This paper reviews current knowledge and experience with food-based approaches to reduce vitamin A and iron deficiencies. It presents a review of recently published literature, highlights some of the lessons learned, and identifies knowledge gaps and research priorities. The main strategies reviewed are food-based interventions that aim at (1) increasing the production, availability and access to vitamin A and iron-rich foods through the promotion of home production; (2) increasing the intake of vitamin A and iron-rich foods through nutrition education, communication, social marketing and behavior change programs to improve dietary quality among vulnerable groups; and (3) increasing the bioavailability of vitamin A and iron in the diet either through home processing techniques or food-to-food fortification strategies. Plant breeding strategies are also discussed because of their potential to increase the content of vitamin A and iron in the diet as well as their bioavailability. The review highlights two contrasting facts. On the one hand, it is clear that the technologies and strategies reviewed have the potential to address many of the concerns about both the intake and the bioavailability of vitamin A and iron among impoverished populations. On the other hand, enormous information gaps still exist in relation to both the efficacy and the effectiveness of most of the strategies reviewed, even for approaches as popular as home gardening. Significant progress has been achieved in the past 10 years in the design and implementation of food-based approaches, particularly with respect to the new generation of projects integrating production and nutrition education and behavior change strategies. Yet, little has been done to evaluate their efficacy, effectiveness, feasibility, sustainability and their impact on the diets and nutritional status of at-risk populations. The same question as that posed in previous reviews decades ago remains at the end of the present review: what really can be achieved with food-based interventions to control vitamin A and iron deficiency? Food based approaches could be an essential part of the long-term global strategy to alleviate micronutrient deficiencies but their real potential is still to be explored.