However, many fortification programs in low- and middle-income countries are regional or voluntary and, thus, might have a limited nutritional impact at the national level (76). Although many efficacy trials show benefits of fortification interventions, scaling up fortification is limited by inadequate coverage and resources (13, 77, 78). Evidence for impact is also affected by suboptimal programming, low-bioavailability fortificants (e.g., reduced iron powder), poor consumption rates, weak enforcement mechanisms, and inadequate monitoring (76, 79, 80). More research is needed to evaluate the long-term impact of fortification and biofortification programs (75). In addition, there is also growing concern about fortifying and promoting food vehicles that have adverse health consequences when consumed in excess, such as salt and sugar, given the rising prevalence of overweight, obesity, and noncommunicable disease (81–83).
Not everyone who is underweight suffers from an eating disorder, but anorexia and bulimia are serious health problems in this country; an estimated 500,000 women suffer from anorexia, and 1 to 2 million women struggle with bulimia. Women with anorexia nervosa starve themselves and/or exercise excessively, losing anywhere from 15 percent to 60 percent of their normal body weight. Some die. Women with bulimia nervosa binge on large quantities of food—up to 20,000 calories at one time—and then try to get rid of the excess calories. Some purge by inducing vomiting, abusing laxatives and diuretics or by taking enemas. Others fast or exercise to extremes.
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.
Of the few studies evaluating nutrition education interventions for women and adolescent girls who were overweight and obese, many were “facility-based” and involved delivery platforms such as health clinics (13, 22), worksites (30), and schools (26, 27, 29). Delivery platforms targeting women and adolescents who were undernourished similarly involved facility-based settings (13), but also included community outreach (16, 28), home visits, community kitchens (15, 28), and text messaging platforms (32). Such community-based platforms could provide additional opportunities for the delivery of nutrition education interventions addressing overweight, obesity, and associated noncommunicable disease in the future.
Our review found that protein-energy supplementation was largely targeted to pregnant and lactating women (19, 86–88, 90, 91); however, there were some studies that evaluated the delivery of protein-energy supplementation to households (92, 93) and adolescents (46). The only studies we found that evaluated the impact of protein-energy supplementation in older, healthy women were hospital-based studies in high-income countries (96). Delivery platforms varied depending on the target audience. The majority of studies targeted pregnant women through antenatal care or through antenatal care–associated community-based programs. National programs targeting low-income families had broader reach, although they targeted households and not women specifically (92). Additional research is needed for how women might best be reached (94). For programs that provided provisions for women to take home, there was also limited information about how much was shared with other members of the household. School-based programs targeting adolescents could be an important venue to target interventions to adolescents in the future. However, children and adolescents not in school would be missed. Despite limited evidence of impacts of energy and protein supplementation on the health of women, supplementation might be an important complement to other interventions (e.g., nutrition education and counseling) to ensure that women have the resources needed to implement other interventions successfully. Indeed, many large-scale programs for protein-energy supplementation are often complemented with nutrition education and counseling (33).
During adolescence and early adulthood, women need to consume foods rich in calcium to build peak (maximum) bone mass. This will reduce the risk of developing osteoporosis, a progressive condition where there is a loss of bone that leaves those affected more susceptible to fractures. Women also need an adequate iron intake because they lose iron through menstruation. Women also need an adequate intake of calories to support energy and nutritional needs in order for the body to function properly. The amount of calories that an individual needs varies for each person and is based on age, gender and activity level. As a general recommendation, women between 23 and 50 years of age generally need between 1,700 and 2,200 calories per day to maintain their current energy needs and body weight. Older women generally require fewer calories to support and sustain energy needs. Consuming fewer than 1,500 calories per day, even in attempts to lose weight, can put women at nutritional risk and can result in malnutrition and poor health. For more information on how to calculate one’s nutritional needs, go to www.choosemyplate.gov and insert your personal information. The 2005 Dietary Guidelines for Americans is another reference or guide to assist you in learning to eat a balanced and nutritious diet for good health.
In the United States, infertility affects 1.5 million couples. Many couples seek assisted reproductive technology (ART) for infertility. In the United States in 2010, 147,260 in vitro fertilization (IVF) procedures were carried out, with 47,090 live births resulting. In 2013 these numbers had increased to 160,521 and 53,252. However, about a half of IVF pregnancies result in multiple-birth deliveries, which in turn are associated with an increase in both morbidity and mortality of the mother and the infant. Causes for this include increased maternal blood pressure, premature birth and low birth weight. In addition, more women are waiting longer to conceive and seeking ART.
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There were also supplementation programs that targeted nonpregnant women. National supplementation programs that provided food baskets to low-income families increased maternal BMI and improved household food insecurity (92, 93). However, there were some unintended consequences. In Mexico, food transfer programs disproportionately increased weight gain in overweight women compared with underweight women (93), and 1 study in Bangladesh found that food transfers had larger impacts on men's intake than women's intake, except with less preferred foods (94). Adolescents who received protein-energy supplementation at school showed an increase in weight gain during supplementation, as well as improvements in school attendance and mathematics scores (46, 95). However, the impact of supplementation on micronutrient deficiencies and, specifically, hemoglobin concentration, was limited (46).
Consult your health care professional. Women of childbearing age may want to consider taking folic acid supplements to reduce the risk of having a pregnancy affected with neural tube defects. Many women and teenage girls don't get enough calcium or vitamin D, both of which are critical to healthy bones and avoiding osteoporosis. Some people with diabetes appear to benefit from chromium. Vegetarians, especially vegans, may want to consider supplements to obtain nutrients they aren't getting from animal products.