted to convey to the world most at this congress was Japan nutrition and contribution to the world. The traditional Japanese diet was not healthy diets but low in energy, protein, fat, vitamins and minerals, many Japanese people suffered from nutritional deficiencies. Japan succeeded in improving its nutrition and became a country of longevity because the government drew up an excellent nutrition policy, dietitians and nutritionists worked hard to educate it, and the people believed in it and put it into practice. Intergovernmental Tourism Organization (JETRO) presented us with the “International Congress Attraction and Hosting Contribution Award” for the best management of an international congress held in 2008.

By hosting the ICD in 2008, we learned that we should teach people in other countries how to solve the malnutrition and to have a health and long life. Particularly in develo** countries in Asia and Africa, where hunger and stunted growth of children due to low nutrition are still unresolved, some wealthy people are suffering from obesity and diabetes. We have contributed to the education and training of registered dietitian Hanoi Medical University in Vietnam.

8.1 “We Could Really Have an International Conference in Japan!”

The 15th International Congress of Dietetics (ICD 2008) was held at Pacifico Yokohama on September 8, 2008 (Heisei 20). The main theme of the Congress was “Collaboration and Cooperation among Dietitians around the World for the Health of Humankind”. 8028 people from 57 countries participated in the Congress, and the main hall of the National Convention Hall, the largest in Japan, was filled with participants. The flags of the participating countries were lined up on the stage, and the hall was filled with unusual excitement when solemn music and a video introducing the significance and history of the ICD were played. A welcome party was held in the Marine Lobby of the Main Hall from 18:00 on the previous day. The number of participants was much larger than expected and the venue was filled with a lively welcome party with Japanese drums, jazz music, and even dancing.

8.1.1 Opening of the ICD in Japan

At 8:30 on the day of the conference, the curtain finally opened on the ICD in Japan. The words “Opening” were projected on a giant screen, and the stage was lined with ICDA (International Confederation of Dietetic Association) directors and officials from the host country. Behind them were the flags of the participating countries, in front of which the 57 national representive were seated. Following the opening remarks by Motoko Sakamoto, ICDA Japan Representative Director, and Sandra Capra, ICDA President, I, as the Chair of the Organizing Committee of the host country, made a speech. In my address, I pointed out that there are problems of under-nutrition and over-nutrition in the world, and that in develo** countries, there are problems of under-nutrition caused by poverty and over-nutrition among the wealthy due to rapid economic growth, and that in developed countries, although there is an abundance of food, a new type of under-nutrition is becoming a serious problem among the injured and sick, the elderly, and young women. I mentioned that face-to-face international exchanges among nutritionists and dietitians from different countries are necessary to solve these problems. In fact, the emblem for the conference was designed by Makoto Wada, a world-renowned illustrator. The message was that although we live in an age of global advances in communication technology, what is important is for human beings to communicate with each other face to face (Photo 8.1).

Photo 8.1

Poster of the 15th ICD (ICD 2008)

The opening ceremony address took about six months to write and was ready a month before the Congress began.

8.1.2 Opening Declaration with Ad-Libs

However, as the event approached, I began to feel inadequate. Not even a week before, not even the day before, could I find the words to express my strong feelings about the stage I had been dreaming of for about 30 years. I wondered if this was the kind of situation where one’s thoughts and feelings exceed words.

On the morning of the opening ceremony, I made up my mind. I’ll just go up to the podium and say what comes naturally to me at that moment. I decided that the words could be in Japanese or English.

One by one, I ascended the steps to the platform of the grand stage, and suddenly I saw the gazes of the participants filling the convention hall, all focused on me. “What a beautiful view!” I thought. My immediate words were, “Everyone. Please take a look. We really had an international conference in Japan.” The audience erupted in applause, and the sound gradually spread until it became a din sound that filled the hall.

When I finished, many people said to me, “With that one word, I understood all your feelings (Photo 8.2).”

Photo 8.2

The opening ceremony

The Minister of Health, Labor and Welfare, the Governor of Kanagawa Prefecture, and the Mayor of Yokohama gave congratulatory speeches.

The Full Range of ICD 2008

In the exhibition hall, there were 52 booths of Japanese companies and organizations, 5 booths of overseas companies, the Nutrition Care Station of the Japan Dietetic Association, and booths of 47 prefectures. In one corner of the exhibition hall, a kitchen stage was set up where 6 companies and organizations from Japan and overseas performed 9 demonstrations for 2 h each. On the 7th, a “Nutrition Walk 2008” was held and a thousand people walked the streets of Yokohama wearing badges with the logo “ICD 2008 Yokohama”. An evening concert by the “Japan Philharmonic Orchestra” (at Yokohama Minato Mirai Hall) was held on the 8th, and a banquet was held (at the Pan Pacific Yokohama Bay Hotel Tokyu) on the 9th, and there were also fun events such as a tour of downtown Edo and Kamakura.

At the closing ceremony, Dr. Shigeru Yamamoto, Chair of the Executive Committee, expressed his gratitude to the participants, and Dr. Marsha Sharp, ICDA Canada Representative Director, explained the history of ICDA’s development, organization, mission, and future activities.

8.2 Determined to Attract International Conferences

The “ICD 2008 Yokohama” was a great success. However, the road to it had not been an easy one. This congress was born in 1950 in Amsterdam, the Netherlands, and is held every four years during the Olympic year, mainly for nutritionists and nutrition scientists who are engaged in practical activities in nutrition. International congresses on nutrition include the International Congress of Nutrition (ICN), which is a conference on basic research in nutrition, and the ICD, which is a conference on practical research in nutrition and on the state of the profession. The 5th conference in Washington was attended by John F. Kennedy, the 10th in Paris by the then Mayor of Paris, Jacques Chirac, and the 13th in Edinburgh received a message from Queen Elizabeth II. It was a great honor to be able to hold such a prestigious international conference on nutrition in our country, and there was a long and arduous road to attracting such a conference.

8.2.1 The Hard Road to Attraction

It was at the time of the ICD in Sao Paulo in 2004 that I made up my mind to invite this international conference to Japan and began to dream of its realization. After the ICD board meeting, I went to the hotel with the president of the Japan Dietetic Association, Mr. Morikawa.

He said “Mr. Nakamura, the Board of Directors recommends that the ICD be held in Japan in eight years.” There are many Japanese immigrants in Brazil and the overall atmosphere of the conference encouraged the decision to hold the conference in Japan, which was recommended by the then President of the Brazilian Dietetic Association.

“President Morikawa, if anyone should be the first in Asia to host the conference, it should be Japan. Let’s do it!” It was a good idea, so I recommended it.

However, former president Morikawa’s words were surprising.

“Unfortunately, the Japan Dietetic Association does not have the financial resources or language skills to hold an international conference.”

I never forgot the sad face of former president Morikawa after that. At this time I began to think about inviting this international conference to Japan.

After the conference, I went to Machu Picchu, a World Heritage Site. I went down the mountain and headed for the station, but the train was stopped by a squall of heavy rain. When we were waiting in the train, we looked outside and saw a girl standing on the gravel on the track, soaking wet, and trying to offer us flowers. The rain was so heavy that we could not open the window. She held the flowers above her head, barefoot, and refused to leave the spot. I indicated with my hand that I could not buy them and that she should go now, but the girl would not move.

8.2.2 The Decision to Attract

Former president Morikawa and his wife, who were sitting in front of me, said, “We, too, were poor after the war and struggled in the same way. If you work hard, things will get better someday,” he said over and over again. I just listened in silence. We were born Japanese and were able to escape from poverty due to economic development, but she was born in this poor village by not her own choice, and I felt that she was not responsible for this. This experience later became the starting point of my own passionate commitment to making an international contribution and the driving force behind my efforts to attract this international conference.

8.3 Red Roses on the Congress Bag

8.3.1 Defeated by the Philippines

Attracting ICD was not an easy task. The first official announcement of an invitation to Japan was made at the ICD General Assembly held in Paris in 1983. At that time, a rival unexpectedly appeared on the scene. It was Manila in the Philippines. At that, the Marcos regime had collapsed in the Philippines and the Aquino presidency was underway. She was the first female president, with outstanding international recognition and tenure, and was also interested in nutrition issues. The American Dietetic Association, which was the largest sponsor of the International Dietetic Association, also supported the Aquino administration. On the other hand, at that time, Japan was in the midst of high economic growth, “Japan is No. 1: Lessons for America” became a best seller, the Japanese economy was dominating the world, and Japanese people were walking around the world. We, too, believed that there was no way Japan could lose to the Philippines.

The result was that we lost by one vote.

I was not in charge of international affairs at the Japan Dietetic Association at the time, so I did not attend the delegate meeting where the election took place. According to what I heard from those who attended the meeting, our country brought many gifts and made a speech to introduce the development after the war, but the Philippine delegate said, “We have no money and cannot give you a lavish gift, but we sincerely welcome you.” After the conference, the executive committee of the ICD at the time advised me that if Japan really wanted to attract the conference, it should make more international contributions, and I became the first Japanese person to be elected as a director of the International Confederation of Dietetic Association.

After that, the Board meetings were held in many parts of the world, and I spent my life traveling abroad. The greatest thing about being on the International Board was that I made three friends who would go on to become key players in global nutrition. They were President Eileen Mackay from the UK, President Sandra Capra from Australia and President Marsha Sharp from Canada. Eileen went on to become President of The European Federation of the Associations of Dietitians, and Sandra and Marsha each became President of the ICDA. At that time, it is no exaggeration to say that the four of us, including myself, were deciding the direction of practical nutrition in the world, and the three of them called me “Teiji” affectionately.

8.3.2 Victory over Australia

In September 2000, the fateful moment arrived. The 13th ICD was held in Edinburgh, and at the delegates’ meeting, it was officially announced that the ICD 2008 would be held in Japan. The rival was Sydney, Australia, where Sandra was the president. The Sydney Olympics were being held that year in 2000, and the whole world was focused on Sydney, putting Japan at a definite disadvantage. In our presentation, we talked about Japan’s international contributions to date, the results of Japan’s efforts to improve nutrition, and the fact that Yokohama is an international city and the site of the World Cup soccer finals, a popular event in Europe. The elections would be held in three days, and the two countries would be battling to attract more candidates.

Australia was a member of the British Commonwealth, and if these countries united, Japan would not have stood a chance. Australia’s powerful president, Sandra, did a great job in gaining support; however, Japan was also keen to attract the attention of everyone attending the conference. We set up a booth in the style of a tea ceremony room, complete with red carpet, and handed out posters, pamphlets and other small items, as well as holding a green tea ceremony. Toward the end of the competition, Ms. Eileen, chairperson of the British, and Ms. Marsha, chairperson of the Canadian delegation, secretly whispered to me, “We will support you, Teiji” would be more idiomatic.

The next day, I attended the delegates’ meeting with a nervous feeling. As I was about to enter the hall, I saw an unbelievable sight. The representatives of the countries related to the British Commonwealth were wearing red roses on their congress bags. It is said that the representatives of these countries got together and decided to support Japan and promised to wear a rose on their bags on the day of the election as a sign of their support.

In the hall, President Sandra was sitting right in front of me in the front row. The election result was an overwhelming victory for our country. Without looking back at me, she put her hand behind her back and said, “Congratulations”. When I looked at her feet, I saw that she had champagne ready for herself. It seems that she had been confident. Confident that she would win and was planning to open the bottle on the spot to celebrate her victory. All the Japanese who attended the meeting in Edinburgh were delighted.

8.3.3 Busy Days of Preparation

There were eight years until Japan hosted the congress, but the difficulty of the preparations was beyond imagination. Each committee held many meetings over and over again. I was personally advised by a company that specializes in consulting for international conferences. It became clear to me that there was a lot of work to do in preparation. At the end of their presentation, I asked them, “What is the most important thing to make it successful?”

The answer was really quite simple.

“It’s about money. How much money you can raise that will determine whether we succeed or not.”

I, and the Japan Dietetic Association, had been hit with what we are most uncomfortable with. However, I understood that this was the most difficult thing to do, but that it was essential for success, and I was determined to become “money-hungry”. At every turn, I bowed to the people concerned and asked them to help the company. I said to the members, “This international congress will not be a success unless the members work together as one. As a sign of this, each member is asked to support us with 10 yen per month” at the general meeting, and this was approved. We thought that if we did not show that we were willing to give money, others would not support us. As a result, the number of sponsors exceeded our expectation, and “Yakult Honsha”, “A**omoto”, “Otsuka Pharmaceutical” and “Kagome” became the gold sponsors at 10 million yen each, which gave us an impetus to raise further funds.

8.4 Hitting the Wall Many Times

During the meeting, there were many times when we could not come to an agreement, the program was not finalized, the speaker was not decided, and many other problems came up. Furthermore, we faced a big personal problem.

8.4.1 Overcoming Life Threats

In 2003 (Heisei 15), I moved from St. Marinna University Hospital to my current position at Kanagawa University of Human Services. This university was established in Yokosuka City as part of Kanagawa Prefecture’s 21st Century Plan, with the aim of training human resources in healthcare and welfare to cope with an aging society. I participated in the preparations for the university two years before its opening date, and every day was like a storm, with abnormal days overlap** with the preparations for an international congress. In April 2003, the Kanagawa University of Human Services was opened with great success. However, after that, I fell ill and was hospitalized during the consecutive holidays in May. The initial diagnosis at the time of hospitalization was severe iron deficiency anemia, but without knowing the cause of the anemia, I was discharged from the hospital because my health had recovered for the time being. I repeatedly visited the outpatient clinic, but my condition did not improve, so I went to see a hematologist. On 12 March 2004, I was diagnosed with “malignant lymphoma”. I was told that I had cancer. I immediately asked the doctor.

“Sir, please let me live until 2008.”

There was no definite reply from the doctor.

I was then readmitted to the hospital and underwent radiation therapy. Since cancer informing patients of a cancer diagnosis was not yet common, I was told that I had an “intractable duodenal ulcer”. When the former president of the Japan Dietetic Association, Pro. Fujisawa, and the former chairman of the board of directors, Mr. Hanamura, came to visit me, I decided to let them know the truth, so I turned up my T-shirt and showed them my stomach where the radiation would be applied, I remember the shocked looks on their faces. Fortunately, it seemed to be a type of radiation therapy that was effective, and I managed to make it to the international congress, and I am still alive today.

In 2004, the 14th ICD, co-hosted by the United States and Canada, was held in Chicago. As this was the last conference before the ICD was held in Yokohama, I started to prepare to invite people to participate in the “ICD Yokohama 2008” and to make a speech as the next host country. At that time, former Prime Minister Junichiro Koizumi was immensely popular not only in Japan but also internationally. Thinking that this was impossible, I asked the government if a welcome message from the Prime Minister could be played on video at the congress in Chicago. To my surprise, the government agreed.

8.4.2 The Then Prime Minister Koizumi’s Quest for Perfection

On May 13, 2004, I went to the Prime Minister’s residence with a film crew. In a prepared room, Prime Minister Koizumi entered with five guards and an expert who checked the English text. I thought it would only take one or two takes, maybe 20 min, but the prime minister made many, many revisions until he was satisfied. Each revision required time for adjustment, and each time I was able to talk with the prime minister alone. We chatted about our hometown of Yokosuka. We managed to finish the filming, but the next day we found ourselves in a serious situation. The Prime Minister’s schedule after the filming had gone away, and it was reported newspapers “A Day in the Life of the Prime Minister” that some of his scheduled had been changed. I rushed to the Prime Minister’s Office to apologize.

At the ICD General Assembly in Chicago, a video message from Prime Minister Koizumi was played in the hall immediately after my address concerning the next opening of the conference. The venue was filled with loud applause, and I received words of praise from the Directors of ICDA, who said, “Well done, Teiji.”

Apart from such glamor on the surface, I also experienced a sad reality behind the scenes.

As the next host country of the conference, we were planning to have a lively display full of Japanese colors at the exhibition hall. Thinking that we would not be able to set it up it in time on the day of the conference, I went to the venue with the people in charge the day before, set up the display, and decorated it with excitement. The result was even better than we had expected, and everyone returned to the hotel satisfied.

8.4.3 Deep-Rooted Resentment

Early the next morning, I walked into the exhibition hall and was amazed.

The booth’s display had been shattered. The five staff members in charge of the booth were at a loss for words and fought back tears of frustration as they worked to correct the damage, and managed to restore the appearance of the booth just before the doors opened. Of course, we didn’t know who the culprit was, and we couldn’t bring ourselves to complain about it to the organizers, so none of us ever spoke about it to the outside world after that. I remembered that someone once told me, “Be careful because some Americans still think that Japan is an enemy country.” I then remembered an exhibit of posters that were put up during the Pacific War in a corner of the Smithsonian Institution in Washington. There was a poster that read “Never forget Pearl Harbor” in an uplifting message to crush the enemy, Japan. I learned once again that the scars of war remain not only in the time of those who were directly involved in the war, but also for generations to come.

War should never be fought, and people should get along well in the world.

8.5 Introduction of the History of Nutritional Improvement in Japan

In preparing for the ICD, there was something I wanted to share with the people of the world. It is the reason why the Japanese people have the longest life expectancy in the world. At the time, when I went abroad, there was a boom in Japanese food, and magazines and newspapers reported on it. Most of the articles were about the health benefits of traditional foods and dishes such as rice, sashimi, tempura, sushi, tofu, natto, and miso soup. I felt uncomfortable with such reports and thought that I had to let people in other countries know the real reason “why the Japanese people have the longest life expectancy in the world”.

At this international congress, I organized a symposium entitled “Health and Nutrition Policy of Japan-Why do Japanese live long?”

8.5.1 From a Short-Life Country to a Long-Life Country

As one of the speakers, I told the following story.

From a nutritional point of view, the traditional Japanese diet was low in energy, protein, fat, vitamins and minerals. Before the Westernization of the diet, many Japanese people suffered from nutritional deficiencies. The neonatal mortality rate was high, children’s growth and physique were poor, their resistance was low, and they suffered from many infectious diseases, which ultimately led to short lives. Under these circumstances, as nutrition officials and others actively worked to improve nutrition, the country was able to escape poverty through rapid economic growth, the food situation improved, and processed livestock foods from Europe and America were introduced, freeing the people from the state of low nutrition. As a result, infant mortality, infectious diseases, and even stroke mortality were reduced. In other words, I argued that Japan had created excellent Japanese food with balanced nutrition by its own efforts through a movement to improve nutrition as well as to escape from poverty through economic development (Table 8.1).

Table 8.1 Key points of nutrition improvement in Japan

After the symposium, an American nutritionist who was listening to the symposium said, “I could understand that Japan succeeded in improving its nutrition and became a country of longevity because the government drew up an excellent nutrition policy, dietitians and nutritionists worked hard to teach it, and the people believed in it and put it into practice. But this kind of thing is impossible in the United States,” she said.

“Why can’t you do it in America?”

“Americans turn to the left when Washington tells them to turn to the right, and registered dietitians (RDs) are professionals who work in clinical organizations and aren’t passionate about improving the nutrition of healthy people.”

The nutritional improvement in Japan has been achieved by mixing the traditional Japanese diet and its low-nutrient density with the nutrient-rich Western diet, and by providing nutritional guidance and education by dietitians in schools, hospitals, workplaces, and even in the community, which has put the brakes on the Westernization of the diet and created a moderate mix. I believe that this can be of great help to the countries of Asia and Africa, which are suffering from the “double burden of malnutrition”, a mixture of thinness and obesity caused by rapid economic development. In other words, the reason why the Japanese people today continue to maintain the world’s longest life expectancy is not that their traditional diet was inherently superior, but that through their own efforts they have created a new Japanese diet that is superior in terms of nutritional improvement.

For example, during the post-war period of food shortages, imported food was used for school lunches in order to give priority to children who had a future, and in local communities, nutritionists and dietary life improvement promoters who worked as volunteers drove “kitchen cars,” which were buses given to them by GHQ and converted from the back into kitchens. They traveled to every corner of Japan, teaching people how to cook and spreading the knowledge of nutrition including for tube feeding, nursing care food (p. 45, Photo 3.4). On the other hand, at a time when improvement of diet alone was insufficient, they developed and spread supplements such as vitamin A, B₁ or iron, and actively worked to improve the state of nutrition.

8.5.2 Improving Dietary Nutrition and Nutrition Policy and to Japan Nutrition

In all countries, the poor suffer from vitamin and mineral deficiencies, and vitamin A deficiency is particularly serious, causing many children to lose their eyesight. Our country solved night blindness and Beriberi by improving the diet and introducing the “fortified food system” at the same time. In the 1960s, post-war malnutrition was almost completely solved, and no other country has solved war-related malnutrition in such a short time and in such an equitable manner. The improvement of nutritional status resulted in healthy and excellent young people, who became excellent human resources for the rapid economic growth that followed and won many medals at the Olympics.

The excessive Westernization of the diet led to overeating, obesity and an increase in lifestyle-related diseases. As a preventive measure, the “Nutrition Improvement Act” was changed to the “Health Promotion Act”, “Health Japan 21” and the “Specific Health Examination and Specific Health Guidance” were promoted, and the “Basic Act on Nutrition Education” was established to provide nutrition education through both group and individual education, thus putting the brakes on excessive Westernization.

These Japanese initiatives are collectively referred to as “Japan Nutrition” and should be a model for the world.

8.6 Everyone Was Impressed

8.6.1 Closing Ceremony of ICD 2008

The final day of the “ICDA 2008 Yokohama” was a great success with all venues fully booked. At the closing ceremony, Pr. Shigeru Yamamoto, Chair of the Executive Committee, thanked the participants for their participation, and Ms. Marsha Sharp, ICDA Canada Representative Director, explained the history of ICDA’s development, organization, mission, and future activities. The ICD flag was handed to Sandra Capra to indicate that the next meeting would be held in Sydney in 2012.

Further remarks were made by Ron Moen, ICDA USA Representative Director, Carole Middleton, ICDA UK Representative Director, and Mary-Ann Sorensen, ICDA Denmark Representative Director, before I concluded with a final thank you to all those involved.

In fact, until 3 h before the closing ceremony, I was struggling to create a farewell text. I was working at my computer to write a text that would explain the significance of the theme of this conference, “Realization of a Peaceful and Healthy 21st Century from the Perspective of Diet and Nutrition,” and to express my gratitude for the cooperation of the participants and others involved. Then I began to type the last sentence on my computer keyboard, “Please never forget the four days we spent here in Yokohama in 2008, working earnestly to solve the world’s nutrition problems”. As I typed the last sentence on my computer keyboard, I felt a sense of relief and memories of the past 30 years began to appear like a magic lantern, tears welled up in my eyes and I could not type any more. I thought that I would cry on the podium, so I went to the restroom, let out all my tears, and tried to calm down.

But the effort was in vain.

8.6.2 Crying Out Loud

When I went up to the podium and gave the final phrase of my closing speech, I cried out loud in front of the public for the first time in my life. I had been taught from childhood that a man should not cry in front of others, so this was a complete surprise to me. However, at this time, I felt a strange pleasure. I was able to forget my shame and feel good. I decided that if I could feel this way, I would cry as hard as I could, no matter what people thought. While crying, I could clearly see the faces of the participants who were crying with me. Applause broke out, and the sound gradually became louder and louder, envelo** the hall.

As soon as I stepped off the stage, Dr. Hosoya said to me, “This is the most moving international congress I have ever attended”. I received warm words from many people. At the end, a video showing the scene during the congress was played, and the participants’ serious studious and smiling faces enjoying the event were shown on the screen one after another, closing the congress with a touching finale. I had spent almost half my life preparing for this congress, all the participants were impressed by the congress.

8.6.3 International Congress Attraction and Hosting Contribution Award

The day after the congress, I was waiting for the train at the platform as usual, and without thinking I started humming. I hadn’t hummed for many years. The song that came out was “Smile,” which was played when we all did gymnastics during the break in the opening ceremony. I was finally able to put down the really, really long and heavy load.

On December 9, 2009, the Japan Intergovernmental Tourism Organization (JETRO) presented us with the “International Congress Attraction and Hosting Contribution Award” for the best management of an international congress held in 2008 (Photo 8.3).

Photo 8.3

International Congress Attraction and Hosting Contribution Award Japan National Tourism Organization December 9, 2009

8.7 Contribution to Asia

I believe that our country is the most successful country in the world in improving nutrition. This is also the country that has shown that it is possible to build a long-lived country. By hosting the ICD in 2008, we learned that we should not just boast about it, but we should teach people in other countries how to do it and make it a goal for all people to have a long life. This is exactly what human nutrition aims to do.

8.7.1 Nutrition in Develo** Countries

Particularly in develo** countries in Asia and Africa, where hunger and stunted growth of children due to low nutrition are still unresolved, some wealthy people are suffering from obesity and diabetes. I was once told the following story by a representative from Africa at an international conference.

“Children are dying of malnutrition because they cannot eat. Even if they could, their learning ability would not improve and they would not be able to develop excellent human resources. If human resources are not nurtured, industries will not develop and people will not become rich. If we cannot become rich, we cannot buy food, and malnutrition cannot be solved. We can’t crawl out of this hell of a vicious circle.” Many of the country’s elites who complain of such misery are large, obese people.

Developed countries are providing economic aid, food aid, and agricultural technical assistance to Asian and African countries. However, it is difficult to solve the nutrition problem. Even if the economic and food problems are solved, economic development creates economic disparity in society, leaving hunger and malnutrition among the poor unresolved, and increasing obesity and non-communicable chronic diseases due to overnutrition among the wealthy, resulting in increased medical costs. In the process of national economic development, advances in food processing technology and the increase in imported foods have made high-calorie foods with high sugar and fat content available at low prices, and new forms of obesity are emerging among the poor.

As a matter of fact, there is a country whose economy had been exhausted by many wars and whose cities had been burnt to the ground by enemy bombing and had lost everything. That was our country, Japan.

Japan experienced the same severe poverty and food shortages as other countries in Asia and Africa. The conditions may have been even worse in Japan, which has no natural resources. However, in less than 20 years after the end of World War II, Japan solved the problem of low nutrition and achieved high economic growth through the efforts of its policy makers and people, and at one time, Japan was called “No. 1”. Although there are many factors that contributed to this miracle, there is one thing that can be said without a doubt as a characteristic of Japan. It is that only Japan tackled the problem of nutrition as a national policy in the process of transition from develo** to modern, and then becoming a stable and prosperous country. It created a law called the “Nutrition Improvement Act”, established a system to improve nutrition, trained a large number of nutritionists and dietitians to be responsible for it, and placed them as professionals in every part of society. In many develo** countries that suffer from malnutrition, there are no professional nutritionists, or if there are, their numbers are small, and specific nutrition policies are often not implemented. In other words, there is little concrete effort to improve the nutritional status of the people, which would guarantee the lives and health of the people who support the nation. In contrast, Japan has been able to produce many excellent human resources by improving the nutritional status of the people even before economic development started, and this has raised the labor productivity and provided a foundation of the nation’s development.

8.7.2 International Contribution to the Training of Registered Dietitians

Since the time I was working at St. Marianna University Hospital, I had been training dietitians from the Philippines, Indonesia, Thailand, Cambodia, and Africa as part of a project of the Japan International Medical Technology Foundation (JIMTEF). When I joined the faculty of Kanagawa University of Human Services, I was still thinking about how to make international contributions. In 2015 (Heisei 27), Professor Shigeru Yamamoto, a senior professor at Jumonji University consulted with me. There was a proposal to establish a training program for registered dietitians at Hanoi Medical University in Vietnam, and he asked if I would be interested in working with him. Due to the long and fierce war with the United States, the food situation in Vietnam was poor, and the country was suffering from energy protein deficiency, iron deficiency anemia, short stature, and vitamin deficiency. Hospital meal service was inadequate and clinical nutrition management was not being implemented. There were nutritionists who specialized in nutrition, but no dietitians.

As in other develo** countries, the food situation in Vietnam is improving due to economic growth, but the poor and rural areas are still under-nourished, while the rich and urban areas are over-nourished. The result was a “double burden of malnutrition”, with thinness, shortness of stature and anemias caused by under-nutrition, and obesity, diabetes and atherosclerosis caused by over-nutrition.

Hanoi Medical University, Vietnam National Institute of Nutrition, Kanagawa University of Human Services, Jumonji University, and the Japan Dietetic Association signed a five-partners agreement on the establishment of a dietitian program in Hanoi on March 23, 2013 (photo 8.4). A**omoto Co., Inc. opened an endowed chair at Hanoi Medical University and helped to create a base to prepare for the establishment of the new department, and the Japan Dietetic Association provided financial support because it was difficult to obtain public support at the preparation stage. In order to modernize hospital meal service, it was also necessary to develop food hygiene management, and Kao Corporation set up a scholarship scheme [maybe ‘program’] for international students to study at the graduate school of Kanagawa University of Human Services after graduating from Hanoi Medical University. The Kanagawa Prefectural Government supported training in Japan for teachers from Hanoi Medical University, and Japan International Cooperation Agency (JICA) helped us to prepare manuals on clinical nutrition and hospital meals, which are necessary when working in hospitals after graduation. The lectures at Hanoi Medical University were given by Japanese lecturers in English and translated into Vietnamese by Vietnamese teachers (Photo 8.5).

Photo 8.4

Five-partners agreement on training dietitians at Hanoi Medical University (2013)

Photo 8.5

Lecture at Hanoi Medical University

In this project, we supported the education and training of professionals in a develo** country through a so-called industry-government-academia collaboration, and we exported 100% of the Japanese method of education and training of dietitians to establish the profession of dietitian abroad. The curriculum and textbooks were translated, and about 30 teachers and other related personnel were dispatched to teach classes and provide practical training. Although the teachers felt stressed about writing the textbooks and teaching in English, they were so impressed by the enthusiasm, excellence, and thoughtfulness of the Vietnamese students that none of them complained. As I went through the classes, I felt less and less uncomfortable with the idea of teaching in English. At the end of the class, students said, “We want to give you a present to thank you, but we don’t have money to buy it,” and they all sang us a song instead. They gave me a pencil sketch of myself, which has become my treasure. No one slept or talked to one another in class, and the way they listened to the teacher’s words with shining eyes reminded me of the origins of education for young people who carry the nation on their shoulders. The Japanese teacher in charge was given the position of “visiting professor” by Hanoi Medical University.

After graduation, some of them go on to graduate schools in Vietnam or abroad, and some of them work in hospitals or government. There is no doubt that they will grow up to be leaders in public nutrition, hospital and clinical nutrition management, healthy eating and diet therapy, school meal programs, and nutrition research in Vietnam. I believe that the seed sown in Vietnam will definitely sprout and bloom in the same way that nutrition in Japan has done.

8.8 Economic Development Alone Will Not Solve the Nutrition Problem

From January 15–20, 2017 (Heisei 29), I went to Cambodia for an inspection tour and to lecture as part of the Nutrition Japan Public Platform (NJPP) organized by the Japan International Cooperation Agency (JICA). Here, as in other parts of Asia, the rapid economic growth had made the rich over-supplied in terms of food, but the poor were still suffering from malnutrition. In the special economic zone being promoted in the capital city of Phnom Penh, a Japanese company had moved in, and many young Cambodians were working in the factory there. Many of these workers were poor young men who had come from the countryside. Due to poor nutrition, they lacked physical strength and were often absent without notice. They were told by local doctors that they had iron deficiency anemia, but they had neither the awareness nor the knowledge to improve their diet. They need to eat a diet rich in iron, protein, vitamin B₂, vitamin B₁₂, folic acid, vitamin C, etc., which are effective in preventing anemia, but they had few opportunities to maintain an adequate diet.

I heard an interesting story from a local manager. When the company first entered Cambodia, workers complained that they collapsed at work because the local president did not pray to God. He immediately built a household shrine. When the collapsed employees were taken to the hospital, they were diagnosed with iron deficiency anemia, and the company felt the need to improve their diet and provided the workers with money for food. However, the young women and men sent the money back home, and their deficient diet did not improve. I suggested that the company create a food service system in the workplace that would provide nutritious meals, even if it cost the company some money. I explained to the person in charge that improving the diet would improve the health of the workers, which in turn would benefit the company by increasing the labor productivity of the workers.

In fact, the improvement of the nutrition of factory workers was an important issue in Japan during the Meiji and Taisho periods, and there was a field called “labor nutrition”. As a result, companies hired nutritionists, built cafeterias in their factories, improved the nutritional content of menus, and provided nutritional education to workers so that they could work effectively, and the costs were paid as part of the employees’ welfare benefits. In other words, the Japanese people created a social system that allowed them to continue to eat nutritionally balanced meals, both in school lunches when they were children and in the staff cafeterias at work. Industrial products made on the basis of such excellent human resources in Japan have come to be highly evaluated by the world as “made in Japan” with few defects.

We hear from experts and leaders in develo** countries that as their economies develop and the incomes of their people increase, their diets will become richer and their nutritional problems will be solved. In Phnom Penh, fashionable cafes and restaurants are increasing on the streets, and the content of meals is beginning to westernize. This phenomenon can be seen in any develo** country, and the problems of hunger and low nutrition to some extent can be solved. However, economic development without a proactive nutrition policy will only end up with the nutrition problem shifting from low-nutrition to over-nutrition due to the Westernization of the diet. When over-nutrition becomes a problem, the number of non-communicable chronic diseases, known as lifestyle-related diseases, increases, and medical and even nursing care costs increase, causing greater social problems. In addition, due to economic disparity and unbalanced health awareness and knowledge, there will be under-nutrition among young people and the elderly, resulting in a variety of nutritional problems. Therefore, even if the economy, industry and culture develop, malnutrition will never be solved naturally. We believe that it is impossible to make the people of a country healthy and happy unless a specific “nutrition policy” is established, based on the country’s unique food culture and food environment, and encompassing food policy, health policy, and economic policy. In other words, a comprehensive nutrition policy is necessary (Table 8.2).

Table 8.2 Suggestions for nutrition policy for develo** countries

8.8.1 Introduction in Nature

In 2016, we received an unbelievable interview. Nature International published an article about our activities and introduced us to the world (Photo 8.6).

Photo 8.6

“Introduction article in Nature international edition Document” Searching for a long, healthy life, Spotlight on Food Science in Japan. Nature 534, 12–13, 2016