September 2010 Issue

Lunch Lessons
By Sharon Palmer, RD
Today’s Dietitian
Vol. 12 No. 9 P. 36

A visit to a Japanese school teaches one RD about the healthful tenets of Shokuiku, the country’s food and nutrition education program: recognizing the traditional diet, serving wholesome dishes, and including a dietitian in the learning environment. Could such a program, she wonders, work in America?

This May, Today’s Dietitian was invited to participate in the Yakult International Nutrition and Health Conference in Japan to discover the latest research on probiotics, witness the importance of eating right from an early age, and more. As the magazine’s contributing editor, I attended the conference and in this article share my observations and thoughts on Japan’s national school lunch program upon visiting a Tokyo elementary school.

A Marvel-Worthy Menu Born of Nutrition Education
What’s a typical meal on the menu at Nishikasai Elementary School in Tokyo, Japan? Miso soup, rice with kelp furikake (a dry Japanese condiment), grilled salmon with miso, Japanese radish salad, citrus fruit, and milk.

As I sat down to lunch with one of the school’s classes one day during the conference, I couldn’t help but marvel over how unique the school lunch program is in Japan. The food before me, neatly arranged on cheerful ceramic plates, was much more than a tasty, attractive meal that looked like it was prepared in a restaurant. The school lunch is the product of a progressive program called Shokuiku (meaning “food and nutrition education”) that aims to promote mental and physical health throughout the life span. A key element of Shokuiku, the school lunches are carefully planned to meet government-established nutritional criteria.

And how about these criteria for a school lunch program made in dietitian heaven: The program features dishes and ingredients from the traditional Japanese diet, especially those that are threatened by “extinction” in modern society; encourages local food self-sufficiency by promoting environmentally friendly food production in communities; observes table manners and promotes the enjoyment of eating; includes foods that children tend to not get enough of at home (eg, seaweed, small fish); includes foods prepared on site and handmade daily from fresh ingredients; promotes a diet associated with preventing lifestyle diseases; allows for the lunch to be a “living learning resource,” as children learn to make the foods they will eat and help serve on “lunch duty”; and includes a nutrition teacher (an RD with teaching skills) to promote a healthful diet for the students, family, and community.

After learning about these components of the school lunch program—as well as the proper way to hold a chopstick!—and watching the students dining with me scrape their plates clean, I almost swooned.

In the Spirit of Tradition
Japan is a land of contrasts. It’s been called the most modern country on the planet, yet it’s steeped in tradition. On one hand, Japan seems to hurl headlong into the future, leaps and bounds ahead of many countries in automation, transportation, and electronics; on the other, it tenaciously preserves an intricate net of traditions that dates back centuries. Scientific evidence is beginning to demonstrate that some of these traditions may be at the core of the Japanese people’s curiously long life span, a rarity in industrialized nations.

According to Shaw Watanabe, MD, PhD, president of the Life Science Promotion Foundation in Japan, the average life expectancy in Japan is 80 years for men and 85 years for women, and the average healthy life expectancy is 75 and 80, respectively. No other country has experienced such a rapid extension of life span during the past 50 years. In 2008, there were 36,000 people aged 100 and older in Japan.

Japanese health experts credit the traditional Japanese diet as a big factor behind the population’s auspicious life expectancy. You might think that Japan has it easy because it hasn’t faced the same challenges of urbanization that Western nations such as the United States have endured—challenges that propelled populations into a tailspin of inactivity and excess calorie consumption due to the increased intake of fats, refined grains, and sugars that has resulted in an obesity and chronic disease epidemic. But think again: In the 1970s, rapid social and economic changes swept Japan, prompting a lack of exercise, the breakdown of the traditional family, overeating, and higher rates of lifestyle-related disease. But these changes didn’t go unnoticed by Japan’s health leaders.

Dietary Changes
In the past few decades, a number of gradual changes have popped up in the Japanese diet, threatening the population’s health and longevity. Naomi Aiba, PhD, nutritional education program director at the National Institute of Health and Nutrition in Japan, reviewed these changes during the conference.

“In the National Health and Human Nutrition Survey in Japan, we surveyed 20,000 subjects, and the data has been helpful for understanding lifestyle disease prevention,” said Aiba. “Currently, there are a variety of foods imported to Japan from all over the world, and health foods and supplements may not be adequately assessed. In the past, most families cooked and ate at home. Now many families go out to eat or eat fast food or cheap food. But many Japanese people are concerned about diet and health.”

Aiba reported other nutritional problems such as high sodium intake—average consumption is 4,400 mg per day—and inadequate intake of fruits and vegetables, although the average intake is almost 4.5 servings per day.

A Nutrition Fix
As health experts came to recognize that many of the country’s new lifestyle issues were related to moving away from a traditional healthful Japanese diet—a diet that had served the people well by fostering a high standard of health in the country—they began to formulate a plan to promote better eating among the public, called Shokuiku.

While the concept of Shokuiku dates to the 19th century, it had disappeared from the modern lexicon until recently. Resurrected in 2005 when the Shokuiku Basic Act came into effect, Shokuiku was targeted as a national movement to reinforce the traditional diet and healthful eating throughout one’s lifetime through educational elements such as food and nutrition education as well as intellectual, physical, and moral learning.

According to Aiba, the following policies were set forth to advance Shokuiku to the public:

• provide dietary education in the family;

• provide dietary education in schools and at nursery centers;

• advance improved eating habits in the community;

• develop the dietary education movement by celebrating a national Dietary Education Month in June and Dietary Education Day on June 19;

• promote exchanges between producers (agriculture, forestry, fisheries) and consumers and promote harmony by protecting the environment;

• support the practice of handing food culture down to future generations; and

• assess food safety, provide research and information about nutrition and eating habits, and promote international exchanges.

Shokuiku in the School Environment
With an ability to cast its positive effects on the public—from children to parents to the community—the school lunch program, by my observations, is a perfect medium for fostering the tenets of Shokuiku.

The law for Japan’s school lunch program changed in 2009 to add standards for promoting Shokuiku and to create the legal definition for a school nutrition teacher. This position is a new license that combines the qualifications of an RD and a teacher, with responsibilities to provide nutrition education through the school lunch program, foster desirable eating habits, and advocate for a healthy diet for families and the community. Following the creation of these standards, about 2,600 nutrition teachers were posted in Japanese schools by the end of 2009. More nutrition teachers are needed, and the government hopes to attract young people to become educated as nutrition teachers.

I discovered that schools are employing a number of creative ways to bring home nutrition lessons. Each school focuses Shokuiku on its own rich, local food cultures and traditions, whether the town is known for its sea urchins or freshwater clams. In Unnan, a city famous for its local farms and markets, the school lunch program promotes an “Eating Is Life” program, emphasizing the use of organic agriculture to show respect for vegetables and the environment. The children participate in activities such as visiting a rice paddy, making healthy bento boxes (Japanese boxed lunches) at home, visiting farmers’ markets, observing food and agricultural traditions with local elders, and assisting during harvest time. Other schools manage organic farms, create fertilizing factories from waste, and plant and collect seaweed.

Could It Work in the United States?
During the conference, Aiba asked to meet with me and another dietitian from the United States, hoping to learn more about the challenges for our school lunch program. She posed this question to us: “Could Shokuiku work in the U.S.?” My initial response was to throw up my hands and say, “What is a traditional diet in the U.S.? Doesn’t it all have to start there?”

If you live in Alabama, a traditional diet means something entirely different from that of Maine. And sadly, it seems like the traditional diet of America, which is being exported around the globe, has come to mean something quite negative lately—a diet filled with fast food, large portions of meat, giant sodas, and processed snack foods.

Aiba nodded in understanding to my comment, as America’s diet and health problems have been well publicized around the world. We filled her in on the problems the U.S. school lunch program has faced—from funding healthful foods to establishing standards that make sense.

But a seed of an idea started germinating in my head. Unlike the Japanese people, Americans don’t have a single traditional diet, but the United States is a young nation filled with people from diverse lands and cultures—something to be celebrated. And why sell ourselves short? We have beautiful regional food sources and traditions—from the berry farms in the Northwest and fresh produce of California to the seafood in New England and Creole food of Louisiana. Instead of narrowing it down to a “traditional” diet, why not customize a school lunch program that focuses on regional dishes and crops?

That’s where Shokuiku could step in. Handmade foods from fresh ingredients—and with a helping hand from students—that celebrate regional recipes and local foods could be prepared daily in school kitchens. A dietitian as nutrition teacher could work in every school. And why not include nutrition curriculum that includes creative, out-of-the-box learning, such as visits to local farms or starting a composting center in every school?

Sure, some U.S. schools have taken great strides. Consider the brilliant work that the Chez Panisse Foundation is doing by creating a school curriculum and school lunch program in which students grow, cook, and share food at the table. But what if similar programs were to become the standard for every school in America? Now I just got chills.

— Sharon Palmer, RD, is a contributing editor at Today’s Dietitian and freelance food and nutrition writer based in southern California.


A Portrait of the Traditional Japanese Diet
What’s so special about the traditional Japanese diet? During the Yakult International Nutrition and Health Conference in Japan, I learned about a few of its healthful components:

Small portions: Many foods are served in individual containers rather than on a Frisbee-sized dinner plate, and the portions are noticeably petite.

Lower fat and calorie load: Traditional Japanese foods don’t involve many heavy sauces or oils. The average calorie intake in Japan is 1,891 kcal per day.

Artistic eating: Japanese foods are delicate and beautifully presented, factors that can spike eating enjoyment.

Vegetables galore: The Japanese people celebrate vegetables of every shape, size, and color, including red and green peppers, green beans, zucchini, eggplant, onions, burdock, tomatoes, lettuce, carrots, spinach, bamboo shoots, beets, lotus root, turnips, daikon (giant white radishes), mushrooms, sweet potatoes, and seaweed. Vegetables are served at every meal—even for breakfast—and in a number of ways, such as steamed, simmered in broth, stir-fried, and pickled. It’s common to nibble on several different vegetables during any given meal.

Healthful spices: Japanese foods are never boring, thanks in part to culinary herbs and seasonings. In fact, a 2004 article in the scientific journal BioFactors found some spices and herbs, such as gennoshoko (Geranium nepalense var. thunbergii), yomogi (Artemisia vulgaris var. indica), senburi (Swertia japonica), iwa-tobacco (Conandron ramondioides), sarunokoshikake (Elfvingia applanata), kanzo (Glycyrrhiza uralensis Fisch), and matatabi (Actinidia polygama), to possess strong antioxidant activity.

Precious probiotics: The Japanese have been consuming probiotics in food products for 75 years.

Something fishy: A Japanese diet wouldn’t be complete without a focus on a variety of seafood, especially omega-3–rich fatty fish (eg, salmon, tuna, mackerel).

Fermented foods: Many fermented foods, such as miso, soy sauce, sake, and dried bonito, are staples in the diet, and experts are exploring the potential health benefits of such foods.

Soy good: A number of whole soy foods such as edamame, tofu, and miso are regular features of the diet.

Few processed snacks and sweets: While the Japanese enjoy dainty confections and rice crackers on special occasions, the diet isn’t known for rich, creamy cakes and bags of deep-fried potato chips, and there is an appreciation for fresh foods.

Healthful grains: While white rice is no doubt a staple—albeit in small portions—there is a resurgence of brown rice in Japan. And don’t forget whole grains such as soba noodles made from buckwheat.

Green tea: Whether served hot or cold, it’s the beverage of choice, and it’s sipped all day. Not only is green tea rich in polyphenols, but it also replaces high-calorie, high-sugar drinks.

— SP


A Snapshot of Japan’s Nutritional Challenges
Naomi Aiba, PhD, nutritional education program director at the National Institute of Health and Nutrition in Japan, reports that the country has faced many nutritional challenges recently, as follows:

• changes in eating habits, such as buying more cooked and convenience meals;

• a nutritional imbalance, including a higher amount of fat in the diet, with the average fat consumption doubling in the past 50 years;

• a dramatic increase in intake of animal proteins as the diet shifts from the traditional Japanese diet based on fish and soy foods to more beef, pork, and poultry;

• a higher rate of overweight in men and underweight in women (due to the pressure to be thin) and a gradual rise in obesity rates in boys and girls (Note: In Japan, obesity is defined as greater than or equal to a body mass index of 25.);

• less acknowledgement or gratitude for food, as fewer people know how their food is produced;

• less recognition of Japan’s food culture due to globalization and confusion about what the traditional Japanese diet is;

• irregular eating habits, such as skipping breakfast, as people lead busier lives;

• an increase in lifestyle-related diseases, especially among men, such as metabolic syndrome and diabetes, which are responsible for 60% of all deaths;

• a dependence on foreign food imports due to globalization of the food supply; and

• increased occurrences of food safety issues.

— SP