Effects of Community-Based Interventions in Reducing the Obesity and Overweight Rate Among Iranian Women Using Urban Health Equity Assessment and Response Tool

Document Type : Original Article


1 Health Department, The Tehran Municipality’s Organization, 15th District, Tehran, Iran

2 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran



Introduction: The increasing prevalence of overweight and obesity is one of the most critical issues of urban health. The current study investigated the effects of community-based interventions on modification of overweight and obesity.
Methods: A program based on the Urban Health Equity Assessment and Response Tool (Urban HEART) was developed and implemented in 2013-2014. A total of 166 Iranian females aged 15 years or older who were classified as overweight or obese using body mass index (BMI) were randomly selected and gave verbal consent to participate in this study. The intervention was carried out for a duration of 4 months.
Results: The mean age of subjects was 43.6±12.2 years. The total number of overweight and obese individuals were 75 (45.2%) and 91 (54.8%), respectively. The mean BMI of the patients before and after the intervention was 30.3 ± 2.7 and 29.4 ± 2.7 kg/m2, respectively (P < 0.05). Higher education level and greater floor area were recognized as valid predictors for reduced BMI after the intervention (P < 0.001).
Conclusion: This study successfully represents the collaborative role of the community in improving health status by reducing overweight and obesity. The Urban HEART provided distinct opportunities for presenting the promising results of interventions to health policymakers and managers so they can adjust macro and micro policies for achieving better community health outcomes.


  1. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557-567. doi:10.1016/S0140-6736(10)62037-5.
  2. Ning X, Zhan C, Yang Y, et al. Secular trends in prevalence of overweight and obesity among adults in rural Tianjin, China from 1991 to 2011: a population-based study. PLoS One. 2014;9(12):e116019. doi:10.1371/journal.pone.0116019.
  3. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-781. doi:10.1016/S0140-6736(14)60460-8.
  4. Kelishadi R, Alikhani S, Delavari A, Alaedini F, Safaie A, Hojatzadeh E. Obesity and associated lifestyle behaviours in Iran: findings from the First National Non-communicable Disease Risk Factor Surveillance Survey. Public Health Nutr. 2008;11(3):246-251. doi:10.1017/S1368980007000262.
  5. Ghassemi H, Harrison G, Mohammad K. An accelerated nutrition transition in Iran. Public Health Nutr. 2002;5(1a):149-155. doi:10.1079/PHN2001287.
  6. Siddiqi A, Hertzman C. Towards an epidemiological understanding of the effects of long-term institutional changes on population health: a case study of Canada versus the USA. Soc Sci Med. 2007;64(3):589-603. doi:10.1016/j.socscimed.2006.09.034.
  7. Horowitz CR, Robinson M, Seifer S. Community-based participatory research from the margin to the mainstream: are researchers prepared? Circulation. 2009;119(19):2633-2642. doi:10.1161/CIRCULATIONAHA.107.729863.
  8. Cargo M, Mercer SL. The value and challenges of participatory research: strengthening its practice. Annu Rev Public Health. 2008;29:325-350. doi:10.1146/annurev.publhealth.29.091307.083824.
  9. Mensah GA. Eliminating disparities in cardiovascular health: six strategic imperatives and a framework for action. Circulation. 2005;111(10):1332-1336. doi:10.1161/01.CIR.0000158134.24860.91.
  10. World Health Organization (WHO). WHO Centre for Health Development. Urban HEART: Urban Health Equity Assessment and Response Tool-manual. Kobe Japan, 2010. http://www.who.int/kobe_centre/publications/urban_heart_manual.pdf.
  11. Asadi-Lari M, Vaez-Mahdavi MR, Faghihzadeh S, et al. Response-oriented measuring inequalities in Tehran: second round of UrbanHealth Equity Assessment and Response Tool (Urban HEART-2), concepts and framework. Med J Islam Repub Iran. 2013;27(4):236-248.
  12. Allahverdipoor H, Behdjat H, Tajaddini N, Vahidi RG, Jabbari H. Report on documentation and evaluation of Urban HEART pilot in Tehran, Islamic Republic of Iran. Tabriz: National Public Health Management Centre, Tabriz Univ Med Sci; 2013.
  13. Vaez-Mahdavi MR, Asadi-Lari M, Malekafzali H. Urban HEART Tehran experience: Round II results. Tehran: Municipality of Tehran; 2013.
  14. Centers for Disease Control and Prevention (CDC). Defining Adult Overweight and Obesity. CDC; 2015. http://www.cdc.gov/obesity/adult/defining.html.
  15. Kelishadi R, Alikhani S, Delavari A, Alaedini F, Safaie A, Hojatzadeh E. Obesity and associated lifestyle behaviours in Iran: findings from the First National Non-communicable Disease Risk Factor Surveillance Survey. Public Health Nutr. 2008;11(3):246-251. doi:10.1017/S1368980007000262.
  16. Ayatollahi SM, Ghoreshizadeh Z. Prevalence of obesity and overweight among adults in Iran. Obes Rev. 2010;11(5):335-337. doi:10.1111/j.1467-789X.2010.00725.x.
  17. Fradgley EA, Paul CL, Bryant J, Roos IA, Henskens FA, Paul DJ. Consumer participation in quality improvements for chronic disease care: development and evaluation of an interactive patient-centered survey to identify preferred service initiatives. J Med Internet Res. 2014;16(12):e292. doi:10.2196/jmir.3545.
  18. Chen M, Qian X, Zhang L. Public participation in environmental management in China: status quo and mode innovation. Environ Manage. 2015;55(3):523-535. doi:10.1007/s00267-014-0428-2.
  19. Morrison Z, Douglas A, Bhopal R, Sheikh A. Understanding experiences of participating in a weight loss lifestyle intervention trial: a qualitative evaluation of South Asians at high risk of diabetes. BMJ Open. 2014;4(6):e004736. doi:10.1136/bmjopen-2013-004736.
  20. Satcher D, Higginbotham EJ. The public health approach to eliminating disparities in health. Am J Public Health. 2008;98(3):400-403. doi:10.2105/AJPH.2007.123919.
  21. Conklin AI, Forouhi NG, Suhrcke M, Surtees P, Wareham NJ, Monsivais P. Socioeconomic status, financial hardship and measured obesity in older adults: a cross-sectional study of the EPIC-Norfolk cohort. BMC Public Health. 2013;13:1039. doi:10.1186/1471-2458-13-1039.
  22. Salonen MK, Kajantie E, Osmond C, et al. Role of socioeconomic indicators on development of obesity from a life course perspective. J Environ Public Health. 2009;2009:625168. doi:10.1155/2009/625168.