No matter how busy you are, eat lunch before 3 p.m., a Spanish study suggests. Researchers placed a group of women on a diet for 20 weeks; half ate lunch before 3 and half consumed their midday meal after 3. Although both groups’ daily caloric intake, time spent exercising and sleeping, and appetite hormone levels were the same, those who lunched late lost about 25 percent less weight than earlier eaters. Being European, lunch was the biggest meal of the day for these women, constituting 40 percent of their calories for the day, so consider slimming down dinner in addition to watching the clock.
For this comprehensive narrative review, we evaluated both nutrition-specific and nutrition-sensitive interventions. Nutrition-specific approaches are those that address the immediate determinants of nutrition (e.g., food and nutrient intake, diet-related practices and behaviors, disease, etc.), whereas nutrition-sensitive approaches are those that address the underlying determinants of nutrition (e.g., food security, access to resources, safe and hygienic environments, adequate health services, etc.) (5, 12). We evaluated the following nutrition-specific interventions described by Bhutta et al. (13, 14): nutrition counseling and education, micronutrient supplementation and fortification, protein and energy supplementation, and lipid-based supplementation. We also included the following nutrition-sensitive approaches described by Ruel and Alderman (5) and Bhutta et al. (14): health care; family planning; water, sanitation, and hygiene (WASH); empowerment; income-generation; education; and social protection. For each intervention, we 1) described the scale and coverage of the intervention, when available; 2) summarized the evidence of effectiveness for women's health and nutrition outcomes; and 3) described and evaluated the target population and delivery platforms, as described in the published articles and as summarized in Table 1. The delivery of interventions included the physical platforms, as well as the adherence and the implementation challenges of the different interventions.
Women have traditionally been disadvantaged in terms of economic and social status and power, which in turn reduces their access to the necessities of life including health care. Despite recent improvements in western nations, women remain disadvantaged with respect to men. The gender gap in health is even more acute in developing countries where women are relatively more disadvantaged. In addition to gender inequity, there remain specific disease processes uniquely associated with being a woman which create specific challenges in both prevention and health care.
In addition, more research is needed to evaluate the impact of targeting women alone compared with targeting women alongside other members of their families and communities (e.g., with groups of other women, men, husbands, children, parents, in-laws, other family members, other community members, etc.). Interventions that targeted women with their children during child health visits or alongside other members of their communities through community mobilization and mass media campaigns showed improvements in knowledge and some health and nutrition behaviors of women. The inclusion of boys and men, for instance, as well as the inclusion of other family and community members, could enhance the impact and delivery of nutrition interventions for women through support of certain practices, reminders, time-savings, and normalization of nutrition behaviors. However, more research is needed to identify effective targeting mechanisms (i.e., alone or alongside other members of households and communities) and we expect that these will likely need to be context- and content-specific.
Globally, women's access to health care remains a challenge, both in developing and developed countries. In the United States, before the Affordable Health Care Act came into effect, 25% of women of child-bearing age lacked health insurance. In the absence of adequate insurance, women are likely to avoid important steps to self care such as routine physical examination, screening and prevention testing, and prenatal care. The situation is aggravated by the fact that women living below the poverty line are at greater risk of unplanned pregnancy, unplanned delivery and elective abortion. Added to the financial burden in this group are poor educational achievement, lack of transportation, inflexible work schedules and difficulty obtaining child care, all of which function to create barriers to accessing health care. These problems are much worse in developing countries. Under 50% of childbirths in these countries are assisted by healthcare providers (e.g. midwives, nurses, doctors) which accounts for higher rates of maternal death, up to 1:1,000 live births. This is despite the WHO setting standards, such as a minimum of four antenatal visits. A lack of healthcare providers, facilities, and resources such as formularies all contribute to high levels of morbidity amongst women from avoidable conditions such as obstetrical fistulae, sexually transmitted diseases and cervical cancer.