We developed the NOURISHING framework to highlight where governments need to take action to promote healthy diets and reduce overweight and obesity.
The framework is accompanied by a regularly updated database (last updated 24 October 2018), providing an extensive overview of implemented government policy actions from around the world.
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The evidence suggests people who want to eat well use nutrient lists to choose healthier options. Interpretative labels help them when they find the labels hard to understand. Nutrition labels also create incentives for food manufacturers to reformulate their products, so helping populations more broadly by increasing the availability of food of higher nutritional value.
Clear standards are also needed on the use of nutrient and health claims. Evidence shows these claims alter the perception people have of these products – making it essential that they do not mislead.
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In March 2015, the Iranian government introduced a new version of the Food and Beverages labelling regulation that introduced a front of pack traffic light label. It displays individual information on the fat, sugar, salt, trans fatty acids and energy content of the product to improve consumer understanding. Green indicates low or a little amount of the corresponding nutritional risk factor, yellow indicates a moderate amount and red shows a high amount, with thresholds set for each colour. For example, the thresholds for salt quantity are green - less than 0.3g of salt per 100g of food, yellow - between 0.3g and 1.5g of salt per 100g of food, and red - more than 1g of salt per 100g of food. The label is mandatory for all industrial foods which are manufactured in, or imported into, Iran. The label is not mandatory for traditional foods and outlet foods. This advanced labelling protocol was implemented step by step over a period of 18 months, extended for another 12 months, and is now fully implemented.
We know from the evidence that making fruit and vegetables available in schools increases consumption. There is also evidence that food standards to restrict availability have the effect of reducing consumption of the restricted food.
For these actions to be effective for all children, they need to be sustained over time and accompanied by complementary behaviour change communication techniques, such as "modelling", school gardens, and communication to all stakeholders involved in the provision and consumption of school food. Worksites and healthcare also present strong potential for improved eating among adults.
In 2008, the Iranian Ministry of Education and Ministry of Health developed the guideline for healthy diet and school buffets. In 2013, the nutrition part of the guideline was updated. The guideline contains a list of healthy and unhealthy food, established by an expert committee based on their content of sugar, salt, fat, and harmful additives. It also includes guidance on proper food preparation and catering as well as maintenance of the physical environment in which food is prepared (kitchen, storage).
There is clear evidence that the advertisements children see influence their food preferences and habits. There is also a lot of evidence that children and adolescents around the world are exposed to a whole host of other promotional techniques, whether on a billboard or through a phone or computer.
Emerging evidence shows that restrictions work to reduce children’s exposure to marketing, but this depends on the criteria used in the restrictions. Given the role played by parents and caregivers in what children eat, consideration is needed of how they are also influenced by promotional activities.
Broadcast advertising of soft drinks has been prohibited in Iran since 2004. In 2014, in the context of its Fifth Five-Year Development Plan (2011–2015), the Ministry of Health and Medical Education prepared a list of 24 food items to be prohibited from advertising in all media. The list has been sent to the Commerce, Industry and Finance ministries for approval.
We are all influenced by the food that is available and affordable when we grow up, and the habits of the people around us. That’s why people in different countries and communities consume differently. We know that when the food supply changes, so does what people eat. This is why we need to improve the quality of the food supply. Evidence from salt reduction indicates that people’s tastes can change.
As part of a national salt reduction strategy, the Iranian government has reduced the standard of salt content of select food groups, including snacks (from 2.5% to 1.5%); canned tomato paste (3% to 2%); potato chips (1.5 % to 1%) and bread (2.3% to 1.8%). Revising the standard for further food items is being discussed by a government committee.
In 2005, the Iranian government revised the national standards for corn oil, palm oil, frying oil and mixed liquid oils to reduce the permissible trans fat content to <10% (existing levels tended to be >20%). All government organisations were mandated to use standard oils with less than 10% trans fat content. In 2011, the oil industries were mandated to reduce the level to <5%. In 2013, the level was reduced to <2% with compliance required by 2016.
Awareness is one precursor to eating well. The evidence suggests that public campaigns can boost awareness. To influence consumption, they need to be sustained and use multiple channels.
Food-based dietary guidelines are an information and communication tool involving the translation of recommended nutrient intakes or population targets into recommendations of the balance of food that populations should be consuming for a healthy diet. They typically promote increased intake of fruit and vegetables and limited intake of salt/sodium and sugar. They may also include guidance on physical activity and healthy weight, and provide guidelines for different population groups. Countries use various formats of presenting the guidelines including cooking pots (Guatemala, Paraguay), pineapples (Fiji), pyramids (Australia, India, US), plates (Colombia, UK), pagodas (China), spinning top (Venezuela), traditional African house (Benin) and circles (Argentina). Some countries have started to include sustainability criteria in their dietary guidelines (eg Germany in 2013, Finland and Brazil in 2014, Sweden and Qatar in 2015, the Netherlands and UK in 2016). Brazil’s revised dietary guidelines, launched in 2014, present food- and meal-based recommendations that take into account cultural dimensions and promote the consumption of minimally processed food as well as health, wellbeing and sustainable food systems, and recommend avoiding ultra-processed food. Details on the content of national dietary guidelines can be found on the FAO database on Food-based dietary guidelines.