Internist and Bariatrician, Tidewater Physicians Multispecialty Group; Assistant Professor of Clinical Internal Medicine, Eastern Virginia Medical School
Two basic principles underlie Dr. Margaret Gaglione’s success with patients struggling to lose weight. The first is that obesity is a chronic disease, with complex behavioral and physiological factors. The second is that maintaining a healthy weight is a skill – and one that many patients need to be taught.
“They need active and direct management,” Dr. Gaglione says. “You don’t see a cancer patient and give them treatment guidance and then say, ‘Okay, I’ll see you next year.’ Some of the lifestyle changes I recommend may seem ‘simple’, but to someone without this skill set, they’re not so simple.”
Dr. Gaglione’s intense, personalized and multifaceted treatment of obesity is the same approach that she takes for all her patients’ health concerns. At Coastal Internal Medicine and Tidewater Bariatrics in Chesapeake, her practice is about 70 percent general internal medicine and 30 percent bariatric medicine. Other specialty areas include diabetes, hypertension and hyperlipidemia management.
Bariatrics was a focus that Dr. Gaglione discovered 18 years ago. With a team of health educators, she has developed education, treatment and maintenance programs to attack the problems that impede each individual’s progress. Most patients start with weekly or biweekly appointments before gradually moving to a bimonthly schedule.
“You can have people who are incredibly skilled in other areas of life, personally and professionally, but not at this,” she notes. “We need active engagement on their part and my part, as we would with any chronic disease.”
Prescribed changes might include meal replacement plans, medication, nutritional supplements or a range of diet and exercise fixes such as bringing lunch to work, scheduling daily walks, buying a standing desk or watching less television. Dr. Gaglione also will recommend bariatric surgery as part of a larger plan if necessary, although many patients who seek her out wish to avoid that.
Patients often can wean off medications while becoming more active, social and self-confident. “Obesity is a very isolating disease,” Dr. Gaglione says. “It’s very gratifying to see people rediscover things they haven’t been able to do in years. It’s also shocking to see how quickly dietary changes can reverse serious health issues such as hyperglycemia.”
Dr. Gaglione takes a data-driven, down-to-earth approach. After precisely calculating each patient’s daily calorie needs based on laboratory tests, body composition analyses and lifestyles, she outlines specific choices that will achieve desired results – along with memorable one-liners.
“I might tell them, ‘I’d like to be 6 feet tall and muscular, but I’m 5-foot-4 and petite,” she laughs. “So, I only need about 1,300 calories to maintain my weight. If I chose to eat what I want, when I want, regardless of boundaries, I will not maintain my weight. Many of my patients eat enough in one day that they would need to be over 7-foot-tall athletes for that to be a ‘normative’ number of calories.”
In Dr. Gaglione’s experience, meal replacements can be highly effective because they ensure patients will eat healthfully most times of a day. She uses Health Management Resources, or HMR, products that are high in protein and low in simple carbohydrates and fat. “If you’re replacing 14 of the 21 meals that someone eats weekly, you’re cutting out two-thirds of the danger zone,” she says. “As patients learn how to eat, they only have to focus on a single meal.”
Any surgery, she adds, should be just one tool in the toolbox – much like a cancer patient wouldn’t stop seeing an oncologist after a surgical procedure.
Originally from Queens Village, N.Y., Dr. Gaglione had a grandmother who was a nurse and encouraged her early dreams of becoming a doctor. After receiving her Bachelor of Science degree from Le Moyne College in Syracuse, she completed a medical degree from Pennsylvania State College of Medicine and a residency in Internal Medicine at Naval Medical Center Portsmouth.
“I love this specialty because I like to think broadly and really get to know my patients – their challenges, living environments, families and how I can empower them,” she says.
For six years after medical school, Dr. Gaglione proudly served on active duty as a Lieutenant Commander in the U.S. Navy. She was a staff internist at Naval Medical Center for 20 years and was in private practice with Tidewater Bariatrics from 2007 to 2015 before moving to TPMG.
Committed to lifelong learning, Dr. Gaglione is a prolific author, popular lecturer and instructor and winner of multiple awards for her service. She is a diplomate of the American Board of Internal Medicine and the American Board of Obesity Medicine, as well as a member of the Clinical Faculty at the Edward Via College of Osteopathic Medicine.
Personally, Dr. Gaglione stays healthy by taking regular walks and bike rides, never skipping meals, cooking often at home and eating plenty of fish, fruits and vegetables. She and her husband, Capt. David Collins, have four children between them.
Dr. Gaglione’s patients – some of whom she has treated for 25-plus years – also have become like family, which makes her happy to go the extra mile for them. In the future, in fact, she hopes to offer more virtual appointments.
“I want to meet people where they are, whether that’s at home, at work or in my office,” she says. “I want them to know how much I care about their lives. My job is to be by their side.”