Benchmarking Public Sector Food Environment Policies in Iran: A Cross-Sectional Expert Assessment Study to Address Implementation Gaps

Abstract

Background and Aims

The escalating burden of obesity and non-communicable diseases (NCDs) in Iran presents a critical public health challenge, underscoring the need for evidence-based policies that foster healthier food environments. This study aimed to comprehensively evaluate national-level food environment policies and supporting infrastructure in Iran using the Healthy Food Environment Policy Index (Food-EPI), benchmarked against international best practices, and to identify priority policy actions to address key implementation gaps.

Methods

The Food-EPI tool was adapted and validated for the Iranian context through expert consultation, including content and face validity assessments. A systematic review of 89 government policy documents was conducted. Thirty-nine experts from academia, government, and civil society assessed the extent of implementation of 47 Food-EPI indicators across 13 domains, using a 5-point scale relative to international benchmarks. Qualitative content analysis of expert feedback was used to extract and synthesize proposed actions to strengthen the current policy landscape.

Results

No policy indicators achieved a “high” implementation rating. The majority of indicators were rated as “low” or “moderate” level of implementation, with the highest scores observed for food composition targets, front-of-pack labeling, and nutrient declarations. Key weaknesses were identified in food promotion, retail regulation, food trade, governance, and transparency. Infrastructure support performed better than policy implementation, particularly in areas such as obesity and NCD monitoring. Experts proposed 48 priority actions emphasizing strengthened regulatory enforcement, enhanced monitoring and intelligence systems, improved intersectoral coordination, sustainable funding mechanisms, and increased public awareness to create a healthier food environment.

Conclusion

This first Food-EPI assessment in Iran reveals substantial opportunities to improve both policy content and implementation to support healthier food environments. The results offer a strategic roadmap for Iranian policymakers to strengthen nutrition governance and reduce diet-related health inequities. Aligning national efforts with global best practices can accelerate progress toward the Sustainable Development Goals and improved population health outcomes.