Villanova University was founded in 1842 by the Order of Saint Augustine. To this day, Villanova’s Augustinian Catholic intellectual tradition is the cornerstone of an academic community in which students learn to think critically, act compassionately and succeed while serving others. Villanova prepares students to become ethical leaders who create positive change everywhere life takes them.


The strength of the Villanova experience comes in part from the University’s welcoming community. All members are bonded together by a shared responsibility to uphold the ideals of Saint Augustine and let the principles of truth, unity and love guide their lives. The Villanova community helps students grow intellectually, professionally and spiritually, and challenges them to reach their full potential.


The University’s rigorous academic experience, rooted in the liberal arts, forms an environment in which students and professors are partners in learning. The Villanova community is dedicated to providing a personalized experience that fosters every student’s intellectual and spiritual well-being. As part of their education, students are encouraged to enrich their own lives by working for those in need. Through academic and service programs, students use their knowledge, skills and compassion to better the world around them.


There are more than 10,000 undergraduate, graduate and law students in the University’s six colleges—the College of Liberal Arts and Sciences, the Villanova School of Business, the College of Engineering, the College of Nursing, the College of Professional Studies and the Villanova University Charles Widger School of Law. These colleges are the setting for an experience that develops both the heart and the mind, and creates the atmosphere where students are called to ignite change.


Villanova University is located in a suburban community 12 miles west of Philadelphia, Pa.

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Nutrition counselor and coach, Nutrition for Living Counseling and Consulting Services, Exton, PA 

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A published author in national and international journals, Diewald is an excellent source on news and trends in healthy eating and nutrition education programs for children and adults. She can address new approaches to treating and preventing obesity, as well as the need for therapeutic diets for medical conditions such as Type 2 diabetes, PCOS, heart and kidney disease.

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new-policy-on-bmi-use-will-change-how-physicians-approach-diagnoses-and-care

Associate Director, MacDonald Center for Nutrition Education and Research  | M. Louise Fitzpatrick College of Nursing

The Body Mass Index – or BMI – table was created in the mid-1800s, and for the last several decades has been viewed as the choice tool to diagnose obesity. However, the American Medical Association (AMA) recently issued a policy clarifying the role of BMI after taking a comprehensive look at both its benefits and limitations as a diagnostic tool.

In short, the new policy urges physicians to use BMI only in conjunction with other measures of risk and recognizes the historical shortcomings of the oft-used formula. 

Lisa Diewald, MS, RDN, LDN, is the program manager of the MacDonald Center for Nutrition Education and Research with Villanova’s M. Louise Fitzpatrick College of Nursing. She applauds the AMA for embracing a more holistic approach to weight and health in individuals.

“This is a huge step forward and I think it will ultimately lead to better health care and an improved practitioner-patient relationship,” Diewald said.

To understand why, one must first understand the history of BMI’s use. The formula that spits out the number we have all come to understand as our BMI considers a person’s height and weight. It was developed in the mid-19th century by a Belgian sociologist to measure the socially ideal person. The modern term and application came about in the 1972 and has been a routine measurement ever since because it is easy, fast, costs nothing and in some cases, said Diewald, does correlate with body fat.

But in recent years, large scale studies have exposed some of the limitations of the measure, building to the point where they needed to be weighed against the overt benefits. For starters, BMI does not measure body fat – or adiposity – directly. Adiposity, per Diewald, is more closely associated with health risk than BMI.

“For this reason, health risk for some individuals with normal BMI but high body fat has been underestimated, and some with high BMI but normal body fat levels have been overestimated,” she said.

 
Nor does it “differentiate between muscle, bone and body fat, or distribution of fat on the body,” Diewald said. “We know that all these factors can influence health and chronic disease risk.”

Other comorbidities or chronic conditions that wouldn’t show up on a BMI chart alongside a number in the “normal” range can also impact health. Conversely, there are health conditions that might be incorrectly assumed just because a BMI is high.

“Not every person with a high BMI experiences these chronic conditions, so developing a more holistic approach can lead to better assessment, treatment and outcomes,” Diewald said.

Another shortfall she pointed out was its failure to factor in gender, race, body composition, ethnicity or physical activity level. Think back to the origins of the chart, intended to be a social standard created in Europe nearly two hundred years ago.

 
“BMI tables were originally designed in the 1800’s using a population of white men,” Diewald said. “Understandably, at one point in time it was all we had to evaluate weight status, but it may not be accurate to use this standard alone with all groups of people.”

These societal, gender and racial/ethnic factors led the AMA to explicitly cite “historical harm, use for racist exclusion and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations” in the new policy on its clinical use. Additionally, the policy addressed the differences in body composition across genders, races and ages that were not being considered.

 
There is also an ignored mental component in its use to diagnose obesity, which can lead to avoidance of doctor visits and, in turn, further physical issues.

  
“Obesity is a multifactorial, complex condition and addressing it with individuals needs to be done with empathy and sensitivity, beginning with how it is measured,” Diewald said. “There are numerous factors influencing weight well beyond simply food intake, physical activity level and BMI, so it is important for practitioners to recognize that and communicate this to patients.

 
“It is extremely difficult for people with higher weight to be told that they have a high BMI and simply need to eat less and move more. When BMI is used as the sole indicator of weight status, this can be psychologically damaging. We know that many who have been told to lose weight simply based on a high BMI may avoid going to the doctors for routine medical visits and skip necessary preventive care.”

It will not be easy, she said, to move away from a method used for so long that has been ingrained as a part of a routine medical visit, but Diewald thinks utilization of the tool in conjunction with other assessments is the best way put this new policy to practice.

She advocates for measures such as “Using BMI as only one of several indicators of chronic disease risk, asking permission to discuss weight and health risk, [and] using shared decision-making between practitioners and patient to determine course of treatment.”

Education is also paramount to proper assessment of weight-related health risks.

“Education cannot stop with physicians, however,” she said. “I think this provides an excellent launching pad for enhanced collaboration among health professionals such as dietitians, nurses, nurse practitioners, physician’s assistants and others involved in providing  care, nutrition counseling and lifestyle modification support to patients… Doing this can better fine tune recommendations for treatment, leading to improved outcomes.”



New Policy on BMI Use Will Change How Physicians Approach Diagnoses and Care

children-face-type-2-diabetes-health-concerns-after-a-year-at-home

Some children are facing health concerns after a year of attending school online. During the pandemic, research found cases of type 2 diabetes among children more than doubled. Lisa Diewald, MS, RD, LDN, Program Manager for the MacDonald Center for Obesity and Education weighed in on causes and potential prevention methods going forward. 

“We know that physical activity level, eating habits, weight status and other lifestyle factors play a significant role in the development of type 2 diabetes in adults and in children,” said Diewald. “Because of disruptions for many children in all four factors during the pandemic, (on top of pre-existing challenges), we are starting to see trickle-down health effects involving lifestyle-related chronic diseases, such as type 2 diabetes and children are not immune to these health effects.”

Type 2 diabetes is related to obesity, exercise habits and diet. Children who struggle with weight may also have many social, genetic and environmental factors impacted by the accelerated risk seen through the pandemic. For example, the absence of healthy school meals while learning from home negatively impacted some children, as processed foods became replacements. 

Eating habits are also largely impacted by one’s mental state. 

“Like adults, children learn to cope with stress and anxiety in different ways. For some, this means reaching for comfort foods, which are often high in refined carbohydrates, saturated fat and sugar-all risk factors for T2 diabetes if consumed in excess,” said Diewald. “These foods can contribute to unhealthy weight gain, especially when physical activity is limited as well. The bad news is that it does not take a lot of weight gain to put a child who is already at risk at greater risk for diabetes.”

But families should be aware of the good news that small changes can make a big difference and that prevention is possible.

Diewald recommends a few small changes to alter a sedentary routine for parents and schools:
•	Build 1 minute brain breaks during the day for activity such as stretching or running up and down the stairs
•	Keep healthy snacks available and sugar sweetened snacks and drinks less visible
•	Create safe and walkable opportunities for children to add physical activity
•	Look for outdoor community sponsored activities that encourage physical activity that can provide safe and accessible physical activity opportunities

Additional measures for parents to prevent the unhealthy coping with foods including working with children to make a list of fun alternative activities (unrelated to food) to do when boredom kicks in and posting in an accessible place in the home. Parents can act as role models and let children see that parents are working on more effective ways to cope as well.

Though the risk of type 2 diabetes has been increasing during the past year, many factors can continually increase a person’s risk. These tips can provide the valuable tools for prevention in the future. 

“Teaching children healthier ways to cope with boredom and depression than eating are skills that can help for a lifetime, well beyond the pandemic,” said Diewald. 

To speak with Diewald, email mediaexperts@villanova.edu.



Children Face Type 2 Diabetes Health Concerns After a Year at Home

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