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s physiques. Up until the present day, there have been significant changes in total energy intake. However, carbohydrate intakes have gradually decreased while the intakes of animal proteins and fats have rapidly increased. After the malnutrition problem was solved, nutritionists and dietitians faced the overwhelmingly negative public that they were no longer necessary. The Ministry of Health and Welfare discussed the possibility that the qualification system for dieticians should be changed from national qualification to private qualification. However, the Japan Dietetic Association obstructed this matter when it con- ducted a vigorous protest movement. Corresponding Author: Teiji Nakamura RD PhD, Professor of Kanagawa University of Human Services, President of Japan Dietetic Association, Japan Tel (+81)46-828-2507;

Fax(+81)46-828-2508 Email: [email protected] Manuscript received

9 September 2007. Accepted

3 December 2007.

350 T Nakamura .Issues involving western-style dietary habits have been brought to people'

s attention more and more since the 1980'

s because of overeating and the obesity epidemic. These are considered national health problems. In the 1990'

s, the prevention and treatment of lifestyle-related diseases such as diabetes, hyperlipidemia, hypertension and arteriosclerosis became a key objective for the nation. In 1994,

1998 and 2004, the rate of obesity has gradually been increasing. In 2004,

20 to 30% of people over

20 years of age had already become obese. In Japan, 23% of men and 8.9% of women over

20 are suspected of having Metabolic Syndrome. Also, 22.6% of men and 7.8% of women are in the preliminary stages of the syndrome. As a result, in

2000 the government settled on Healthy Japan

21 as the premier preventive policy of lifestyle- related diseases. Healthy Japan

21 is made up of

9 fields that are important in public health and medical set- tings (Table 1). The Healthy Japan

21 campaign began in 2000, and the objective values after

10 years were set. The govern- ment aimed to advance Healthy Japan

21 as a more realistic option in the prevention of lifestyle-related dis- eases. In 2005, another survey on the effectiveness of the campaign was conducted, but the results did not turn out as expected. The Ministry of Health, Labor and Welfare focused on the important items, and they made the Japa- nese Food Guide Spinning Top (ST) as a practical and easy way to improve eating habits. Dietitians are in the process of developing new nutritional standards by using this guide. CHANGES IN DIETITIANS'

ROLE The first dietitian started working in 1926. This was

55 years after the science of nutrition was introduced to Ja- pan in 1871. In 1937, they started working at public health centers for the prevention of tuberculosis under the auspices of the Public Health Center Law. In 1945, dieti- tians were expected to work throughout Japan, because of the food shortage after World War II. In 1999, the Ministry of Health and Welfare started the Advisory Committee for the Future State of Nutrition in the 21st century , which convened wide-ranging debates and discussions throughout the country for approximately one year. This report pointed out the necessity of shifting from food-based nutrition to human-based nutrition in studies for the prevention of lifestyle-related diseases, and to train dietitians to do their work based on this in their local communities and clinical fields. In 2000, the Dietitians Law was revised. Registered dietitians(管?蜒)are defined as the following: -Nutrition professionals holding a degree in nutrition science from an accredited university. -Providing nutrition management, including nutrition education and nutrition support to sick and wounded people. In 2002, new education and training programs were started. In 2006, newly registered dietitians started work- ing on nutrition practices. The new education and training programs are organized in Table