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).
Nutrition education, including communication and counseling to raise awareness and promote nutrition-related knowledge and behaviors aligned with public health goals, was found to increase women's knowledge and improve women's dietary diversity and protein intake (15–21). It also reduced energy intake of overweight women over a 9-mo period (22). However, evidence for the effectiveness of nutrition education interventions showed mixed impact on biological and anthropometric markers of women's nutritional status (14–16, 18, 23–29). This could be due to lack of statistical power given the small sample sizes of the reviewed studies. For adolescent girls, nutrition education was found to reduce odds of overweight, and improve knowledge, dietary intake, physical activity, and sedentary behavior (27, 29, 30). This was particularly true for nutrition education that lasted longer than 12 mo (29). Nutrition education was also more strongly associated with changes in health outcomes in studies evaluating childhood obesity treatment, rather than childhood obesity prevention (29).
Complementing income-generating interventions with interventions that more directly target women's nutrition has potential to have greater impacts on women's nutritional status (171). Integrated interventions were associated with improvements in health knowledge and behaviors, as well as increased intake of nutrient-rich foods (5, 164, 169, 170, 172). In Bangladesh and Cambodia, the aforementioned EHFP program was associated with increased income, decision-making power in the household, food expenditure (including on oils, salts, spices, fish, rice, and meat), and consumption of fruits and vegetables from home gardens (160, 173). There was also limited, but mixed, evidence of income-generating interventions and behavior change communication causing improvements in maternal anemia and BMI (164, 168, 170).
Women's nutrition is often eclipsed by maternal nutrition. There are important linkages between maternal nutrition and the health, cognitive development, and earning potential of future generations (1). However, with reduced childbearing and longer life spans, women's experiences extend beyond motherhood (2). Interventions and policies that target women solely as mothers fail to account for women before they conceive, after they no longer engage with programs targeting maternal–child health, as well as those who never have children (3, 4). A woman's nutrition should matter not (only) because of her reproductive potential, but because it is fundamental to her rights as a person and to her well-being and ability to thrive (5–7). With increasing attention to the nutritional needs of adolescent girls (8, 9), in addition to the rising prevalence of overweight, obesity, and noncommunicable disease affecting women later in life (10), it is becoming more imperative that interventions reach women at all life stages.
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.
When you’re at the bar or a party and starving, your options aren’t always the best. But if it’s bruschetta, chips and salsa, or wings, go for the chicken (though nuts would be even better). Protein fills you up faster than carbs do, making it less likely that you’ll overeat, says Christopher Ochner, Ph.D., a research associate at New York Obesity Nutrition Research Center at St. Luke's Roosevelt Hospital Center. And since it’ll keep you satiated longer, you won’t be as tempted when your friend orders a brownie sundae or brings out a tray of blondies.
There are many well-documented challenges in disentangling empowerment interventions from other interventions with which they are delivered. Empowerment interventions are often integrated into income-generating activities and agricultural extension, and many empowerment approaches are retroactively classified as “nutrition-sensitive” despite a lack of nutrition components in the original intervention designs (5). In addition, many studies are limited in scope and their evaluation of nutrition outcomes (159), and it is difficult to evaluate which dimensions of women's empowerment matter most for nutrition (162). Notably, indicators to quantify women's empowerment are also not used consistently and vary widely between individual studies (158).
Systematically report and evaluate women's nutrition outcomes in research and program evaluation documents in low- and middle-income countries, including outcomes for adolescents, older women, and mothers (as opposed to reporting on women's nutrition as child nutrition outcomes alone). When possible, report and evaluate differences by setting (e.g., rural compared with urban) and socioeconomic status.