Danielle Hawkins

New college study finds personalized dietary recommendations combined with continuous glucose monitoring helps individuals with prediabetes lose more weight

dhawkin — Fri, 06 Sep 2024 14:45:49 +0000

New college study finds personalized dietary recommendations combined with continuous glucose monitoring helps individuals with prediabetes lose more weight dhawkin Fri, 09/06/2024 - 10:45

In This Story

Raedeh Basiri, PhD, RDN

Lawrence J. Cheskin, MD

The randomized clinical trial found that this approach can enhance weight loss and reduce carbohydrate intake in individuals with prediabetes.

Individuals with prediabetes who had obesity and overweight are at high risk of developing diabetes and its related medical conditions. However, long-term weight loss can be challenging, and programs that focus on weight loss through calorie restriction can be difficult to maintain.

A new College of Public Health study led by Raedeh Basiri in the Department of Nutrition and Food Studies used new methods to help individuals with prediabetes who had obesity and overweight lose weight without following a weight-loss diet. The study didn’t focus on a reduction in calories or an increase in physical activity. Instead, it focused on healthy eating and personal goal setting based on how the body responds to different types of foods. They found that using continuous glucose monitoring devices (CGMs) along with personalized nutrition therapy doubled participants’ weight loss and fat reduction. This suggests that when participants can see the effects of foods on their blood glucose, they follow the recommendations more seriously.

“Personalizing dietary recommendations can reduce unnecessary restrictions while still supporting weight loss, improved body composition, and blood glucose control in individuals with prediabetes who had overweight and obesity,” explained Basiri. “This approach promotes greater compliance and long-term sustainability due to fewer dietary restrictions.”

The randomized clinical trial followed 30 participants over 30 days. All participants wore CGMs and received personalized nutrition recommendations for lowering blood glucose. However, the treatment group was able to see the blood glucose results in real time, and the dietitian also used this CGM data to further tailor their dietary recommendations. Both the control group and the dietitian were blinded to the CGM data, and it couldn’t be used to further tailor their dietary recommendations.

Both groups lost significant weight and fat mass. However, the treatment group lost more than double the amount of weight and fat mass than the control group. The treatment group also decreased their consumption of carbohydrates, increased their physical activity, and had more compliance with the dietary recommendations.

Basiri explained, “Individuals who could see the effects of foods on their blood glucose in real time showed notably higher compliance, suggesting that real-time feedback from CGMs, combined with personalized glucose control education, can lead to significant weight loss and body composition improvements without focusing solely on weight loss as the primary goal.”

“The approach we took in this study, personalizing dietary recommendations combined with using CGMs could be a great alternative for controlling blood glucose in individuals at risk of type 2 diabetes who have overweight or obesity and can’t achieve or maintain their weight loss goals.”

This is the first study to evaluate the effects of personalized nutrition therapy along with using CGM on body composition in individuals with prediabetes.

“Personalized Nutrition Therapy without Weight Loss Counseling Produces Weight Loss in Individuals with Prediabetes Who Are Overweight/Obese: A Randomized Controlled Trial” was published online in Nutrients in July 2024 and was chosen as a featured paper in Obesity and Energetics offerings. The Obesity and Energetics Offerings (OEO) is a collaboration between Indiana University and the University of Alabama at Birmingham, providing curated resources on obesity, metabolism, and energy balance. It serves as a valuable hub for researchers and professionals, offering the latest research, news, and policy updates in the field. The organization emphasizes the importance of scientific rigor and reliability in obesity research.

The research was supported by George Mason’s College of Public Health.

Lawrence J. Cheskin from George Mason’s College of Public Health was also an author of the paper.

Topics

Diabetes

Prediabetes

Weight Control

Nutrition and Weight Management

Department of Nutrition and Food Studies

Personalized Medicine

blood glucose control

Cancer Survivors Overestimate the Quality of their Diets, Finds First Study on the Topic

dhawkin — Thu, 25 Jun 2020 13:41:05 +0000

Cancer Survivors Overestimate the Quality of their Diets, Finds First Study on the Topic dhawkin Thu, 06/25/2020 - 09:41

George Mason University study finds cancer survivors estimate a higher than actual intake of fruits, vegetables, and whole grains, providing opportunities for interventions to improve cancer survival rates.

There are 15 million cancer survivors in the United States, and prior research has provided strong evidence that lifestyle interventions, such as diet and physical activity, are especially important in the long-term recovery of cancer survivors. Energy imbalance – when energy expenditure does not equal energy intake- and metabolic changes after cancer treatment can directly affect the risk of cancer relapse, progression, and mortality, making it critical for cancer patients and survivors to accurately estimate their dietary intake.

However, new research led by George Mason University’s College of Health and Human Services found that the majority of cancer survivors (56%) tend to overestimate the quality of their diets, increasing the risk of energy imbalance. They report a higher than actual intake of fruits, vegetables, and whole grains, and a lower than actual intake of empty calories.

New Mason research found that the majority of cancer survivors tend to overestimate the quality of their diets, reporting a higher than actual intake of fruits, vegetables, and whole grains, and a lower than actual intake of empty calories.

Dr. Hong Xue led the study published in the European Journal of Clinical Nutrition. “Our study is an important step in the fight against cancer,” explains Xue. “Now that we know the difference in perceived and actual diet quality among survivors, we can design tailored interventions to improve diets in this population. We know from earlier studies that this can reduce the risk of cancer relapse and improve long-term outcomes.”

Xue and colleagues analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2005-2014 on 2,361 cancer survivors and 23,114 participants who had not had cancer as a comparison group. They analyzed the nationally representative NHANES data combined with participants’ scores on the Healthy Eating Index (HEI) 2010, which measures adherence to dietary recommendations, as a measure of diet quality.

They found that cancer survivors’ diet quality has not improved over the past 10 years. Additionally, cancer survivors’ diets were generally poor as measured by the HEI, although healthier than the diets reported by the general population.

Older participants, those with higher incomes or levels of education, and Hispanic participants were more likely to overestimate their diet quality. Those who overrated their diet quality also had poorer diets overall than those who under-rated their diet quality.

This study was supported in part by research grants: P30 CA016059 “Massey Cancer Center Core Support” (NIH-NCI) and U54TR001366 “Racial Disparities in Breast Cancer Treatment and Outcomes: A Transdisciplinary Approach” (NCATS/CTSA). The content is the responsibility of the authors and does not necessarily represent the official views of the funder.

About George Mason University

George Mason University is Virginia's largest and most diverse public research university. Located near Washington, D.C., Mason enrolls 38,000 students from 130 countries and all 50 states. Mason has grown rapidly over the past half-century and is recognized for its innovation and entrepreneurship, remarkable diversity and commitment to accessibility. For more information, visit https://www2.gmu.edu/.

About the College of Health and Human Services

George Mason University's College of Health and Human Services prepares students to become leaders and shape the public's health through academic excellence, research of consequence and interprofessional practice. The College enrolls 1,917 undergraduate students and 950 graduate students in its nationally recognized offerings, including: 5 undergraduate degrees, 12 graduate degrees, and 11 certificate programs. The College is transitioning to a college public health in the near future. For more information, visit https://chhs.gmu.edu/.

Precision Discovery of Neuroimaging Biomarkers for Parkinson’s Disease

dhawkin — Tue, 24 Mar 2020 20:57:32 +0000

Precision Discovery of Neuroimaging Biomarkers for Parkinson’s Disease dhawkin Tue, 03/24/2020 - 16:57

Dr. F. DuBois Bowman, professor and dean of the School of Public Health at the University of Michigan, was the fourth speaker in the College of Health and Human Services Dean’s Seminar Series. Bowman shared his research on precision discovery of neuroimaging biomarkers for Parkinson’s disease.

There are more than 10 million people globally with Parkinson’s Disease and more than 60,000 diagnoses each year in the United States. That number is expected to increase, in fact by 2020, we expect to have 930,000 adults 45 or older with Parkinson’s Disease, and more than 1.2 million by 2030.

Bowman is part of the Parkinson's Disease Biomarkers Program, which is made up of researchers, patients, family members, and healthcare professionals who are dedicated to accelerating the pace of biomarkers research. This program provides funding for research, biorepositories, and data management resources to collaboratively build biomarker knowledge and resources.

“Our entry point in thinking about PD was in thinking about neuroimagery biomarkers,” explains Bowman, and most of his work has involved MRIs. His goal is to identify biomarkers that can assist in earlier diagnosis of PD.

Bowman and colleagues analyzed data from two studies – one that examined medicated PD patients, and the other unmedicated PD patients, both with control groups. They identified 150 million neuroimaging biomarkers per person. He explained that there are two ways to approach this amount of data – either with an exploratory large data approach or hypothesis-driven. His team took the exploratory approach, using machine learning to narrow down the biomarkers to 13 features that mattered. These 13 features were only present in the PD patients, but more work needs to be done before it can be applied in clinical (and particularly surgical) settings.

Bowman’s future research aims to predict the progression of PD in patients over one year and identify neuroprotective interventions to slow the progression of the disease.

Suicide and Depression has been Increasing among Adolescent Girls Since 2010: Challenging What We Think We Know

dhawkin — Fri, 14 Feb 2020 22:05:59 +0000

Suicide and Depression has been Increasing among Adolescent Girls Since 2010: Challenging What We Think We Know dhawkin Fri, 02/14/2020 - 17:05

Dr. Katherine M. Keyes was the second speaker in the College of Health and Human Services Dean’s Seminar Series on January 27, 2020. Keyes is an associate professor of epidemiology and co-director of the Psychiatric Epidemiology Training Program at Columbia University’s Mailman School of Public Health. She shared her research and the current understanding on the increase of depressive symptoms and suicide in adolescent girls.

She challenged everyone in the room to come up with their own best explanations and then we can think of studies to test them.

What is happening with adolescent mental health?

Depressive episodes among males have remained constant, but they have increased among girls since 2010. The largest decrease in self-esteem was among girls who identify as a liberal or democrat following the 2016 election.

When looking at adolescent ER visits, the total number of visits for boys and girls has remained stable since 2010, while more of them have been for suicide attempts or ideation. In addition, completed suicides are increasing overall, and males are more likely to complete suicide than females.

Is the increase linked to drug and alcohol use (a historic predictor of depressive symptoms)?

Keyes is part of a long-time National Institute on Drug Abuse study, Monitoring the Future, which has been studying high school students since 1976 asking the same questions about drug and alcohol abuse so that they can be compared over time. They found that in the 90’s and early 2000’s, kids who binge drank were more likely to be depressed, but drug and alcohol have been going down since then.

“Declines in adolescent alcohol use are part of a broader decline in use of many substances and problem behaviors since the 90’s/2000’s,” Keyes explained. “We call this this ‘the great decline.’ And yet, depressive symptoms and suicide are increasing among this group, so this is a new trend we’re seeing.”

There are two exceptions to the great decline: use of cannabis and e-cigarettes. With the changes in legality for cannabis use within states, researchers questioned whether that had an effect. Both frequent use of cannabis and experimenting are increasing. Is this happening because certain states have legalized its use in one form or another? The consensus across the studies is that the legalization of cannabis has not increased adolescent use in the states it has been legalized in.

It appears that drug and alcohol use are not responsible for this 2010 increase. However, we need more research to understand the impact of e-cigarette use.

What about smart phones?

The iPhone was released in 2007, so this was one of the first questions researchers had – are smart phones responsible for these increases? While some studies have found a link between smart phone use and increased suicide, others have found a “goldilocks effect”—a little screen time is good, but too much has a detrimental effect on child and adolescent mental health.

In order to other potential influences on mental health, Orben and colleagues analyzed the many different ways adolescents spent their time and the effect on their mental health. They found that activities such as binge drinking were three times worse than smart phone use. Marijuana use was ten times worse for adolescent mental health. On the plus side, eating fruit was ten times better.

While excessive use of smart phones may have a negative effect on adolescent health, they are not solely responsible for the increase in depressive symptoms and suicide. There is something else going on here.

Keyes explains that while limiting excessive adolescent use of smart phones may be beneficial, we shouldn’t jump to taking away adolescent smart phones, as we have early indications that they can have a protective effect as well—offering a good way to deliver therapy.

Are adults experiencing a similar increase in depressive symptoms and suicide?

Yes and no. Adults in higher socioeconomic statuses (SES) are not seeing a decline in mental health. However, those in the lower SES certainly are. Adults in crisis have increased more than 30% in 10 years, and the group most likely to complete suicide are middle-aged men.

Adults are sleeping less. However, contrary to adolescent behavior, alcohol use among some adult groups has been increasing since the 2000)’s. Alcohol use has remained relatively constant among men (although they do drink more than women), and it has also remained constant among women with children or lower levels of education. The largest increase in alcohol use has been among middle-aged high-income and highly educated women who do not have children.

What can we do?

“The trends – adults drinking increasing, adolescent mental health, adult mental health, they’re not disconnected. These are the same people moving through historical time, and if you follow them as birth cohorts, you start to uncover critical trends,” Keyes explains. “This is why it’s so important to study people over the lifespan.”

Keyes recommends that we don’t stop with prevention efforts at age 18 and that we have programs—particularly for alcohol abuse prevention—beyond that.

“We still don’t know exactly why this increase in depressive symptoms and suicide is happening among young people in the United States, and so far, the research shows that it’s not due to any one thing,” Keyes explains.

Video Recording

View the full recording here. (YouTube)

Dean’s Seminar Series

This presentation was part of the College of Health and Human Services Dean’s Seminar Series. Learn more about the series, upcoming speakers, and RSVP.

Celebrating Culture through the Culinary Arts

dhawkin — Tue, 04 Feb 2020 17:50:59 +0000

Celebrating Culture through the Culinary Arts dhawkin Tue, 02/04/2020 - 12:50

In November, the Department of Nutrition and Food Studies held an event to celebrate diversity and culture through food—the first in a series scheduled this semester.

“I think it’s a great event to get to experience new things with taste and sample culture,” explained Nicholas Menacho, a Mason student majoring in Criminology and taking the Introduction to Nutrition Course at the College.

Nicholas Menacho (left) serves mojito water.

Participants had the opportunity to taste food including ensalada de repollo (a cabbage salad from Nicaragua), pupusas (Salvadoran stuffed flatbread), alfajores (a Peruvian dessert), salsa verde (a well-known Mexican recipe for salsa), and mojito water (a well-known Cuban beverage).

“At Mason, we’re surrounded by such diversity that we wanted to celebrate it, and what better way than with food?” explained Dr. Larry Cheskin, chair of the Department of Nutrition and Food Studies. “We’re already planning more events to celebrate the rich cultures present in our students, faculty, and staff.”

Offices from around campus also shared information on their programs with students and others stopping by. Participants included the Departments of Global and Community Health, Nutrition and Food Studies, and Global Affairs, as well as the Offices of International Programs and Services, Global Education, and College of Humanities and Social Sciences Undergraduate Admissions.

The VALÉ project—A Multidisciplinary Childhood Obesity Treatment Program for Latino Communities—also had a booth where they invited participants to guess the amount of sugar in popular beverages.

The VALÉ project—A Multidisciplinary Childhood Obesity Treatment Program for Latino Communities—invited participants to guess the amount of sugar in popular beverages.

“Tell Me Your Story”: How to Provide Health Care in a Culturally Diverse Environment

dhawkin — Mon, 18 Nov 2019 19:20:24 +0000

“Tell Me Your Story”: How to Provide Health Care in a Culturally Diverse Environment dhawkin Mon, 11/18/2019 - 14:20

The Washington, DC metropolitan area is one of the fastest growing and most diverse regions in the United States, and increasing evidence points to significant and preventable health care disparities within the region and the country.

As part of the mission to become a leading source of workforce development in the region, the Northern Virginia Area Health Education Center (NVAHEC) offered the first module in its Cultural Competency Training Series November 8. NVAHEC is based in George Mason University’s College of Health and Human Services in the newly opened Population Health Center. NVAHEC works to increase diversity among health professions and support interdisciplinary training for practicing professionals and students in health career academic programs.

Culture can include a range of factors such as ethnicity, language, religion, gender identity, sexual orientation, age or peer group, geography, and other sociological characteristics. Cultural competence involves being conscious of one’s own biases and how that may affect how you interact with or provide care to others and understanding where differences may arise in the health care system related to culture so that those can be addressed during the provision of care for better patient experiences and health outcomes.

“The training is called ‘Tell Me Your Story,’ because each patient has a different story,” explained NVAHEC Director Karen Brown. “You have your own culture as a provider as well, and culture can affect how patients respond and access the care they need.”

Brown kicked off the first module—Navigating the Healthcare System—by working with the participants to set ground rules for the experience. The participants were broken into small groups and asked to share personal examples of cultural experiences. They went on to view videos and discuss how care providers can improve the patient experience when cultural competency is incorporated into their care. Some of the solutions the participants discussed included asking patients about their full histories (not just their medical histories or looking at one point on a chart), which can give providers additional clues about their illnesses and their familiarity (or unfamiliarity) with the U.S. health care system.

The participants discussed the importance of considering the whole patient experience—from beginning to end—starting from the time they set up the appointment. Underserved patients often report being mistreated throughout the health care experience, and this prevents them from seeking care in the future. Additionally, the U.S. health care system is more complex and more expensive than in other countries, which can be a particular challenge for new immigrants.

One solution offered was to prepare registration personnel with a script or form to help identify those patients who may need additional explanation of how the process works or how many bills they can expect to receive.

“It’s about each person being treated as an individual and with dignity and respect, and how far that goes on top of everything else,” explained Rachel Lynch, director of the Community Health Improvement at Inova Health System, who helped develop the training.

Dr. Caroline Sutter, director of professional and workforce development at the Population Health Center and co-director of the Mason and Partners (MAP) Clinics, explained, “It’s important that we make sure that patients understand their diagnosis, and the next steps for treatment to help them to actively navigate to health. We tend to be focused on treating the disease but need to remember that is not always the direct provision of care that makes the biggest difference but rather taking the time to listen to any barriers that may prevent them from being successful in becoming healthy. Maybe it takes more time to listen, but maybe that’s the most important part.”

She emphasizes, “It’s important for us to have accountability at every touch point in the health care system if patients are to successfully navigate this complicated health care system.” She recommended, as is routine at the MAP Clinics, when sending patients to the hospital or other care providers, to provide them with written details to share with that next place of care. They encourage their patients to be advocates for themselves and give their patients tools to do so.

The participants in this first training module included nursing faculty and students at all levels and representatives from Inova and Fairfax County Health Department. The training is geared toward an interprofessional audience, and NVAHEC hopes to offer the module to other professionals working in the medical field, such as social workers, receptionists, technicians, financial services, and anyone who might have contact with a patient.

Lynch helped develop the modules because as she explains, “Everyone has biases—implicit or otherwise—and we need to better understand what these are in ourselves and in our health care system. Recognizing that and understanding how it affects patient care, raising the awareness of how it impacts outcomes, and just again the importance of the whole patient and patient-centered care, that’s what the heart of this really is.”

The curriculum for the Cultural Competency Training Series is grounded in the Culturally and Linguistically Appropriate Services (CLAS) standards, developed by the U.S. Department of Health and Human Services Office of Minority Health. It aims to prepare an interprofessional workforce for working in a culturally diverse health care environment—often working with individuals from backgrounds quite different from their own. Brown delivered the training, which NVAHEC developed with Inova, Partnership for a Healthier Fairfax, Fairfax County Health Department, and George Mason University.

Additional Tell Me Your Story modules include Social Determinants of Health and Behavioral Health. For more information about the trainings, contact Karen Brown at kbrown62@gmu.edu.

Using Public Health Stats to Improve Health Care Treatment: Dr. Scott Zeger Presents the Inaugural Dean’s Seminar

dhawkin — Mon, 18 Nov 2019 16:25:06 +0000

Using Public Health Stats to Improve Health Care Treatment: Dr. Scott Zeger Presents the Inaugural Dean’s Seminar dhawkin Mon, 11/18/2019 - 11:25

Dr. Scott Zeger, John C. Malone professor of biostatistics and medicine and former chair of the Department of Biostatistics at Johns Hopkins Bloomberg School of Public Health was the inaugural speaker for the College’s new Dean’s Seminar Series.

The United States has the highest health care spending per capita ($1 trillion more than the next highest), and we’re not healthier. Dr. Scott Zeger calls this the “big datum problem with the U.S. Public’s Health.”

Zeger, John C. Malone professor of biostatistics and medicine and former chair of the Department of Biostatistics at Johns Hopkins Bloomberg School of Public Health was the inaugural speaker for the College’s new Dean’s Seminar Series. The series is made possible by a generous gift from an anonymous donor.

Zeger opened his comments by promising to challenge the audience – as faculty and students of an emerging college of public health – because, he said, “this is a unique time and our society depends on you.”

“The unpleasant truth is that we’re spending more on health care and not getting health,” explains Zeger. But, what can we do about it, and specifically, what can public health and medical professionals do about it (in addition to voting)?

First, Zeger said, we must consider what causes this overspending. A larger part of it is due to waste, such as failures of care delivery, failures of care coordination, and overtreatment, which are themselves based on bad decisions. This type of overspending does not improve care, so reducing spending on waste should therefore be prioritized over other actions such as changing benefit structures, payment levels, or eligibility.

This is where Zeger recommends public health and medical professionals work together to bring down the cost of health care. By comparing what we know about an individual to what we know about a population, we can help health care providers make smarter decisions that reduce waste without a negative effect on health.

They can also work together to build systems that integrate practice, data, and knowledge for better decision-making. Additional changes also must be made, such as creating a new public health business model that financially rewards health—not ineffective health care services.

Zeger shared an example of public health and the medical system working together for better decision-making for treating prostate cancer. Zeger and colleagues found that prostate removal was commonly recommended to patients with prostate tumors, with serious consequences (impotence, incontinence), and that aggressive cancerous tumors were rare and slow growing. They developed a Bayesian hierarchical model—a multi-level statistical model that accounts for uncertainty in the data—to help predict which patients would be more likely to develop an aggressive cancer and therefore be important candidates for prostate removal (vs. irradiation or monitoring). The Precision Medicine Analytics Platform (PMAP) uses this model and presents data from a variety of sources to clinicians in a user-friendly treatment platform, which helps them and their patients make better decisions about treatment.

The Precision Medicine Analytics Platform (PMAP)

Zeger encourages similar work integrating population and individual-level data for clinical decisions. He calls for public health professionals to take responsibility for the success of the health care system and to work with medical professionals to incorporate population-level data in their decision-making.

Zeger likened changing the health system to changing the engine of a 777 while flying over the Atlantic. “We have to bring what we do into alignment with what we think,” he explains. “If you wait around for the medical system to change, it’s going to happen later than it needs to.”

A full video recording is available of Zeger’s presentation for the Dean’s Seminar Series. View the video recording here.

CHHS Welcomes Three New Advisory Board Members

dhawkin — Fri, 17 May 2019 15:08:22 +0000

CHHS Welcomes Three New Advisory Board Members dhawkin Fri, 05/17/2019 - 11:08

Three new members have joined the College of Health and Human Services (CHHS) Advisory Board: Ellie Dehoney, vice president of policy and advocacy at Research!America; Karen Remley, senior fellow at the de Beaumont Foundation; and Tonga Turner, director of Kaiser Permanente Community Health Division.

As new members of the board, they will join the 10 current members in advising and assisting the Dean in strategic planning for the College.

“We’re delighted to welcome Ellie Dehoney, Karen Remley, and Tonga Turner to our advisory board,” says Dr. Germaine Louis, Dean of the CHHS. “Their expertise will be instrumental to the College as we work together to build Virginia’s first College of Public Health and strive to improve the public’s health and well-being across the lifespan.”

Read more about the three new advisory board members below and visit the advisory board page to learn more about the current members of the board.

Ellie Dehoney, Vice President of Policy and Advocacy, Research!America

Eleanor (Ellie) Dehoney, has been vice president of policy and advocacy at Research!America since March of 2011. Prior to joining Research!America, Ellie served as legislative director in the office of Sen. Sherrod Brown (D-OH). Ellie also served as the legislative director for Brown in the House of Representatives, where she maintained lead responsibility for work related to his role as Ranking Member of the Energy and Commerce Committee’s Health Subcommittee. Before joining Brown’s staff, Ellie served as a legislative assistant for former Senate Minority Leader Tom Daschle (D-SD). Previous positions included serving as a special assistant in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the Department of Health and Human Services and in other executive branch and private sector roles focused on health care financing and delivery.

Ellie received a BA in Economics and English from the College of William & Mary and an MSPH from the University of North Carolina at Chapel Hill.

Dr. Karen Remley, Senior Fellow, de Beaumont Foundation

Dr. Karen Remley joined the de Beaumont Foundation in August 2018 as a senior fellow. Remley, who has more than 30 years of experience in public health and health care, previously served as CEO of the American Academy of Pediatrics, which represents 67,000 practitioners dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults.

In her role as senior fellow, Remley serves an advisory and leadership role in the Foundation’s efforts to create practical solutions to build healthier communities. She brings a unique combination of public health, health care, and clinical experience, and a track record of improving social and economic factors that result in better health for all.

In addition to leading the AAP, Remley has had a diverse career as a commissioner of health for the Commonwealth of Virginia, a pediatric emergency physician, and the chief medical director of Anthem Blue Cross Blue Shield Virginia. As Virginia’s health commissioner from 2008 to 2012, she advised the governor on public health issues and helped lead improvements in the rates of teen pregnancy, infant mortality, and cardiovascular disease. She is a professor of pediatrics at Eastern Virginia Medical School and has held senior leadership roles in hospitals and health nonprofits, including Operation Smile Inc., Physicians for Peace, and Sentara Healthcare.

Remley earned an MBA from the Fuqua School of Business at Duke University, an MPH at the University of Massachusetts Amherst, and her MD from University of Missouri in Kansas City. She completed her pediatrics residency at St. Louis Children’s Hospital-Washington University School of Medicine in St. Louis.

Tonga Turner, Director, Kaiser Permanente Community Health Division

Tonga Turner serves as a director in Kaiser Permanente’s Community Health division where she oversees the Northern Virginia Community Health portfolio. In her role, Tonga, develops and executes the overall Northern Virginia Health Strategy which focuses on changing policy, systems, and environments in communities that experience inequities with the goal of promoting health, equity and justice.

Tonga joined Kaiser Permanente from the U.S. Department of Health & Human Services Centers for Medicare & Medicaid (CMS), where she worked on federal policy and legislative matters on behalf of the Federal Coordinated Health Care Office. Under her leadership, she worked on several major federal policies, rules and regulations impacting the dual-eligible (Medicare-Medicaid) population, including the development and implementation of the CMS Medicare-Medicaid Health Plan Enrollment Disenrollment Guidance, which is currently utilized by several states and Managed Care Organizations across the nation.

Prior to her work at the federal level, Tonga worked for Booz Allen Hamilton and the American Institute for Research as a senior leader in developing and implementing policies and initiatives focused on addressing health disparities and leveraging the social determinants of health to improve health outcomes in vulnerable communities. Tonga holds a bachelor’s degree in health sciences from Howard University, an MBA from the University of Maryland, and a Master’s in Health Care Administration from the University of Maryland. Tonga’s passion for community transcends into her private life; she volunteers and serves as a mentor to young women at several Maryland and Northern Virginia education and workforce development community non-profits.