Enabling Food Environment in Kindergartens and Schools in Iran for Promoting Healthy Diet: Is It on the Right Track?
2. Materials and Methods
2.1. Conceptual Framework
2.2. Scoping Review Methodology
2.2.1. Identifying the Research Question
- What are the policies/programs implemented to improve the food environment of schools and kindergartens in Iran?
- What is the purpose of each of these policies/programs?
- According to the conceptual framework of the study, which dimensions of the food environment are covered by each of these policies/programs?
- What are the strengths, weaknesses, advantages, and limitations of each policy?
- What were the outputs or effectiveness of these policies?
2.2.2. Identifying Relevant Studies
2.2.3. Study Selection
2.2.4. Charting the Data
2.2.5. Collating, Summarizing and Reporting Results
3.1. Feeding Program—Providing One Warm Meal in Rural Kindergartens
3.2. The Ban Law of Food Marketing and Advertising in Kindergartens and Schools
3.3. Healthy School Canteen Policy
3.4. National School Free Snack Program
3.5. School Milk Program
3.6. Health-Promoting School (HPS) Program
3.7. The IRAN-Ending Childhood Obesity (IRAN-ECHO) Program
3.8. Weight and Obesity Control of Students (Kouch)
Conflicts of Interest
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|Title of the Program/Rule||Food Environment Affected by the Policy||Setting||Target Group (Years Old)||Year of Implementation||Aims and Objectives||Key Actors||Results or Outcome Measures||Weaknesses of the Program/Intervention||References|
|Feeding program—providing one warm meal in rural kindergartens||Physical and economic||Kindergartens||Children in rural kindergartens (2–5)||2007||Provide part of the nutritional needs of children|
Increase children’s nutrition awareness
Improving healthy eating habits and behaviors in children
Monitoring the growth of children and determining anthropometric indicators
Enhance parents’ awareness about children’s nutrition and development
Persuade and encourage parents to send their children to kindergarten
Raising the awareness of kindergarten managers and coaches about children development and nutrition
|Ministry of Welfare and Social Security, MoHME and Welfare Organization||A quasi-experimental study in Birjand: 3% improvement in weight-for-height and 2% improvement in weight-for-age indices of children||Lack of coverage of many deprived areas|
Did not include a control group
Did not collect data on confounding factors such as food security, crowding index, household income
|The ban law of food marketing and advertising in kindergartens and schools||Communication||Kindergartens and Schools||All children (2–18)||1978||The ban on all marketing and advertising in kindergartens and schools||Ministry of Culture and Islamic Guidance and MoE|||
|Healthy school canteen policy||Physical||Schools||All students (7–18)||2014||Increase access to healthy snacks|
Prevent the supply of foods with low nutritional value
Provide a portion of required energy (300 kcal per day in snacks at school), protein, and necessary nutrients
|MoHME and MoE||In the Kerman study : low compliance of school canteens with HSC guidelines, with about half of food items in school canteens being unhealthy, e.g., chips, fried foods, and sugary drinks|
In the study in Tehran: More than 54% of available foods in 64 school canteens did not comply with the permitted food list of HSC guideline 
|Restricted fiscal resources of the schools and financial profitability of canteens||[25,39,40,41,42,43]|
|National School Free Snack Program||Physical and Economic||Schools||Students in deprived areas||Late 1990s||Improving the nutritional status of students||Welfare Organization/ MoHME/ MoE||Low nutrition value of distributed snacks|
Low variety of snacks
|School milk program||Physical and Economic||Schools||All students (4–18)||2001||Promoting milk consumption|
Improving health level in students
|MoE/ National Milk Committee/ MoHME/ Program and Budget Organization/ Ministry of Industry, Mine and Trade/ National Standardization Organization||A cross-sectional study in Yazd city on 703 students :|
37% of the students did not consume milk at all
No correlation between the knowledge and acceptance of milk
A correlation between the attitude and acceptance of milk
63% of students who had consumed milk noted benefits of milk for their health as the reason for its consumption.
64% of the students who had not consumed milk did not drink it for its bad taste.
|Shortage of funds|
Low quality distributed milk in some cases
Improper milk distribution schedule
Problems related to milk transportation and storage
|Health-promoting school program||Social, Communication and Physical||Schools||All students (7–18)/ school principals and staff/ parents||2011||Foster the healthy development of the whole school community|
Provide a framework for developing health promotion initiatives in a way that supports and enhances the implementation of the curriculum
Support the planning, implementation, and evaluation of health-related activities under the school development planning process
Enhance the links between schools and their communities
|MoE /MoHME||Urmia  and Babol  studies: A significant increase in scores of healthy physical environment and nutrition improvement after implementing the program in schools (p < 0.05).|
Karaj  and Tehran  studies: Not effective in improving students’ nutrition and food intake (p > 0.05).
The Kerman study : No significant difference between the frequency of consumption of healthy and unhealthy snack items and snacking behaviors in HPS and non-HPS schools (p > 0.05)
|Weak collaborations among responsible organizations|
lack of strong legal support
Insufficiency of funding
Ambiguity of rules about assessment and monitoring of students and school staff’s health
The scarcity of health training programs for students’ parents or school personnel
Shortage of human resources
Inconsistency between the findings of the studies
|The IRAN-Ending Childhood Obesity program||Social, Communication and Physical||Kindergartens and Schools||All children (2–18)||2016||Reduction in the incidence of childhood obesity and identification and treatment of preexisting obesity in children and adolescents||MoE /MoHME||The coverage of school-age children : Tehran (46%), Isfahan (57%) and Ardabil (52%)|
The results of after intervention in the pilot phase (7149 students aged 7–18 years who participated for six months in six cities) :
The frequency of desirable nutrition-related knowledge significantly increased (32.5% vs. 24.8%, p = 0.02)
The mean score of attitude regarding obesity complications significantly increased (73.09 vs. 74.78, p-value < 0.05)
The mean score of practice in relation to low consumption of unhealthy snacks significantly increased (46.39 vs. 48.02, p-value = 0.03)
|Weak intersectoral and intra-sectional cooperation|
Insufficient human resources and facilities
Low economic status of students
Shortage of health-care providers in schools
|Weight and obesity control in students (Kouch)||Social and Communication||Schools||All students (5–18)||2020||Screening obese and overweight students and determining the body mass index of all students in the country in two stages|
Advocacy and attracting collaboration of all stakeholders for better implementation of the plan
Changing students’ behavior and lifestyle to an active and healthy lifestyle
3% reduction in the number of obese and overweight students
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Omidvar, N.; Babashahi, M.; Abdollahi, Z.; Al-Jawaldeh, A. Enabling Food Environment in Kindergartens and Schools in Iran for Promoting Healthy Diet: Is It on the Right Track? Int. J. Environ. Res. Public Health 2021, 18, 4114. https://doi.org/10.3390/ijerph18084114
Omidvar N, Babashahi M, Abdollahi Z, Al-Jawaldeh A. Enabling Food Environment in Kindergartens and Schools in Iran for Promoting Healthy Diet: Is It on the Right Track? International Journal of Environmental Research and Public Health. 2021; 18(8):4114. https://doi.org/10.3390/ijerph18084114Chicago/Turabian Style
Omidvar, Nasrin, Mina Babashahi, Zahra Abdollahi, and Ayoub Al-Jawaldeh. 2021. "Enabling Food Environment in Kindergartens and Schools in Iran for Promoting Healthy Diet: Is It on the Right Track?" International Journal of Environmental Research and Public Health 18, no. 8: 4114. https://doi.org/10.3390/ijerph18084114