Obesity prevalence. Overweight/obesity by education. Overweight/obesity by age. Overweight/obesity by region

(1)

Report card

Iran

1 Contents Page Obesity prevalence 2 Overweight/obesity by education 4 Overweight/obesity by age 6 Overweight/obesity by region 7

Overweight/obesity by socio-economic group 9

Insufficient physical activity 11

Estimated per-capita fruit intake 14

Estimated per-capita processed meat intake 15

Estimated per-capita whole grains intake 16

Mental health - depression disorders 17

Mental health - anxiety disorders 18

Oesophageal cancer 19 Breast cancer 21 Colorectal cancer 22 Pancreatic cancer 24 Gallbladder cancer 26 Kidney cancer 28

Cancer of the uterus 30

Raised blood pressure 31

Raised cholesterol 34

Raised fasting blood glucose 37

(2)

Obesity prevalence

Adults, 2016

Adults Men Women

0 10 20 30 40 50 60 Obesity Overweight %

Survey type: Measured

Age: 18+

Sample size: 31050

Area covered: National

References: Djalalinia S, Saeedi Moghaddam S, Sheidaei A, Rezaei N, Naghibi Iravani SS, Modirian M, Zokaei H, Yoosefi M, Gohari K, Kousha A, Abdi Z, Naderimagham S, Soroush AR, Larijani B, Farzadfar F. Patterns of Obesity and Overweight in the Iranian Population: Findings of STEPs 2016. Front Endocrinol (Lausanne). 2020 Feb 26;11:42. doi: 10.3389/fendo.2020.00042. PMID: 32174887; PMCID: PMC7055062.

Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

(3)

Children, 2015

Children Boys Girls

0 5 10 15 20 25 Obesity Overweight %

Age: 10-12

Sample size: 2506

Area covered: Regional

References: Moradi G, Mostafavi F, Azadi N, Esmaeilnasab N, Ghaderi E.Socioeconomic Inequality in Childhood Obesity.J Res Health Sci. 2017 Aug 15;17(3):E1-6. Notes: Region: Sanandaj, Western Iran, Cut off: WHO 85th & 95th Centile NB. Combined child data estimated. These estimates were calculated by weighting male and female survey results. Weighting based on World Bank Population % total female 2019 (https://data.worldbank.org/indicator/SP.POP.TOTL.FE.ZS - accessed 21.10.20)'

Cutoffs: WHO

(4)

Overweight/obesity by education

Adults, 2016

Illiterate 1-6 yrs education 7-12 yrs education > 12yrs

0 10 20 30 40 50 60 Obesity Overweight %

Age: 19+

Sample size: 31050

(5)

Children, 2015

Uneducated Elementary Guidance High school Academic

0 5 10 15 20 25 30 35 40 45 Obesity Overweight %

Age: 10-12

Sample size: 2506

Area covered: Sub National - City of SANANDAJ

References: Moradi G, Mostafavi F, Azadi N, Esmaeilnasab N, Ghaderi E.Socioeconomic Inequality in Childhood Obesity.J Res Health Sci. 2017 Aug 15;17(3):E1-6. Notes: WHO Cut off 85th & 95th Centile Socioeconomic & Educational status based on self report questionnaire Estimated calculated by World Obesity, not age standardised

Cutoffs: WHO

(6)

Overweight/obesity by age

Adults, 2016

Age 19-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-69 Age 70+

0 10 20 30 40 50 60 70 Obesity Overweight %

Sample size: 31050

(7)

Overweight/obesity by region

Adults, 2016

Rural Urban 0 10 20 30 40 50 60 Obesity Overweight %

Age: 19+

Sample size: 31050

(8)

Children, 2012-2013

City Rural 0 5 10 15 20 Obesity Overweight %

Age: 6-12

Sample size: 2195

Area covered: Regional - Semnan Province

References: Batool Karimi; Raheb Ghorbani. Overweight and Obesity in the Iranian Schoolchildren. Middle East Journal of Rehabilitation and Health 01/2015; 2(1). DOI: 10.17795/mejrh-24433 Notes: Overweight is defined as a BMI ≥ 85th percentile and lower than the 95th percentile for children of the same age and sex. Obesity is defined as a BMI ≥ 95th percentile for children of the same age and sex.

Cutoffs: Other

(9)

Overweight/obesity by socio-economic group

Adults, 2016

Poorest 2nd 3rd 4th Richest 0 10 20 30 40 50 60 70 Obesity Overweight %

Age: 19+

Sample size: 31050

(10)

Children, 2015

1 (poorest) 2nd 3rd 4th 5 (wealthiest) 0 10 20 30 40 50 60 Obesity Overweight %

Age: 10-12

Sample size: 2506

Area covered: Regional

References: Moradi G, Mostafavi F, Azadi N, Esmaeilnasab N, Ghaderi E.Socioeconomic Inequality in Childhood Obesity.J Res Health Sci. 2017 Aug 15;17(3):E1-6. Notes: Sub National - City of SANANDAJ WHO Cut off 85th & 95th Centile Socioeconomic & Educational status based on self report questionnaire Estimated calculated by World Obesity, not age standardised

Cutoffs: WHO

(11)

Insufficient physical activity

Adults, 2016

Jordan Morocco Tunisia Egypt Oman Iran Pakistan Lebanon Libya Qatar UAE Iraq Saudi Arabia Kuwait

0 10 20 30 40 50 60 70

% insufficient physical activity

References: Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

(12)

Men, 2016

Jordan Morocco Iran Egypt Pakistan Tunisia Oman Libya Qatar UAE Iraq Lebanon Saudi ArabiaKuwait

0 10 20 30 40 50 60

(13)

Women, 2016

Jordan Morocco Lebanon Tunisia Egypt Oman Libya Pakistan Iran Qatar UAE Iraq Saudi Arabia Kuwait

0 10 20 30 40 50 60 70

(14)

Estimated per-capita fruit intake

Adults, 2017

DjiboutiSomaliaAfghanistanPakistanIraq Yemen South SudanSudan PalestineSyria Jordan Libya KuwaitSaudi ArabiaTunisiaUAE LebanonEgypt MoroccoBahrainIran Qatar Oman

0 50 100 150 200 250 g/day

Age: 25+

References: Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/

Definitions: Estimated per-capita fruit intake (g/day)

(15)

Estimated per-capita processed meat intake

Adults, 2017

AfghanistanYemen SomaliaPalestineSudan Syria Jordan Libya TunisiaMoroccoIraq LebanonIran South SudanSaudi ArabiaDjiboutiEgypt PakistanOman BahrainUAE KuwaitQatar

0 0.5 1 1.5 2 2.5 g/day

Age: 25+

Definitions: Estimated per-capita processed meat intake (g per day)

(16)

Estimated per-capita whole grains intake

Adults, 2017

MoroccoLebanonAfghanistanIran YemenJordan PakistanSudan Syria TunisiaLibya PalestineBahrainIraq Qatar UAE DjiboutiSaudi ArabiaKuwaitSomaliaOman Egypt South Sudan

0 5 10 15 20 25 30 35 g/day

Age: 25+

Definitions: Estimated per-capita whole grains intake (g/day)

(17)

Mental health - depression disorders

Adults, 2015

AfghanistanEgypt Sudan Yemen Iraq Syria Jordan SomaliaPakistanSouth SudanLibya MoroccoSaudi ArabiaLebanonOman BahrainIran Tunisia Kuwait DjiboutiQatar UAE

0 1 2 3 4 5 % of population

References: Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Definitions: % of population with depression disorders

(18)

Mental health - anxiety disorders

Adults, 2015

SomaliaSouth SudanDjiboutiPakistanAfghanistanOman Sudan UAE Yemen Egypt Qatar BahrainJordan Saudi ArabiaSyria Iraq Libya MoroccoIran Kuwait Tunisia Lebanon

0 1 2 3 4 5 % of population

References: Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Definitions: % of population with anxiety disorders

(19)

Oesophageal cancer

Men, 2018

LebanonPalestineIraq Oman Syria TunisiaJordan BahrainQatar Saudi ArabiaLibya MoroccoUAE Egypt KuwaitDjiboutiSudan YemenPakistanIran SomaliaSouth SudanAfghanistan

0 2 4 6 8 10 12 14 16 Incidence per 100,000 Age: 20+

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

(20)

Women, 2018

Libya PalestineLebanonSyria TunisiaIraq Jordan MoroccoEgypt Saudi ArabiaBahrainUAE KuwaitOman Qatar DjiboutiPakistanSudan Iran South SudanYemenAfghanistanSomalia

0 2 4 6 8 10 12 Incidence per 100,000 Age: 20+

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

(21)

Breast cancer

Women, 2018

Libya YemenSaudi ArabiaAfghanistanIran TunisiaSouth SudanOman Iraq Sudan DjiboutiSomaliaQatar PakistanBahrainMoroccoEgypt UAE KuwaitPalestineJordan Syria Lebanon

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, breast, females, ages 20+. ASR (World) per 100,000

(22)

Colorectal cancer

Men, 2018

PakistanAfghanistanDjiboutiSudan Egypt Iraq South SudanSomaliaYemenOman MoroccoKuwaitLibya TunisiaQatar BahrainSyria Iran UAE Jordan Saudi ArabiaLebanonPalestine

0 5 10 15 20 25 30 35 Incidence per 100,000 Age: 20+

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

(23)

Women, 2018

AfghanistanPakistanSudan Iraq DjiboutiEgypt South SudanSomaliaYemenOman MoroccoSaudi ArabiaTunisiaIran BahrainLibya UAE Qatar KuwaitSyria PalestineJordan Lebanon

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

(24)

Pancreatic cancer

Men, 2018

DjiboutiSudan PakistanSomaliaAfghanistanQatar South SudanUAE Yemen Saudi ArabiaMoroccoIraq TunisiaKuwaitIran Oman BahrainSyria PalestineLebanonEgypt Jordan Libya

0 1 2 3 4 5 6 7 8 9 Incidence per 100,000 Age: 20+

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

(25)

Women, 2018

PakistanDjiboutiAfghanistanSudan Saudi ArabiaSomaliaMoroccoTunisiaSouth SudanIraq Yemen Oman Jordan Syria Iran Egypt LebanonBahrainPalestineLibya Qatar Kuwait UAE

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

(26)

Gallbladder cancer

Men, 2018

DjiboutiYemen Sudan South SudanSomaliaAfghanistanMoroccoIraq Egypt Iran BahrainSaudi ArabiaPakistanLebanonLibya Syria Kuwait TunisiaPalestineQatar Jordan Oman UAE

0 1 2 3 4 5 Incidence per 100,000 Age: 20+

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

(27)

Women, 2018

Yemen DjiboutiEgypt Iran Oman South SudanSudan Saudi ArabiaSomaliaBahrainMoroccoAfghanistanIraq Kuwait PalestineLebanonSyria TunisiaJordan Qatar PakistanLibya UAE

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

(28)

Kidney cancer

Men, 2018

YemenSouth SudanDjiboutiSomaliaSudan PakistanAfghanistanMoroccoBahrainOman Qatar TunisiaIraq KuwaitEgypt Iran Saudi ArabiaUAE Jordan Syria Libya PalestineLebanon

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

(29)

Women, 2018

Yemen South SudanBahrainMoroccoSudan PakistanAfghanistanSomaliaDjiboutiEgypt Iraq Oman Kuwait TunisiaLibya Iran Syria Saudi ArabiaJordan LebanonPalestineQatar UAE

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

(30)

Cancer of the uterus

Women, 2018

YemenIraq Egypt Iran PalestineSaudi ArabiaJordan KuwaitSyria BahrainQatar TunisiaLebanonOman UAE AfghanistanPakistanSudan Libya DjiboutiMoroccoSomaliaSouth Sudan

0 5 10 15 20 25 30 35 40 45 Incidence per 100,000 Age: 20+

References: Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) Definitions: Estimated age-standardized incidence rates (World) in 2018, cervix uteri, females, ages 20+. ASR (World) per 100,000

(31)

Raised blood pressure

Adults, 2015

Iran LebanonJordan UAE Bahrain Qatar Tunisia Saudi ArabiaKuwait Libya Syria Oman Egypt Iraq MoroccoDjibouti PakistanAfghanistanYemen Somalia

0 5 10 15 20 25 30

% raised blood pressure

References: Global Health Observatory data repository, World Health Organisation,

http://apps.who.int/gho/data/node.main.A875?lang=en

Definitions: Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

(32)

Men, 2015

Iran UAE Bahrain Qatar Jordan LebanonTunisia Saudi ArabiaEgypt Syria Libya Kuwait Iraq Oman MoroccoDjibouti Yemen AfghanistanPakistanSomalia

0 5 10 15 20 25 30 35

(33)

Women, 2015

LebanonUAE Jordan Iran Bahrain Qatar Kuwait Saudi ArabiaLibya Oman Tunisia Syria Iraq Egypt Djibouti MoroccoPakistanAfghanistanYemen Somalia

0 5 10 15 20 25 30

(34)

Raised cholesterol

Adults, 2008

AfghanistanSomaliaPakistanYemen Sudan Libya DjiboutiMoroccoSaudi ArabiaEgypt Syria Tunisia Iraq LebanonJordan Oman Bahrain Iran Kuwait Qatar UAE

0 10 20 30 40 50 60 % raised cholesterol

http://apps.who.int/gho/data/node.main.A885

Definitions: % Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

(35)

Men, 2008

AfghanistanSomaliaPakistanYemen Sudan Egypt Libya MoroccoSaudi ArabiaDjiboutiTunisia Syria LebanonIraq Jordan Oman Iran Bahrain Kuwait Qatar UAE

0 10 20 30 40 50 % raised cholesterol

(36)

Women, 2008

AfghanistanSomaliaPakistanSudan Yemen DjiboutiLibya MoroccoSaudi ArabiaSyria Tunisia Iraq Egypt LebanonJordan Oman Bahrain Kuwait Qatar Iran UAE

0 10 20 30 40 50 60 % raised cholesterol

(37)

Raised fasting blood glucose

Men, 2014

SomaliaDjiboutiSudan Yemen BahrainPakistanAfghanistanLebanonOman Iran Tunisia MoroccoSyria UAE Libya Saudi ArabiaJordan Iraq Qatar Kuwait Egypt

0 5 10 15 20

% raised fasting blood glucose

Definitions: Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

(38)

Women, 2014

SomaliaSudan DjiboutiIran AfghanistanBahrainTunisia PakistanYemen MoroccoSyria Oman LebanonUAE Libya Egypt Jordan Iraq Saudi ArabiaQatar Kuwait

0 5 10 15 20

% raised fasting blood glucose

Definitions: Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

(39)

Health systems

Economic classification: Upper Middle Income

Health systems summary

The Iranian health system has undergone several reforms in the past few decades. Currently, there is considered

to be universal coverage of primary care services, but there are continued challenges for secondary and tertiary

care. Primary care is fully financed by the government. The “Health Network System” was established in 1986 to

increase access to primary care, and now health networks are accessible to all and provide basic preventative and

treatment services mostly free of charge. The fact that public coverage extends only to primary care is relatively

unique.

The ‘Universal Health Insurance Act’ of 1994 resulted in improved insurance coverage for secondary and tertiary

care - 95% of the population was considered to be covered by 2014. There are 4 main insurance organisations;

one for employees of the formal private sector and their dependents, one for government employees, the

self-employed, students and others, one for military personnel and finally, one for those with low-income. Criticisms of

the insurance system include the multiple risk pools and differing benefit packages, resulting in great

fragmentation. Out of pocket expenditure in Iran is estimated to be 50%.

Indicators

Where is the country’s government in the journey towards defining ‘Obesity as a disease’?

Defined as disease

Where is the country’s healthcare provider in the journey towards defining ‘Obesity as a

disease’?

Some progress

Is there specialist training available dedicated to the training of health professionals to

prevent, diagnose, treat and manage obesity?

No

Have any taxes or subsidies been put in place to protect/assist/inform the population around

obesity?

No

Are there adequate numbers of trained health professionals in specialties relevant to obesity

in urban areas?

Yes

Are there adequate numbers of trained health professionals in specialties relevant to obesity

in rural areas?

Some progress

Are there any obesity-specific recommendations or guidelines published for adults?

Yes

Are there any obesity-specific recommendations or guidelines published for children?

Yes

In practice, how is obesity treatment largely funded?

Not known

(40)

Perceived barriers to treatment

Lack of political will

and interest

Lack of financial

investment and

funding for coverage

Fragmented and/or

failing health system

Lack of

multi-disciplinary teams

Poor health literacy &

behaviour

Cultural norms and

traditions

Summary of stakeholder feedback

It appears that obesity is high on the agenda in Iran. Stakeholders reported that the Ministry of Health is currently

trying to raise awareness through education, with obesity health education provided in schools, hospitals and

public places. Other prevention efforts noted included mandatory food labelling, but it is acknowledged that more

needs to be done. Overall, it was agreed that the Ministry of Health and civil society in Iran were making a

concerted effort to inform people about obesity and its effects on health.

There is also said to be some action at the healthcare provider level. At the primary care level, there are obesity

services available and health education in the form of brochures. At the tertiary level, it was claimed that most

hospitals had obesity clinics where there was a focus on treatment rather than prevention. It appears that a whole

range of obesity treatment is covered by social insurance. However, stakeholders reported that in practice,

treatment is paid for by insurance and out of pocket payments.

It was reported that it is fairly straightforward to enter the health system in Iran (although access is poorer in rural

areas). In primary care, nutrition counselling is said to be available to all and from primary care, general

practitioners can refer individuals onto tertiary care. This referral process however is said to not be

well-established. There was no consensus on the BMI level that obesity treatment was started in Iran.

There is no specialist training in obesity medicine in Iran, except for a single obesity surgery fellowship. Obesity

treatment is said to be most often left to endocrinologists.

Based on interviews/survey returns from 5 stakeholders

Last updated: June 2020

PDF created on November 20, 2020

Obesity prevalence. Overweight/obesity by education. Overweight/obesity by age. Overweight/obesity by region

Full text

Report card

Iran

Obesity prevalence

Adults, 2016

Children, 2015

Overweight/obesity by education

Adults, 2016

Children, 2015

Overweight/obesity by age

Adults, 2016

Overweight/obesity by region

Adults, 2016

Children, 2012-2013

Overweight/obesity by socio-economic group

Adults, 2016

Children, 2015

Insufficient physical activity

Adults, 2016

Men, 2016

Women, 2016

Estimated per-capita fruit intake

Adults, 2017

Estimated per-capita processed meat intake

Adults, 2017

Estimated per-capita whole grains intake

Adults, 2017

Mental health - depression disorders

Adults, 2015

Mental health - anxiety disorders

Adults, 2015

Oesophageal cancer

Men, 2018

Women, 2018

Breast cancer

Women, 2018

Colorectal cancer

Men, 2018

Women, 2018

Pancreatic cancer

Men, 2018

Women, 2018

Gallbladder cancer

Men, 2018

Women, 2018

Kidney cancer

Men, 2018

Women, 2018

Cancer of the uterus

Women, 2018

Raised blood pressure

Adults, 2015

Men, 2015

Women, 2015

Raised cholesterol

Adults, 2008

Men, 2008

Women, 2008

Raised fasting blood glucose

Men, 2014

Women, 2014

Health systems

Economic classification: Upper Middle Income

Health systems summary

The Iranian health system has undergone several reforms in the past few decades. Currently, there is considered

to be universal coverage of primary care services, but there are continued challenges for secondary and tertiary

care. Primary care is fully financed by the government. The “Health Network System” was established in 1986 to

increase access to primary care, and now health networks are accessible to all and provide basic preventative and

treatment services mostly free of charge. The fact that public coverage extends only to primary care is relatively

unique.

The ‘Universal Health Insurance Act’ of 1994 resulted in improved insurance coverage for secondary and tertiary

care - 95% of the population was considered to be covered by 2014. There are 4 main insurance organisations;

one for employees of the formal private sector and their dependents, one for government employees, the

self-employed, students and others, one for military personnel and finally, one for those with low-income. Criticisms of

the insurance system include the multiple risk pools and differing benefit packages, resulting in great

fragmentation. Out of pocket expenditure in Iran is estimated to be 50%.

Indicators

Where is the country’s government in the journey towards defining ‘Obesity as a disease’?

Defined as disease