The extent to which interventions target women more generally, as opposed to just mothers, is not well documented. It requires reflecting on “Who is the woman in women's nutrition?” to identify which women are actually targeted in nutrition interventions, which are not, how they are reached, and gaps in policies and interventions to reach women who are missed. To address this, in this comprehensive narrative review, we 1) summarize existing knowledge about interventions targeting women's health and nutrition in low- and middle-income countries, 2) identify gaps in current delivery platforms that are intended to reach women and address their health and nutrition, and 3) determine strategies to reshape policies and programs to reach all women, at all stages of their lives, with a particular focus on women in low- and middle-income countries.


Downloading that new weight-loss app may not be as beneficial as you think. A study published in American Journal of Preventive Medicine rated the top 30 weight-loss apps using criteria set by the Centers for Disease Control and Prevention’s Diabetes Prevention Plan, which consists of 20 behavior-based strategies, including willpower control, problem solving, stress reduction, motivation, and relapse prevention. Twenty-eight of the programs offered 25 percent or fewer of these essential tummy-trimming tactics. If you’re into tech, use your apps to log food and share your progress on social networks, but don't rely on either too heavily to make lasting lifestyle changes. 
The impact of income-generation interventions on women's nutrition has not been sufficiently evaluated. Income-generating interventions were associated with increases in women's income, empowerment, and household decision-making (161, 164–166). However, these gains were often at the expense of more work for women (5). Income-generation interventions have been associated with increased food-related expenditures, improved household food security, and greater household dietary diversity (160, 161, 165–168). Income-generating interventions targeting adolescents improved their social status; however, these showed no impact on their access to food, nor on individual and household food security (169). There was also limited evidence of impacts of income-generating interventions on women's anthropometric and biochemical nutrition outcomes (5, 169, 170). Increased income was associated with reductions in maternal underweight and anemia, but the reductions were modest (171). Studies suggested that the limited impact was related to continued poor access to health services (167), poor measurement, and the need for longer evaluation periods (164, 165, 167, 169).
Men who choose to drink and can do so responsibly may benefit from one to two drinks a day, counting 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of spirits as one drink. But women face an extra risk: Even low doses of alcohol can raise their risk of breast cancer. So women who choose to drink might be wise to limit themselves to half as much as men.
“Berries, and a lot of fruits, are an excellent source of antioxidants and water-soluble vitamins,” says Julia Hincman, MS, RD, LDN, a registered dietitian with Massachusetts General Hospital in Boston. “They are important for the prevention of cancer and to maintain your weight.” They may also lower your risk of coronary heart disease. One of the many studies done on the benefits of berries looked at blueberries, a known powerhouse. Researchers found that all their benefits remained even after cooking. The serving size is one-half cup of fresh berries (or one-quarter cup if they are dried).

More power to these women, and sure, you could say that fashion and magazines are aspirational over reality-based. If you want reality, look in a mirror, but that’s just it: The super-cut flat abs of Maria Menounos are a far cry from most of us, and can even more damaging to young girls who would do better to avoid the unrealistic ideals that their mothers and older sisters had to grow up with.
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).

Consider including peppermint in your pre-workout snack or drink. In a small study published in the Journal of the International Society of Sports Nutrition, men drank 2 cups water with 0.05 milliliters (basically, a drop) peppermint oil mixed in and then ran on a treadmill to test their stamina and power. The mint appeared to help relax muscles, boost oxygen to muscles and the brain, and elevate pain threshold, leading to improved overall performance.

“It was a privilege to have taken the course with you. Already, I have used the cueing methods on 2 clients. I have also taken the initiative to ask one of my post-natal client today about her birthing journey and she was so open and excited to share with me. It struck me that usually nobody asks them about it as more attention is focused on the baby.”
Shape’s mantra seems a far cry from the health and fitness publications of old. It also significantly strays a bit from the current Men’s Health magazine, which still happily screams at you to get off your ass, already. The Jan/Feb top headline: “Get Back In Shape!”, which sounds like an angry command more than a helpful title to a magazine article. The tagline to Men’s Health is “tons of useful stuff,” which all seem to incorporate words like “hot,” “beast,” and “crush.” Inside, the “useful stuff” ranges from the difference between beef stock and beef broth to how to dump someone before Valentine’s Day. And reps. Lots of reps. These guys love reps.
Women also understand the relationship between working out and how it can affect everything they do in life. Most major health issues affecting women can be treated or improved by a simple workout plan. Weight loss and cardiovascular exercise help everything from stress and heart disease to diabetes. And don't forget the small, but important "fringe" benefits of fitness such as just feeling better about yourself, having more energy for your family and loved ones and living a life that begins every day by feeling good about getting up and getting moving.
Nutrition-sensitive approaches are difficult to link to women's nutritional status (5, 102). This is due to limited measurement of benefits to program beneficiaries, families, households, and communities, limited timeframes to evaluate long-term impact, logistical and political realities that make implementation difficult, and different priorities of different stakeholders in multisectoral programs (102). Many nutrition-sensitive approaches, as will be described, thus focus on more distal measures of impact (e.g., coverage, knowledge) and not more proximal measures of women's nutritional status (e.g., BMI, anemia status, etc.).
Women often received micronutrient supplements during antenatal and postnatal care (13, 35–42, 51, 60), and, as such, supplementation was often targeted to pregnant and lactating women. The delivery of micronutrient supplementation commonly occurred in health care settings for at-home consumption. Community-based antenatal care that involved home visits by community health workers was also a common delivery platform for supplementation delivery. There were some studies that reported micronutrient supplementation to adolescents, women of reproductive age, pregnant women, and women with young children outside of the antenatal care setting. These included primary health care clinics, home visits, community centers, pharmacies, and workplaces (32, 38–43, 45, 52, 53). Adolescent girls were also reached by community- and school-based programs (26, 41, 46). School-based programs were more efficacious in reducing rates of anemia among adolescent girls, compared with the community-based interventions (26, 46). However, many of the reported studies to date involved small samples of adolescents in controlled settings, and additional research is needed on the effectiveness of these programs (59, 62).
Calcium: Although some bone loss is inevitable with age, women can slow the process by getting enough calcium and vitamin D. Women between the ages of 50 and 70 need 1200 mg of calcium and 600 IU of Vitamin D a day. Women older than 70 require 1200 mg of calcium and 800 IU of Vitamin D a day. Because the skin becomes less efficient at converting sunlight to vitamin D as we age, older women may need more vitamin D in the form of supplements. Talk to your doctor.
Although creating financial incentives to lose weight isn't a new idea, now we know cashing in to stay motivated works long-term. In the longest study yet on this topic, Mayo Clinic researchers weighed 100 people monthly for one year, offering half the group $20 per pound lost plus a $20 penalty for every pound gained. Those in the monetary group dropped an average of nine pounds by the end of the year, while non-paid participants shed about two pounds. If you’re ready to gamble away weight, consider sites such as Healthywage, FatBet, or stickK.
Many women and teenage girls don't get enough calcium. Calcium-rich foods are critical to healthy bones and can help you avoid osteoporosis, a bone-weakening disease. Additionally, recent studies suggest that consuming calcium-rich foods as part of a healthy diet may aid weight loss in obese women while minimizing bone turnover. The National Institute of Medicine recommends the following calcium intake, for different ages:

Not getting enough fiber can lead to constipation and can raise your risk for other health problems. Part of healthy eating is choosing fiber-rich foods, including beans, berries, and dark green leafy vegetables, every day. Fiber helps lower your risk for diseases that affect many women, such as heart disease, diabetes, irritable bowel syndrome, and colon cancer. Fiber also helps you feel full, so it can help you reach and maintain a healthy weight.

To help you learn how to eat healthfully, start with the U.S. Department of Agriculture's (USDA) dietary guidelines system, which you can find at http://www.mypyramid.gov. The MyPyramid system, which looks somewhat like the familiar food pyramid of old, offers guidance based on individual needs and replaces "serving" recommendations with actual amounts of food. It also emphasizes the importance of balancing nutritious (and tasty!) food choices from all food groups every day with daily physical activity.
  Markets and retail  ↓/NC anemia, ↑ MN status (Hgb, Fe stores, ferritin, folate, iodine), ↓/NC goiter prevalence, ↓ folate deficiency, NC retinol-binding protein, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe)  ↓/NC anemia, ↑ Hgb, ↑/NC Fe stores, ↑/NC serum ferritin, ↑ serum folate, ↑ urinary iodine, ↓ goiter prevalence, ↓ folate deficiency, NC retinol-binding protein, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe)  ↓/NC anemia, ↑ serum folate, ↓ folate deficiency, ↑ urinary iodine concentration, ↓ goiter prevalence, ↑ mean adequacy ratio of diet, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe)  ↑/NC Fe stores, ↑/NC serum ferritin, ↑ serum folate, NC B-12 deficiency, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe) 
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).
It doesn't matter how many pushups you can do in a minute if you're not doing a single one correctly. “There is no point in performing any exercise without proper form,” says Stokes, who recommends thinking in terms of progression: Perfect your technique, then later add weight and/or speed. This is especially important if your workout calls for performing “as many reps as possible” during a set amount of time. Choose quality over quantity, and you can stay injury-free.

Calories. Most times, women need fewer calories. That’s because women naturally have less muscle, more body fat, and are usually smaller. On average, adult women need between 1,600 and 2,400 calories a day. Women who are more physically active may need more calories. Find out how many calories you need each day, based on your age, height, weight, and activity level.


It’s the fourth week in January, the time when many new year’s resolutions are faltering, if they haven’t fallen away altogether. If the diet/exercise/fitness menu was on your list for 2018, you’re not alone, as many people try to eat less in the beginning of the year to help combat their excesses from Halloween candy, Thanksgiving dinner, and end-of-year sweets.
Current understanding of biologic processes indicates that women's nutritional status before and during early pregnancy may play an important role in determining early developmental processes and ensuring successful pregnancy outcomes. We conducted a systematic review of the evidence for the impact of maternal nutrition before and during early pregnancy (<12 weeks gestation) on maternal, neonatal and child health outcomes and included 45 articles (nine intervention trials and 32 observational studies) that were identified through PubMed and EMBASE database searches and examining review articles. Intervention trials and observational studies show that periconceptional (<12 weeks gestation) folic acid supplementation significantly reduced the risk of neural tube defects. Observational studies suggest that preconceptional and periconceptional intake of vitamin and mineral supplements is associated with a reduced risk of delivering offspring who are low birthweight and/or small-for-gestational age (SGA) and preterm deliveries (PTD). Some studies report that indicators of maternal prepregnancy size, low stature, underweight and overweight are associated with increased risks of PTD and SGA. The available data indicate the importance of women's nutrition prior to and during the first trimester of pregnancy, but there is a need for well-designed prospective studies and controlled trials in developing country settings that examine relationships with low birthweight, SGA, PTD, stillbirth and maternal and neonatal mortality. The knowledge gaps that need to be addressed include the evaluation of periconceptional interventions such as food supplements, multivitamin-mineral supplements and/or specific micronutrients (iron, zinc, iodine, vitamin B-6 and B-12) as well as the relationship between measures of prepregnancy body size and composition and maternal, neonatal and child health outcomes.
The trick to biking uphill is to look ahead and anticipate. “Try to plan for what's coming,” says Georgia Gould, a LUNA pro athlete and 2012 Olympic bronze medalist in women's mountain biking. “Start shifting down one gear at a time for a smooth, energy-saving transition. Ideally your cadence should stay the same as you transition from harder to easier gears.”
The ’90s turned toward a lot more talk about “fat-blasting” in the Snackwell’s/heroin chic era. But as the new millennium dawned, front cover messages started to sway from scolding to encouraging. Which makes sense: Why would someone want a magazine to yell at them? That’s why the current crop of women’s health magazine headlines stress taking time for yourself over how flat your abs might get. As Elizabeth Goodman, editor-in-chief of Shape magazine, explained via email: “As a women’s magazine, it’s our job to help women be their best selves—both inside and out. However, we don’t want to set the standard for normal or tell women what normal is; we want to encourage women to find and be proud of their normal… Our approach with our readers is not to judge or demand, just to inspire and support.”

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
Also known as “myofascial release,” foam rolling is an easy way to benefit your entire body. “While stretching addresses the length of muscle fiber, rolling improves the quality of the tissue,” says Rob Sulaver, CEO and founder of Bandana Training. This leads to tension- and pain-free muscles, which function better so you perform better. Be sure to roll for five minutes before your workout. Not sure what to do? Try these 10 ways to use a foam roller.
  Home visits  ↓/NC anemia, ↑/NC Hgb, ↑ serum ferritin, ↑/NC serum retinol, ↓ vitamin A deficiency  ↓/NC anemia and Fe-deficiency anemia, ↑/NC Hgb, ↑/NC serum ferritin, ↑ serum folate, ↑ serum zinc, NC serum retinol  ↓ anemia, ↑ Hgb, ↑ serum ferritin, ↑/NC serum retinol, ↑ erythrocyte thiamine diphosphate concentrations, ↓ night blindness, ↑/NC weight gain  ↓ anemia, ↑/NC Hgb, ↑ serum ferritin, NC serum retinol, ↑ serum calcium, ↑ 25(OH)D concentrations, ↓ PTH, ↓ bone turnover 
Katz DL, O'Connell M, Yeh MC, Nawaz H, Njike V, Anderson LM, Cory S, Dietz W; Task Force on Community Preventive Services. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep  2005;54(RR-10):1–12.
Shape’s mantra seems a far cry from the health and fitness publications of old. It also significantly strays a bit from the current Men’s Health magazine, which still happily screams at you to get off your ass, already. The Jan/Feb top headline: “Get Back In Shape!”, which sounds like an angry command more than a helpful title to a magazine article. The tagline to Men’s Health is “tons of useful stuff,” which all seem to incorporate words like “hot,” “beast,” and “crush.” Inside, the “useful stuff” ranges from the difference between beef stock and beef broth to how to dump someone before Valentine’s Day. And reps. Lots of reps. These guys love reps.
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.
“The reason most people don't see changes isn't because they don't work hard—it's because they don't make their workouts harder,” says Adam Bornstein, founder of Born Fitness. His suggestion: Create a challenge every time you exercise. “Use a little more weight, rest five to 10 seconds less between sets, add a few more reps, or do another set. Incorporating these small variations into your routine is a recipe for change,” he says.
It sounds counterintuitive, but fatty fish are actually good for you because they deliver omega-3 polyunsaturated fatty acids (PUFAs), fats with cardiovascular and anti-inflammatory benefits. While fish oil capsules will help you meet your PUFA needs, studies have found that fish itself offers even more nutritional benefits, including vitamin D, selenium, and antioxidants. Among the best choices are salmon, albacore tuna, herring, and trout. Recommendations are for 1 gram of PUFAs daily for people with coronary heart disease and at least 250 to 500 mg daily for those who want to prevent it.
Iron: Essential for healthy blood cells, iron becomes especially important when girls begin to menstruate. With each period, a woman loses small amounts of iron. “About 10% of American women are iron deficient,” says Dorothy Klimis-Zacas, PhD, a professor of nutrition at the University of Maine and co-editor of Nutritional Concerns of Women (CRC Press, 2003). “About 5% have iron deficiency anemia.” Symptoms of low iron include fatigue, impaired immunity, and poor performance at school or work.
Iron helps to create the hemoglobin that carries oxygen in your blood. It’s also important to maintaining healthy skin, hair, and nails. Due to the amount of blood lost during menstruation, women of childbearing age need more than twice the amount of iron that men do—even more during pregnancy and breastfeeding. However, many of us aren’t getting nearly enough iron in our diets, making iron deficiency anemia the most common deficiency in women.

Oaks BM, Young RR, Adu-Afarwuah S, Ashorn U, Jackson KH, Lartey A, Maleta K, Okronipa H, Sadalaki J, Baldiviez LM et al. Effects of a lipid-based nutrient supplement during pregnancy and lactation on maternal plasma fatty acid status and lipid profile: results of two randomized controlled trials. Prostaglandins Leukot Essent Fatty Acids  2017;117:28–35.


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.
SOURCES: Elaine Turner, PhD, RD, associate professor, department of Food Science and Human Nutrition, University of Florida, Gainesville. Sharon B. Spalding, MEd, CSCS, professor, physical education and health; and associate director, Virginia Women's Institute for Leadership, Mary Baldwin College Staunton, Va. American Dietetic Association web site. Institute of Medicine at the National Academies web site.
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.
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.
Health care experts haven't reached a consensus on the issue of vitamin and mineral supplements. Many say that if you are healthy and eat a well-balanced diet, you don't need any. But not all of us eat a well-balanced diet. And sometimes, you may follow a nutritious diet and still be deficient. Many women fail to get the adequate amount of vitamins and minerals. Stress increases your need for vitamins and minerals, especially C, B-complex and zinc.
It’s one thing to tell women that their curves are awesome; it’s another thing to depict women who actually have them, making Shape’s #LoveMyShape section the most inspiring part of its site, much more than that bit about those last five pounds. Showing always trumps telling. Ramping up the normal-sized body movement might actually help get women on the road to “Hot & Happy”—as they realize that the order of those two adjectives should be transposed.
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