{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T21:27:18Z","timestamp":1782768438591,"version":"3.54.5"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Decreasing calories, salt, sugar and fat intake is considered the golden solution to reduce obesity and cardiovascular diseases (CVDs) related to unhealthy diet. This study aimed to investigate the health system induced barriers to a healthy diet in Iran.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>This is a qualitative health policy analysis. We collected data through 30 semi-structured, face-to-face interviews with purposefully identified experts, including policy-makers, top-level managers and related stakeholders. All interviews were transcribed verbatim, and analyzed with qualitative content analysis, facilitated by MAXQDA 11 software.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>We identified six categories of barriers: structural problems within the Ministry of Health and Medical Education (MoHME), i.e. Supreme Council of Health and Food Security (SCHFS); the MoHME\u2019s inadequate stewardship of public health, the short life of the deputy of social affairs within the MoHME and its possible impact on the National Health Assembly; inefficient traffic lights labelling for foods; lack of adequate policies and guidelines for monitoring restaurants and fast foods and insufficient incentive policies for the food industry.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>In line with the World Health Organization (WHO) Global Action Plan, in 2015, Iran defined its roadmap for prevention and control of NCDs, i.e. some nutritional interventions. However, different stakeholders including MoHME and other sectors need to provide series of interventions to change people\u2019s approach about food choice so that they might reduce the consumption of foods with excessive salt, fat and sugar.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0278280","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T18:36:22Z","timestamp":1674758182000},"page":"e0278280","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["The health system barriers to a healthy diet in Iran"],"prefix":"10.1371","volume":"18","author":[{"given":"Mohammad","family":"Amerzadeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7806-5558","authenticated-orcid":true,"given":"Amirhossein","family":"Takian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamed","family":"Pouraram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Akbari Sari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshin","family":"Ostovar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,1,26]]},"reference":[{"key":"pone.0278280.ref001","doi-asserted-by":"crossref","first-page":"753861","DOI":"10.3389\/fpubh.2022.753861","article-title":"Increased Mortality Trends in Patients With Chronic Non-communicable Diseases and Comorbid Hypertension in the United States, 2000\u20132019.","volume":"10","author":"F Ouyang","year":"2022","journal-title":"Front Public Health."},{"issue":"10258","key":"pone.0278280.ref002","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019.","volume":"396","author":"Vos","year":"2020","journal-title":"The Lancet"},{"key":"pone.0278280.ref003","article-title":"Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.","author":"G Danaei","year":"2014","journal-title":"Lancet Diabetes & Endocrinology."},{"issue":"6","key":"pone.0278280.ref004","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1038\/ejcn.2016.234","article-title":"The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review.","volume":"71","author":"L Hyseni","year":"2017","journal-title":"European journal of clinical nutrition"},{"issue":"9859","key":"pone.0278280.ref005","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","article-title":"Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990\u20132010: a systematic analysis for the Global Burden of Disease Study 2010.","volume":"380","author":"CJ Murray","year":"2012","journal-title":"The lancet"},{"key":"pone.0278280.ref006","volume-title":"Research AIfC. 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