The Global Alliance for Improved Nutrition (GAIN) and Wellspring Development designed and hosted a series of in-person and online consultations with partners of the Dutch Ministry of Foreign Affairs to examine challenges in improving the quality of diets of population groups living in rural areas of Low and Lower-Middle Income countries. These groups still largely consume nutrient-inadequate, even unhealthy, diets and face heavy burdens of malnutrition. This sixth and final paper considers how to recognise and manage trade-offs that inevitably emerge in large scale programmes. The discussions focused on how to identify when trade-offs occur and possible ways of addressing these