High-fat milk consumption in Iran: lessons from a recent policy affecting public health.

In Iran, recent government action to change low-fat milk consumption highlights the importance of evidence-based and multi-dimensional rule making when it affects public health. We know that individual dietary behaviors respond to community attributes, such as societal values, regulations, and food availability. Tordoff et al have shown that nutrient availability has a strong effect on dietary behavior in laboratory animals and can override physiological controls of intake. They concluded that availability, rather than physiological mechanisms, is more likely to be responsible for the poor diet choice, hyperphagia, and obesity displayed by many humans. Fisher et al reported that low-fat milk consumption in households was related to the proportion of low-fat milk in stores. In July 2007, the Iranian Economic Council, prohibited producers from increasing prices of low-fat milk and yoghurt in response to increased wages and supply costs. Milk processors refused to comply, taking low-fat dairy products off the market. To stay in business, they produced more high-fat products at higher prices. Knowing the relationship between availability and consumption mentioned above, the result of this policy change might have been devastating. High dietary fat consumption is a leading behavioral risk factor for cardiovascular and other chronic diseases. In Iran, the Ministry of Health reports that about 38 per cent of all deaths can be attributed to cardiovascular diseases. Among individuals aged 25–64 years, the prevalence of obesity (BMI430) is about 14.2 per cent and hypercholesterolemia (total chol4200) 28.6 per cent. Environmental interventions are important to overall efforts to improve public health. Increasing access to healthy foods is an efficient one – primary prevention. But there can be obstacles, including insufficient forethought and consultation with public health authorities. In Iran, government reversed the negative effects of the price limits on low-fat products by paying milk producers to offer low-fat dairy products. Availability returned to its previous levels. We see that the consequences of limiting price increases was the opposite of what was initially intended. The authorities planned to keep the low-fat dairy prices low in order to increase accessibility. Instead, it resulted in high-fat products being more accessible. We urge that