Both your nutritional needs (the food and water) and your metabolism (how fast your body converts food to energy) change at this age. Your metabolism gets slower. Women lose about half a pound of muscle per year starting around the age of 40. That makes losing weight even more difficult. Some of the changes women experience are due to decreased hormones, reduced activity level, and medical conditions.

Give your body a little more credit: It tells you when you’re hungry—you may not be listening, though. Before chowing down because there’s only one slice of pie left or because the last guest arrived at the brunch, stop and check in with your stomach. “If you’re not hungry, make yourself a small plate and sip on some tea or coffee while everyone else digs in,” recommends Elle Penner, M.P.H., R.D., a MyFitnessPal expert. When your belly starts to finally grumble, food will be there.
I subscribed to this magazine thinking it would be about health, fitness, and above all, working out. The headlines on the cover seemed to suggest that was true, with the biggest fonts advertising things like "flat abs now" and "maximize your workout". In reality, the content of the magazine is mostly beauty (how that counts as "health" is beyond me) and weight-loss. Oh, the endless, endless articles about "burn more fat!" "three new foods that will help you burn fat!" "drop pounds with this easy exercise!" I don't need to lose weight and I found that these articles just played into my growing impression, as issue after issue dropped on my doormat, that the magazine views women as vapid, stereotypical beings whose only desire is to look good, whether through exercise (almost inevitably restricted to cardio and yoga), the "right" work-out clothes (really?) or knowing what dress is in fashion or what color make-up to buy. If you enjoy that sort of thing, that's fine- it is essentially one step above Cosmopolitan on the seriousness scale. If you're looking for actual information about working out and building muscle, know that Women's Health magazine is barely aware that these things exist, and when it does, it will come wrapped in the form of "ten minutes a day to tone your bum like a super-model!" or something equally cringe-inducing.
Women's menstrual cycles, the approximately monthly cycle of changes in the reproductive system, can pose significant challenges for women in their reproductive years (the early teens to about 50 years of age). These include the physiological changes that can effect physical and mental health, symptoms of ovulation and the regular shedding of the inner lining of the uterus (endometrium) accompanied by vaginal bleeding (menses or menstruation). The onset of menstruation (menarche) may be alarming to unprepared girls and mistaken for illness. Menstruation can place undue burdens on women in terms of their ability to participate in activities, and access to menstrual aids such as tampons and "sanitary pads". This is particularly acute amongst poorer socioeconomic groups where they may represent a financial burden and in developing countries where menstruation can be an impediment to a girl's education.[113]
Sweet chili peppers may not be a winter food, but continue eating them in your burritos, stir-fries, and soups, and you may burn more fat during your outdoor cold-weather runs. These not-hot veggies contain chemicals called capsinoids, which are similar to the capsaicin found in hot peppers. Combine capsinoids with 63-degree or cooler temps, and you increase the amount and activity of brown fat cells—those that burn energy—and give your metabolism an extra boost, according to a study published in the Journal of Clinical Investigation.
Iodine is needed for normal mental development of the baby, but it can be difficult to get enough from food. Ways of increasing iodine intake include using iodised salt, eating fish and seafood weekly (see your health professional for advice about safe types and amounts of fish), or using a multivitamin supplement that contains iodine and is safe for pregnancy.
Many nutrition-sensitive approaches were delivered in broader community-based settings and more equitably reached women across the life course. Non-facilities-based settings more equitably delivered nutrition interventions to women who were not pregnant or lactating, and who were less engaged with health clinics and schools. For instance, food fortification, which was often delivered through markets, home visits, and community centers, seemed to be more effective at reaching women of reproductive age than health center–based delivery platforms. Community-level interventions are often reported as more equitable than platforms that require access to “fixed and well-equipped health facilities” (212). This aligns with our findings, where we found that community-based platforms such as home visits, community centers, homes of community leaders, work, mass media, mobile phones, and commercial settings were effective at reaching women across the life course (Table 1). Other delivery platforms such as marketplaces, water points, tailoring shops, and agricultural points for seeds or inputs were also effective. These locations need to be context-specific in order to capture where women spend their time. For instance, in countries where many adolescent girls do not attend school, school-based delivery platforms might be less effective. Delivery platforms also need to be sensitive to the sociodemographic differences that influence where women spend their time, such as differences for women in rural and urban areas, and of different socioeconomic statuses. Additional research needs to identify and report where women and adolescent girls are, and how best to reach them.
When women reach childbearing age, they need to eat enough folate (or folic acid) to help decrease the risk of birth defects. The requirement for women who are not pregnant is 400 micrograms (mcg) per day. Including adequate amounts of foods that naturally contain folate, such as citrus fruits, leafy greens, beans and peas will help increase your intake of this B vitamin. There also are many foods that are fortified with folic acid, such as breakfast cereals, some rices and breads.  Eating a variety of foods is recommended to help meet nutrient needs, but a dietary supplement with folic acid also may be necessary. This is especially true for women who are pregnant or breast-feeding, since their daily need for folate is higher, 600 mcg and 500 mcg per day, respectively. Be sure to check with your physician or a registered dietitian nutritionist before taking any supplements., .
Women's life expectancy is greater than that of men, and they have lower death rates throughout life, regardless of race and geographic region. Historically though, women had higher rates of mortality, primarily from maternal deaths (death in childbirth). In industrialised countries, particularly the most advanced, the gender gap narrowed and was reversed following the industrial revolution. [6] Despite these differences, in many areas of health, women experience earlier and more severe disease, and experience poorer outcomes.[18]
Picture your perfect self with your flat abs, firmer butt, and slim thighs every day. Seeing really is believing: “You become consciously and acutely aware of everything that can help you achieve the visualized outcome that you desire when you impress an idea into the subconscious part of you,” says celebrity yoga coach Gwen Lawrence. “It eventually becomes ‘fixed,’ and you automatically move toward that which you desire.” 
WASH interventions, such as toilet facilities, access to improved and safe water supply, and hand washing are associated with improved nutrition and health of entire communities (13, 14, 125–128). For women and adolescent girls, WASH interventions were associated with improved menstrual hygiene (126), reduced diarrhea and intestinal worm infections (128–131), and reduced maternal mortality (132). Women and young girls are also more affected by the physical and time burdens of collecting water (126), and harassment and violence associated with inadequate and unsafe toilet facilities (133, 134). Closer water points and sanitation facilities eased these gendered burdens (126, 135). WASH interventions and perceived water availability were associated with less time spent on water-related chores, and improved school attendance, women's empowerment, and self-esteem (126, 135, 136).
Poor nutrition can manifest itself in many ways. The more obvious symptoms of a nutritional deficiency include dull, dry or shedding hair; red, dry, pale or dull eyes; spoon-shaped, brittle or ridged nails; bleeding gums; swollen, red, cracked lips; flaky skin that doesn't heal quickly; swelling in your legs and feet; wasted, weak muscles; memory loss; and fatigue.
The new guidelines encourage eating more nutrient-dense food and beverages. Many of us consume too many calories from solid fats, added sugar and refined grains. The guidelines promote a diet that emphasizes vegetables, fruits, whole grains, fat-free or low-fat dairy products, seafood, lean meat and poultry, eggs, beans and peas, and nuts and seeds.
Nutrition is particularly important during pregnancy to ensure your health and the health of the baby. It's normal to gain weight during pregnancy—not just because of the growing fetus, but because you'll need stored fat for breast-feeding. The Institute of Medicine (IOM) recommends a gain of 25 to 35 pounds in women of normal weight when they get pregnant; 28 to 40 pounds in underweight women; and at least 15 pounds in women who are overweight when they get pregnant. The IOM has not given a recommendation for an upper limit for obese women, but some experts cap it as low as 13 pounds. If you fit into this category, discuss how much weight you should gain with your health care professional.
“Whole grains help with digestion and are excellent for your heart, regularity [because of the fiber content], and maintaining a steady level of blood sugar,” says Hincman. “They are also a great source of energy to power you throughout the day.” Whole grains, such as oats, also help improve cholesterol levels. While food manufacturers are adding fiber to all sorts of products, whole grains, like whole wheat, rye, and bran, need to be the first ingredient on the food label of packaged foods, she stresses. Watch your serving sizes, however. Current guidelines are for six one-ounce equivalent servings per day (five if you’re over 50). One ounce of whole-wheat pasta (weighed before cooking) is only one-half cup cooked.
It's even more important for older people to stay hydrated. Age can bring a decreased sensitivity to thirst. Moreover, it's sometime harder for those who are feeble to get up and get something to drink. Or sometimes a problem with incontinence creates a hesitancy to drink enough. Those who are aging should make drinking water throughout the day a priority.
Iodine is needed for normal mental development of the baby, but it can be difficult to get enough from food. Ways of increasing iodine intake include using iodised salt, eating fish and seafood weekly (see your health professional for advice about safe types and amounts of fish), or using a multivitamin supplement that contains iodine and is safe for pregnancy.
We live in a modern world with amazing advancements in technology, yet our soil lacks minerals that it once contained causing whatever grows out of it (i.e. fruits, vegetables, and whole foods) to be significantly lower in minerals than it once was. Not only is our soil different, but our food takes a long time to get to us! Unless we’re growing our own whole food in our gardens, picking it out with our bare hands, and washing it off before eating, most likely our produce has been picked weeks before it reaches your grocery store and is purchased by you. This entire process can take weeks and cause nutrients to be depleted from the whole food (2).
Iodine is needed for normal mental development of the baby, but it can be difficult to get enough from food. Ways of increasing iodine intake include using iodised salt, eating fish and seafood weekly (see your health professional for advice about safe types and amounts of fish), or using a multivitamin supplement that contains iodine and is safe for pregnancy.
Focus on the long term. Diets fail when people fall back into poor eating habits; maintaining weight loss over the long term is exceedingly difficult. Most people regain the weight they've lost. In fact, some studies indicate that 90 to 95 percent of all dieters regain some or all of the weight originally lost within five years. Your program should include plans for ongoing weight maintenance, involving diet, exercise and a behavioral component. While there are some physical reasons for obesity, there are also behavioral reasons for excessive eating. For example, many women use food as a source of comfort (perhaps to deal with stress). For these women, a weight loss program with a behavioral component will offer alternatives to replace food in this role.
When layering for an outdoor activity this winter, consider a compression fabric for your base layers. “These fabrics are fantastic at wicking moisture from the body, which allows you to sweat and breath while keeping you warm,” says Chiplin, who notes they can also reduce fatigue and muscle soreness so you’re ready to head out again tomorrow. Consider throwing them in the dryer for a minute before dressing to further chase away the morning chill. 

Some fat is an important part of your diet; fat is part of every cell. It maintains skin and hair; stores and transports fat-soluble vitamins A, D, E and K; keeps you warm; and protects your internal organs. It even helps your mental processes—not surprising given that fat comprises about 60 percent of your brain. But many women consume too much fat. The American Heart Association (AHA) recommends that you keep your total fat intake between 25 and 35 percent of your total calories.


Adult women, and particularly women with children, were the primary targets for empowerment interventions. Empowerment interventions were predominantly delivered through community-based programs, including home visits, community groups, and community centers (5, 161, 163). There was some evidence that empowerment interventions that included delivery platforms such as radio and television, as a complement to the community- and home-based delivery platforms (5), could have some impact on reaching a wider audience. Adolescent girls were largely not the target of empowerment interventions, except for those relating to reproductive health (158), and could potentially benefit from them.

We live in a modern world with amazing advancements in technology, yet our soil lacks minerals that it once contained causing whatever grows out of it (i.e. fruits, vegetables, and whole foods) to be significantly lower in minerals than it once was. Not only is our soil different, but our food takes a long time to get to us! Unless we’re growing our own whole food in our gardens, picking it out with our bare hands, and washing it off before eating, most likely our produce has been picked weeks before it reaches your grocery store and is purchased by you. This entire process can take weeks and cause nutrients to be depleted from the whole food (2).


  Home visits  ↑/NC knowledge about hygiene and sanitation, ↑ hand-washing, ↑ water quality, ↓/NC diarrheal morbidity, ↓ intestinal parasite prevalence  ↑/NC knowledge about hygiene and sanitation, ↑ hand-washing, ↑ water quality, ↓/NC diarrheal morbidity, ↓ intestinal parasite prevalence  ↓ maternal mortality, ↑/NC knowledge about hygiene and sanitation, ↑/NC hand-washing, ↑ water quality, NC waste disposal, ↓/NC diarrheal morbidity, ↓ intestinal parasite prevalence  ↑/NC knowledge about hygiene and sanitation, ↑ hand-washing, ↑ water quality, ↓/NC diarrheal morbidity, ↓ intestinal parasite prevalence 
Grains, vegetables and fruits are essential to getting the vitamins, minerals, complex carbohydrates (starch and dietary fiber) and other nutrients you need to sustain good health. Some of these nutrients may even reduce your risk of certain kinds of cancer. But experts say we rarely eat enough of these foods. To make matters worse, we also eat too much of unhealthy types of food, including fat (and cholesterol), sugar and salt.

  Community centers  ↑/NC knowledge about hygiene and sanitation, ↑ water quality, ↓ diarrheal morbidity  ↑/NC knowledge about hygiene and sanitation, ↑ water quality, ↓ diarrheal morbidity  ↑/NC knowledge about hygiene and sanitation, ↑/NC hand-washing, ↑ water quality, NC waste disposal, ↓ diarrheal morbidity  ↑/NC knowledge about hygiene and sanitation, ↑ water quality, ↓ diarrheal morbidity 
A healthy vegetarian diet falls within the guidelines offered by the USDA. However, meat, fish and poultry are major sources of iron, zinc and B vitamins, so pay special attention to these nutrients. Vegans (those who eat only plant-based food) may want to consider vitamin and mineral supplements; make sure you consume sufficient quantities of protein, vitamin B12, vitamin D and calcium. You can obtain what you need from non-animal sources. For instance:
The major differences in life expectancy for women between developed and developing countries lie in the childbearing years. If a woman survives this period, the differences between the two regions become less marked, since in later life non-communicable diseases (NCDs) become the major causes of death in women throughout the world, with cardiovascular deaths accounting for 45% of deaths in older women, followed by cancer (15%) and lung disease (10%). These create additional burdens on the resources of developing countries. Changing lifestyles, including diet, physical activity and cultural factors that favour larger body size in women, are contributing to an increasing problem with obesity and diabetes amongst women in these countries and increasing the risks of cardiovascular disease and other NCDs.[11][20]
Vinyasa and power may not be the only forms of yoga that will get you closer to that long, lean, limber look. Research presented at the 73rd Scientific Sessions of the American Diabetes Association found that restorative yoga—which focuses more on relaxing and stress-reducing movements rather than a challenging flow or balancing poses—burns more subcutaneous fat (the kind directly under your skin) than stretching does. By the end of the yearlong study, yogis who practiced at least once a month lost an average of about three pounds, nearly double the amount lost by those who only stretched. So if you don’t feel up for a more athletic yoga class, ease your way into a practice with a gentle one.

Cardiovascular disease is the leading cause of death (30%) amongst women in the United States, and the leading cause of chronic disease amongst them, affecting nearly 40% (Gronowski and Schindler, Tables I and IV).[6][7][119] The onset occurs at a later age in women than in men. For instance the incidence of stroke in women under the age of 80 is less than that in men, but higher in those aged over 80. Overall the lifetime risk of stroke in women exceeds that in men.[27][28] The risk of cardiovascular disease amongst those with diabetes and amongst smokers is also higher in women than in men.[6] Many aspects of cardiovascular disease vary between women and men, including risk factors, prevalence, physiology, symptoms, response to intervention and outcome.[119]
Third, of the interventions that were evaluated, many interventions targeted women who were pregnant, lactating, or with young children <5 y of age. We do not refute the important focus on mothers and their children as a group deserving of special attention, given women's increased nutrient needs during pregnancy and lactation and the intergenerational consequences during this period. However, even the interventions that focused on maternal nutrition often only reported on birth and nutrition outcomes of the child, and not those of the mother. In addition, although there were interventions that targeted adolescent girls and women of reproductive age, they were fewer and less well evaluated than interventions that targeted women as mothers. This aligns with findings from other research which illustrated a higher proportion of programs targeting pregnant and lactating women and women with young children (209). We also found major gaps in the targeting of interventions for older women. With growing rates of overweight, obesity, and noncommunicable diseases, in addition to undernutrition and micronutrient deficiencies, it is essential to think outside of the maternal-focused paradigm to reach women at all life stages.
The Center for Young Women’s Health (CYWH) is a collaboration between the Division of Adolescent and Young Adult Medicine and the Division of Gynecology at Boston Children’s Hospital. The Center is an educational entity that exists to provide teen girls and young women with carefully researched health information, health education programs, and conferences.
Improvements in maternal health, in addition to professional assistance at delivery, will require routine antenatal care, basic emergency obstetric care, including the availability of antibiotics, oxytocics, anticonvulsants, the ability to manually remove a retained placenta, perform instrumented deliveries, and postpartum care.[11] Research has shown the most effective programmes are those focussing on patient and community education, prenatal care, emergency obstetrics (including access to cesarean sections) and transportation.[41] As with women's health in general, solutions to maternal health require a broad view encompassing many of the other MDG goals, such as poverty and status, and given that most deaths occur in the immediate intrapartum period, it has been recommended that intrapartum care (delivery) be a core strategy.[39] New guidelines on antenatal care were issued by WHO in November 2016.[51]

If you thought texting changed your love life, imagine what it could do for your waistline. When people received motivational text messages promoting exercise and healthy behaviors twice a week (i.e., “Keep in the fridge a Ziploc with washed and precut vegetables 4 quick snack. Add 1 string cheese 4 proteins”), they lost an average of about 3 percent of their body weight in 12 weeks. Participants in the Virginia Commonwealth University study also showed an improvement in eating behaviors, exercise, and nutrition self-efficacy, and reported that the texts helped them adopt these new habits. Find health-minded friends and message each other reminders, or program your phone to send yourself healthy eating tips.


Interventions resulting in public infrastructure changes were found to be less effective than household-based interventions; however, both are important aspects of improved health outcomes for women (128, 130). Public water infrastructure requires regular maintenance and periodic replacement and water from these sources is often contaminated (130). However, even public water points that provide good-quality water have had minimal impacts on health outcomes (136). One review estimated that water-source interventions were associated with a 27% reduction in diarrhea risk at all ages, whereas household-based interventions were associated with a 43% reduction (128). This could be associated with bias and confounding, as measuring WASH outcomes is not a blinded process (128). The differential impact could also be related to practice. As compared with public water sources, home water connections were associated with greater odds of handwashing and fecal waste disposal (136). As a significant portion of diarrheal disease is a result of person-to-person transmission and poor hygiene, interventions that improve domestic hygiene behaviors can have a significant impact (136). Behavior change communication and resource provision, e.g., soap and point-of-use water treatment resources, were also important and sustainable aspects of WASH interventions (131, 137).
If you lose weight suddenly or for unknown reasons, talk to your health care professional immediately. Unexplained weight loss may indicate a serious health condition. And even if it doesn't, simply being underweight is linked to menstrual irregularity, menstrual cessation (and sometimes, as a result, dental problems, such as erosion of the enamel and osteoporosis) and a higher risk of early death.
Women's life expectancy is greater than that of men, and they have lower death rates throughout life, regardless of race and geographic region. Historically though, women had higher rates of mortality, primarily from maternal deaths (death in childbirth). In industrialised countries, particularly the most advanced, the gender gap narrowed and was reversed following the industrial revolution. [6] Despite these differences, in many areas of health, women experience earlier and more severe disease, and experience poorer outcomes.[18]
Both your nutritional needs (the food and water) and your metabolism (how fast your body converts food to energy) change at this age. Your metabolism gets slower. Women lose about half a pound of muscle per year starting around the age of 40. That makes losing weight even more difficult. Some of the changes women experience are due to decreased hormones, reduced activity level, and medical conditions.
Fiber is an important part of an overall healthy eating plan. Good sources of fiber include fortified cereal, many whole-grain breads, beans, fruits (especially berries), dark green leafy vegetables, all types of squash, and nuts. Look on the Nutrition Facts label for fiber content in processed foods like cereals and breads. Use the search tool on this USDA page to find the amount of fiber in whole foods like fruits and vegetables.
Changes in the way research ethics was visualised in the wake of the Nuremberg Trials (1946), led to an atmosphere of protectionism of groups deemed to be vulnerable that was often legislated or regulated. This resulted in the relative underrepresentation of women in clinical trials. The position of women in research was further compromised in 1977, when in response to the tragedies resulting from thalidomide and diethylstilbestrol (DES), the United States Food and Drug Administration (FDA) prohibited women of child-bearing years from participation in early stage clinical trials. In practice this ban was often applied very widely to exclude all women.[151][152] Women, at least those in the child-bearing years, were also deemed unsuitable research subjects due to their fluctuating hormonal levels during the menstrual cycle. However, research has demonstrated significant biological differences between the sexes in rates of susceptibility, symptoms and response to treatment in many major areas of health, including heart disease and some cancers. These exclusions pose a threat to the application of evidence-based medicine to women, and compromise to care offered to both women and men.[6][153]
Salt, caffeine and alcohol intake may interfere with the balance of calcium in the body by affecting the absorption of calcium and increasing the amount lost in the urine. Moderate alcohol intake (one to two standard drinks per day) and moderate tea, coffee and caffeine-containing drinks (no more than six cups per day) are recommended. Avoid adding salt at the table and in cooking
Women's experience of health and disease differ from those of men, due to unique biological, social and behavioural conditions. Biological differences vary all the way from phenotype to the cellular, and manifest unique risks for the development of ill health.[1] The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".[2] Women's health is an example of population health, the health of a specific defined population.[3]
If you count calories, count fat calories, too. Food labels indicate how many calories come from fat, both in actual grams and in percentages. This helps you assess the percentage of fat in your diet. If the total number of fat calories is 30 percent or more of the total calories you consume in a day, you probably need to cut back. But don't be misled by terms like "lower fat." Ask yourself "lower than what?" and look at the overall percentage of fat calories in the food.
Integrated health care, which integrates curative and preventive interventions, can improve nutrition outcomes for women across the life course through improved access to counseling, vaccinations, and screening and treatment of illnesses (103–107). Access to primary health care positively contributed to the prevention, diagnosis, and management of both communicable and noncommunicable disease (108). Distribution of insecticide-treated bed nets, condoms, screening and testing for disease, and delivery of medical treatments were often associated with integrated health initiatives and improved health and nutrition outcomes (13, 109). Access to health care was associated with the delivery of nutrition-specific interventions to manage pregnancy-induced hypertension, diabetes, pre-eclampsia, and hemorrhage (106, 107, 110). However, some studies showed that integrated services increased knowledge, but did not result in changes in health or nutrition outcomes (103). In addition, in many settings, quality of care was inadequate (107) and incorrect diagnoses and treatments were common (111).

According to researchers who recently reviewed the risks associated with coronary heart disease (CHD) in women, a poor diet was linked to 20 percent of all cases of heart disease. Factor in diet’s effect on other chronic diseases like diabetes and osteoporosis, and it’s obvious that good nutrition has huge women's health benefits. One way to immediately turn your health situation around is through the foods you choose to eat. Here are nine foods that you'll want to make part of your daily diet.
Calcium: For adult women aged 19-50, the USDA recommended daily allowance is 1,000 mg/day. For women over 50, the recommended daily allowance is 1,200 mg/day. Good sources of calcium include dairy products, leafy green vegetables, certain fish, grains, tofu, cabbage, and summer squash. Your body cannot take in more than 500 mg at any one time and there’s no benefit to exceeding the recommended daily amount.
Poor nutrition may be one of the easiest conditions to self-diagnose. Look at the food pyramid and the suggested servings. Look at your diet. Are you getting the recommended daily amounts of fruits and vegetables? Enough calcium? Read the labels and compare what you eat to what you need. You may discover that even if your weight is ideal, you are not getting enough nutrition.
Omega-3s: These essential fatty acids, EPA and DHA, play many roles in the body, including building healthy brain and nerve cells. Some studies show that omega-3s, especially DHA, can help prevent preterm births. Even women who don't plan to have children should be sure to get plenty of omega-3s. These healthy oils have been shown to reduce the risk of heart disease, the number one killer of women.
Just like trying to find a guy who meets certain exact standards, trying to reach an exact weight is a lofty—and often unattainable—goal. Having a range, such as losing five to 10 pounds, may lead to a more successful outcome than if you aim to lose precisely 8 pounds in four weeks, according to a study published in the Journal of Consumer Research. Flexible goals seem more feasible, which in turn boosts your sense of accomplishment, encouraging you to stay driven, the study authors say.

Our findings identified gaps and limitations in the evaluation, scope, targeting, and delivery platforms of nutrition interventions in low- and middle-income countries. First, the monitoring and evaluation of nutrition programs that reported on women's nutrition outcomes was generally inadequate. Many of the studies we identified included small-scale efficacy trials. Although there were many large-scale programs that targeted women and adolescent girls with nutrition-specific and nutrition-sensitive approaches, they lacked rigorous evaluation. Whether the evidence about women's outcomes was limited because they are not systematically measured or because they are not well reported is not clear. Negative results are often not published, and many evaluations of nutrition interventions that are conducted by the same groups responsible for implementing them are typically presented positively. This may have also skewed our findings. More intentional research-quality program evaluation, including of large-scale programs, would provide a stronger evidence base. Of the studies identified in this review, many reported on short-term findings such as changes in knowledge, dietary behaviors, and program coverage. They were limited in their ability to report clinical and anthropometric outcomes for women, the duration of those outcomes, and the feasibility of scaling up programs. There is also a need for systematic, long-term evaluations of interventions whose effects on nutrition outcomes are more distal (e.g., nutrition education compared with micronutrient supplementation). The effects of multisectoral interventions are even more complex to measure. However, frameworks exist to evaluate complex interventions (102) and could be utilized to evaluate the impact of interventions across the life course.

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