A prospective analysis of dietary policies in Iran: Applying the NOURISHING Framework to Identify Challenges and Policy Gaps

Abstract Background: Non-communicable diseases (NCDs) remain a major global challenge, imposing significant costs on health systems worldwide. In low and middle-income countries, where challenges like malnutrition and infectious diseases are prevalent, NCDs remain a severe problem requiring attention. The present study aimed to evaluate dietary policies and compare them with best practices in European countries to analyze Iran’s progress in NCD-related nutritional challenges. Methods We conducted a case study to identify dietary policies in Iran. We searched the National databases with relevant keywords. After that, for a deep understanding of nutritional policies, we identified a total of 31 individuals from different sectors of the food system. Finally, 27 of them accepted our request. We systematically transcribed and analyzed these semi-structured interviews using a mix of inductive-deductive approach within the NOURISHING framework and the Health Policy Triangle. Framework analysis was conducted for content analysis. Results Findings of analyzing documents and interviews revealed that dietary interventions in Iran, compared to the NOURISHING framework, are classified in 3 main policy processes, which are: · 30% of interventions in Iran have not been formulated. · 15% were formulated but not implemented. · 55% have been implemented. Challenges in policy implementation were analyzed across three main dimensions: policy process, policy content, and policy context, as well as four sub-dimensions: dietary behavior, food environment, and food system. Actions requiring improvement include: · Food Environment (12%): Measures like unhealthy food taxation, unhealthy food advertisements, food quality in retail outlets, and school canteen standards need revision. · Dietary Behavior (2%): Nutrition education in schools and community education requires modifications. · Food System (1%): Cross-sectoral collaboration within the food system in Iran is weak. Conclusion In this research, we found that Iran has made considerable efforts to mitigate NCDs. However, due to low attention to socio-economic factors in policy making, weaknesses in food system governance, environmental and educational dietary policies have not reached their expected efficiency. We recommend that food environment policies be developed in Iran.