Is there anything Sir Keir could learn from the Japanese? They certainly have a better diet. For one thing, it is easy to get hold of a wide range of fresh fish, whereas in UK supermarkets much of our fish is either frozen, breadcrumbed or gives off that tell-tale fishy smell that means it’s already going bad. Add to that tofu, fresh and pickled veg, miso soup and nattō — sticky fermented soybeans — and you have the basis of a very wholesome diet. What’s more, in Japanese cuisine there is an emphasis on high-quality ingredients, simply prepared, with comparatively little in the way of complex sauces liable to introduce large amounts of fat, sugar or salt into a meal. Japanese children learn about nutrition in depth at school, and lunches there are prepared with strict nutritional guidelines in mind. Youngsters are also taught to stop eating when they feel 80% full, on the basis that by that point they have eaten all they need and the brain just needs a little time to register the fact.

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Still, there is more to the story than diet and nutrition. Successive governments stretching back to the late 19th century have had a hand in crafting Japanese attitudes towards physical health — and not always out of straightforward concern for people’s wellbeing. Some of modern Japan’s earliest nutritionists worked for the armed forces, trying to build the bodies of their soldiers in the 1860s and 1870s. One of the reasons why Japan dropped its Buddhist prohibition on meat-eating — ushering in a first generation of “stew-restaurants” — was the hope that beef-eating in particular would help soldiers to heal faster from their injuries. Everyone from the Emperor downwards soon began eating beef for its promised health benefits.

Nineteenth-century doctors in Japan took a great interest, too, in the health of pregnant women. Healthy women and healthy babies were thought to be essential to the building of a robust workforce. Much was made of how workers in Western countries were often taller and stronger, placing Japan at a competitive disadvantage in everything from industry to future combat. In short, the thought emerged very early in the life of modern Japan that a person’s health is a public good.

This was part of a bigger picture in which the job of the state was not so much to fulfil the wishes of the population as to manage it according to what a small ruling elite regarded as being in the country’s best interests. Japan’s civil servants regarded themselves as “shepherds of the people”: they would research the sorts of Western social problems to which a modernising Japan was liable to fall victim, come up with solutions and then implement them with the help of doctors, midwives and school teachers. Compared to countries such as the UK, mass party politics and the idea of bottom-up political change never really took hold in pre-war Japan. People were taught that the state, as the expression of the Emperor’s will (in reality, the will of a tiny ruling clique), knew best. This idea survived into the postwar period, when after a brief flirtation with Left-wing politics an “iron triangle” of Right-leaning politicians, businesses and the civil service helped to manage the country’s remarkable economic recovery.

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The result of all this has been that people in Japan accept a degree of paternalism and official cajolery from their leaders that would feel culturally alien in the UK. Public trust is sometimes undermined, when politicians are revealed to be on the take or when the state response to disasters — notably the earthquake, tsunami and nuclear meltdown of March 2011 — is exposed as inadequate. But the Japanese state has proven resilient over the years, notably in responding to public disquiet about environmental pollution in the Sixties and Seventies by advising big businesses to salvage their reputations and protect themselves against legal action by agreeing to stringent environmental and health and safety legislation. This included workplace health checks like the ones that Labour are considering for the UK: these have been happening in Japan for more than 50 years.

The trend, over time, has been towards expanding the scope of these checks. What started, in 1972, as a basic physical exam alongside blood and urine tests steadily expanded to include tests for cholesterol and blood sugar levels and even electrocardiograms. Employers are under a legal obligation to follow up with their employees, meaning that your boss may insist on you taking measures to lose weight. For the past decade, psychological stress has been tested too, partly in response to high-profile lawsuits launched by families of workers who died from overwork, including by suicide.

It may be that in the UK, too, once people have accepted the idea of health checks in the workplace then the scope of those checks will steadily grow. Whether or not we will become comfortable with our employers taking a close interest in our health, however, remains to be seen. During the mindfulness boom of the 2010s, suspicions were raised that companies encouraging their employees to meditate might have their eye more on improving workers’ productivity than their wellbeing. Besides, in Japan it has long been accepted — if not necessarily welcomed by all — that employers and even complete strangers may comment on your physical health. It was part of a culture of corporate paternalism that saw employers regularly attending their employees’ weddings and even giving speeches at them. At the same time, what might be considered fat-shaming or plain old rudeness in the UK happens quite frequently in Japan: people report having comments made about their size in public, even receiving gentle prods in the stomach as someone marvels at their excess flesh.

Some say that we can’t tackle obesity, Japan-style, because we would first need to reimagine our society, accepting a deeper level of involvement by the state, our employers and even complete strangers in our physical health. But perhaps that puts things the wrong way around. It may be instead that by adopting measures of the kind that Labour is proposing, the idea takes root that physical health is a communal rather than just a personal good, not least because it eases pressure on the NHS. Obesity is less obviously harmful to others in the way that smoking and drink-driving are: two practices that were reversed in part by establishing them as socially taboo. But it is not impossible to imagine the case being successfully made.

Critics of Japanese conformity might say that this isn’t the sort of society we want to become; that “community” is all very nice until you bump up against ideas that you find unacceptable, but which other people seek to impose on you. And yet for those who think that post-Covid Britain is losing its sense of community and basic interpersonal trust, workplace health checks — conducted with compassion and with real interest in people’s lives and wellbeing — might, in time, become part of our road to recovery.

Despite the risk of public shame and the menace of non-reimbursable insurance cost ($1,349 a month for Wegovy and $1,060 a month for Zepbound), steep demand has sent the stock market valuations of Novo Nordisk and Eli Lilly through the stratosphere of the S&P 500. Not since the debut of Viagra has there been such hype in pharma, raising questions as to whether Eli Lilly and Novo Nordisk can produce enough of the magical elixir, as demand outstrips supply.

As competitors flood the field — most recently, Amgen’s MariTide, yet another semaglutide already in Phase 2 trials — Goldman Sachs analysts estimate that by 2030, the market for such drugs will be worth in excess of $100 billion. The lion’s share will be sold in America, where for hundreds of years the seemingly simple alternative — to eat or not to eat — has been a national obsession. Washington Irving, America’s first author whose fame crossed the Atlantic, invested a great deal of his literary capital describing the young republic’s utter lack of proportion when it came to food. His History of New York, published in 1809, asserted that the earliest political leadership of Manhattan was a Dutch “colony of huge feeders”, in which the burgomasters were “generally chosen by weight”. Their chieftains were “the best fed men in the community; feasting lustily on the fat things of the land, and gorging so heartily on oysters and turtles, that in process of time they acquire the activity of the one, the form, the waddle, and the green fat of the other”.

Today, Americans are no less obsessed with weight. Such disses of the Dutch were the Federalist equivalent of present-day body-image disputes over Ozempic, typified by the hysterical row last month over Barbra Streisand’s intervention as to whether or not Melissa McCarthy was shooting up with the serum.

Despite the morass of scientific explainers, confessional essays and philosophical think pieces, all this food freak-out should be filed under “old news”. Americans have been gaining weight for as long as they have been trying to lose it. Indeed, a few hundred miles north of the turtle-gorging Dutch of Manhattan, the Puritans of Massachusetts were gauging their status as chosen people through their gastrointestinal tract, as Samuel Sewall’s noted in a diary entry from 1690: “Mr Torrey is for a fast or at least a fast first. Mr Willard for a Thanksgiving first. Mr Torrey fears lest a Thanksgiving should tend to harden people in their carnal confidence.”

Thus did binge-eating, spiked with self-induced starvation, find its earliest footholds in the land of milk and honey. The great Puritan divine Cotton Mather outlined the toxic paradox when he asked: “Has not my soul as much amiss in it as my stomach?” Mather’s unflinching investigations of depraved digestions came to all-too recognisable conclusions.

In the case of apoplexy, vomits do a deal of good.
In the case of vertigo, vomit.
In the case of hiccups, vomit.
In the case of nightmares, vomit.
In the case of a coma, more vomits …

Bulimarexia, like religious freedom, was native to these shores.

After the colonial period came America’s great expansion, in which the republic’s rampant eating mania — and subsequent dyspepsia — expressed itself in extraordinary feats of consumption. In 1789, the renowned Methodist John Wesley noted cases of “Canine Appetite”, and American frontier literature teems with stories of thunder-swallowing backwoodsmen who devoured buffalo, alligators and rattlesnakes. Davy Crocket’s penchant for eating bears was only matched by his passion for killing the natives. Today, the same sort of digestive blood lust can be observed across social media, which features endless streams depicting the carnivorous habits of modern day meat-eaters and paleo dieters, even though it’s growing ever more clear that the Neanderthals mostly ate roots and leaves.

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Ozempic has opened the door to what every psychiatrist will recognise as the danger zone of behaviour: the return of the repressed. And what have we repressed? The fact that in the beginning, the boundaries of consumption had been smashed. The fact that, here, it was finally possible to eat anything. In 1609, Henry Hudson sat down with some upstate Wappingers for a solemn feast of fatted dog. A bit farther south, the Lenapes were kind enough to share their raccoon and lynx, which they gobbled raw. Food publicity filled the 19th-century press with outrageous accounts of primordial American foodstuffs: out in the sticks there were caribou and antelope, epic beets the size of cedar stumps and corn that grew so fast its percussion killed a hog. Markets in New York City, Cleveland and throughout Iowa offered black-bear steaks and panther chops as late as 1832, and bison, elk, reindeer and moose remained available far into the 19th century.

The story of westward expansion was a romance of superhuman ingestions and prodigious wastes. Davy Crockett’s threat to “eat any man opposed to Jackson” did not land him in jail for threatened manslaughter, but in Congress. And Crockett was not alone. Liver-Eating Johnson hunted down and consumed Crow Indians. Mark Twain’s Mississippi raftsman ate “a bushel of rattlesnakes and a dead body”. The recipe for cowboy sonofabitch stew included everything from beef brains to beef liver, tongue, heart and bones. America in its 19th-century imperialist prime was an insatiable power that viewed the entire continent, if not the world, as its manifest dinner.

Then the frontier closed. The physical limits of continental expansion had been reached, so the stomach, given no other recourse, became a transcendent object of adoration. “The stomach-sac”, the American poet Walt Whitman proclaimed, “food, drink, pulse, digestion…”

“O I say these are not the parts and poems of the Body only, but of the Soul,
O I say now these are the Soul!”

The end of the American stomach’s will to political power meant a number of other curtailments, too, most clearly articulated by the 19th-century American diet guru, Catherine Beecher, when she noted that “it is the opinion of most medical men, that intemperance in eating is one of the most fruitful of all causes of disease and death”. Followed by her profound observation that “it is possible to put much more into the stomach than can be digested. To guide and regulate in this matter, the sensation called hunger is provided.”

Indeed. A “sensation called hunger”.

Thus did American eating mania crash into a new derangement: the diet. At the height of America’s literary renaissance, when Emerson, Thoreau, Dickinson and Whitman were furiously scribbling curricular content for the next century’s American Literature courses, neither Walden nor Moby Dick could boast sales anywhere near Sylvester Graham’s edition of Discourses on a Sober and Temperate Life. “Few things are more deceptive to children or adults, than soft lazy dishes,” Graham declared. “This is a universal rule.”

In 1838, the famous vegetarian (and author of more than 100 books) Dr William Andrus Alcott railed against ginger, fennel, cardamom, nutmeg and coriander, declaring that molasses and sauces were indecent “drugs”. He worshipped “pure, plain, unperverted pudding”. And he inspired a terror of mince pie, which might actually consist of a dozen or so ingredients, and thus would “stupify our immortal souls”.

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Meanwhile, the founder of Seventh-Day Adventism, America’s “Prophetess of Health”, Ellen Harmon White, sought God through her plant-based diet. In her wake, America’s diet culture has continued the tradition of eating as a way to pursue both spiritual and capitalist perfection, from Joran Rubin’s recent The Maker’s Diet (that implores disciples to eat what Jesus ate) to the latest from Park Avenue’s “top diet doctor”, Jana Klauer: How the Rich Get Thin. Not to mention the long history of American cookbooks wooing audience by trumpeting themselves as quasi-spiritual tomes: The Sauce Bible, The Smoothies Bible, The Bread Bible, and The Pie and Pastry Bible. Linking sanctity and thinness had long been a fixture of the American psyche, most recently demonstrated by participants in a recent survey of 260 Latter Day Saint BYU students, who judged that “smaller-bodied females” were, as a rule, “more moral than larger-bodied females”.

The American desire to discipline the dysfunctional stomach would soon be subverted into another instantly recognisable tradition: the fad diet. The evangelist John Wesley advised those who suffered from scurvy to “live on turnips for a month”. Dr Alcott’s associate, Samuel Larned, decided to subsist for one year on nothing but crackers. The next year, he ate nothing but apples. America introduced the milk diet, the turtle diet, grapefruit, bone broth, the infamous cabbage soup diet of the Fifties and the Nineties classic 12-step eating recovery programme, “The Love-Powered Diet”.

But the American stomach would not be so easily deterred from its voracious rounds, typified by what would prove to be a pivotal year in the history of eating. In 1997, when George and Richard Shea founded the International Federation of Competitive Eating (since re-branded as Major League Eating), which over the past quarter century has sponsored hundreds of eating contests — featuring gorgers of everything from jalapeños to buffalo wings, oysters to doughnut, pancakes to sushi, bologna to straight mayonnaise — not to mention the greatest triumph of American consumption, the Nathan’s Famous Fourth of July International Hot Dog Eating Contest. The professional gurgitator would be the final incarnation of the digestive imperialists, the grotesque and stunted descendants of industrialists, frontiersmen, and founders.

The dream of consuming everything might have been disciplined to a 12-minute eating contest, but it would not die. As the dimensions of American ambition contracted from mountains and valleys to the virtual horizons of the smartphone, it was, perhaps, inevitable that the fate of American eating would at long last devolve into yet another triumph of technology, the unsexy and unsavory glucagon-type agonist — and thus where we find ourselves today, stuck between the glories of Ozempic and the horrors of Ozempic face.

Novo and Lilly and Amgen come at the end of a long line of American diet history, whose gurus might have been surprised to learn the side effects of not eating, as monthly doses of Nordisk peptides have been known to cause nausea, diarrhea, vomiting, flatulence, constipation, fatigue, not to mention an increased risk of vision changes, kidney problems, gall bladder disease, hypoglycemia and pancreatitis. Such are minor inconveniences in light of the true American dream: the nirvana of bodily perfection. A shot of pure poison is a small price to pay for a glimmering mirage of health and wealth on Facebook, even if the sagging, haggard, fat-starved face has now been joined by Ozempic butt and boobs.

Will there be no more July 4th hot dog eating contest? No more avocado shortages on Super Bowl Sunday? No more gastroporn on Reelz? Can we finally foresee the tragic death of the foodie? Will there be no more food fads, food taboos, food fetishes and paranoias regarding what would or would not pass the holy threshold of our lips? There is much to mourn.

And, perhaps, something to celebrate. Ozempic may toll the death knell for America’s age-old mania of stuffing everything into our imperial systems, a delusion that dates back to our famished origins, when out of the howling wilderness appeared the grim shadows of natives bearing the makings of the first Thanksgiving. The American identity, no longer confined by the twin poles of feast and famine, might seize the moment to define itself anew.