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Worse becomes the worst: obesity inequality, its determinants and policy options in Iran

  • Toorang, Fatemeh1, 2, 3
  • Amiri, Parisa4
  • Djazayery, Abolghassem1
  • Pouraram, Hamed1
  • Takian, Amirhossein5, 6, 7
  • 1 Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran
  • 2 Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Science, Tehran
  • 3 Department of Medical and Surgical Sciences, University of Bologna, Bologna , (Italy)
  • 4 Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran
  • 5 Departments of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran
  • 6 Department Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran
  • 7 Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran
Published Article
Frontiers in Public Health
Frontiers Media SA
Publication Date
Feb 07, 2024
DOI: 10.3389/fpubh.2024.1225260
  • Public Health
  • Original Research


Background This tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities. Methods This study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran’s policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status framework to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study. Results Inequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary. Conclusion Obesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered.

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