Dr. Rebecca Manganello, a provider on our WakeMed Medical Weight Management team, is dual board certified by the American Osteopathic Board of Family Physicians and a diplomate of the American Board of Obesity Medicine.
Dr. Manganello is passionate about empowering patients. She recognizes the importance of a supportive partnership and is dedicated to providing this support — without judgment. Through her experience in primary care and chronic disease management, she has seen that a comprehensive approach to health care — including weight management — is critical. She is here for her patients every step of the way.
Please take five minutes to read this interview and get to know Dr. Manganello.
Q: Tell us a bit about your background.
I was born and raised in South Florida, mostly in the Fort Lauderdale area. I began my academic journey at the University of Florida in Gainesville, FL where I earned my bachelor’s degree. Next, I attended Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, FL. I then went on to complete my residency at St. Petersburg General Hospital in St. Petersburg, FL.
Q: Tell us about your approach to care.
I focus on lifestyle education and medication management, where needed, offering a very comprehensive approach. I discuss diet, stress management, exercise, overall healthy lifestyle and how medication can be used to help achieve those goals.
I am not a surgeon, so I don’t offer bariatric surgery — though I do support bariatric surgery as an amazing tool to help patients achieve weight loss.
Foremost for me is helping patients understand that weight challenges are not the patient’s fault. Weight is about so much more than willpower. There is more that goes into weight loss than just “Eat less; move more.” If it were truly that simple, there would be no need for my specialty at all.
Weight challenges are similar to any other chronic condition, so I address it in a variety of ways, tailoring my approach to meet the patient’s needs.
Q: Could you explain why willpower isn’t the end-all-be-all of weight loss?
Many factors contribute to weight gain or difficulty with weight loss — genetics, other chronic conditions, stress, mental health, medications, emotional eating and eating disorders, to name a few.
A common challenge is emotional eating, which is often a major accepted practice. When we are under stress, we learn early on to go to food for comfort. When we want to celebrate an accomplishment, we are often taught in childhood to go to food as a reward. Recognizing emotional eating is powerful.
I also believe in acknowledging and comprehensively treating disordered eating. I appreciate the resources available through WakeMed Bariatric Surgery and Medical Weight Loss, including the chance to work closely with a wonderfully supportive, specially trained psychologist, if patients desire.
We work to reframe relationships with food, if needed. Food is not the enemy; food is fuel. We often don’t need to completely cut out favorite foods but instead learn how to enjoy them without overdoing it.
I also hold the philosophy that we are complete people, and all aspects of our lives can impact our eating habits — from stress eating to eating around third-shift work schedules.
Q: How do you help patients who feel stuck?
Sometimes keeping the weight off or continuing to take weight off can be even more challenging than meeting that initial weight loss goal. Getting stuck — plateauing — is going to happen because the body and brain adjust to our new habits.
First, I help patients celebrate how far they’ve come. It is so important to recognize non-scale victories, such as lower blood pressure, lower cholesterol, fewer aches and pains, increased range of motion and more energy.
Then, I focus on what can be done to adjust, so my patients can continue moving forward. Adjustments may include strength training, reviewing medications or modifying eating plans — individualized to each patient.
This is why it is important that medical weight management providers are involved in championing patients throughout their entire journey and during every plateau. There is no graduating from our program. Our patients can remain with us for as long as they need and desire our support. We are here for life.
Q: How do you help incorporate a holistic, individualized approach for each and every patient?
I believe it is crucial that patients realize they are not their condition. They are patients who are having difficulty with a medical condition. I reframe it as, “You are not an obese person. You are a person dealing with obesity.”
I take the time to get to know each patient as an individual because I find it vital to understand the patient’s motivation for weight loss. “Is it keeping up with grandkids, having more energy, eliminating prediabetes or something else?”
I look at the complete picture. I need to know how obesity is impacting a patient’s overall health. When patients need to lower blood pressure, reduce cholesterol, lower blood sugar and relieve stress on joints, along with losing weight, I review how best to go about achieving those goals. Medical weight management is more than pounds on a scale. The goal isn’t to get everyone down to a certain size — weight, alone, doesn’t define health. The goal is to help individual patients achieve a healthy lifestyle that addresses specific needs.
Q: How do you help patients identify their own goals?
I understand that my patients’ lives impact their weight. We discuss goals at each appointment — both short-term and long-term — and recognize that goals can change. We have an open conversation about sustainable goals, including weight and non-scale goals.
We address risks for different conditions as it relates to our approach to care. For example, if a patient has diabetes, we work on developing a sustainable, healthy eating plan, conscious of lower sugar intake. If a patient has genetic risks for heart disease, we may discuss adopting a Mediterranean diet. We tailor to each patient.
I can also help patients find their “why.” If a patient has high cholesterol and four young children, the patient may not be driven to lose weight based on high cholesterol, but the patient may desire to lose excess weight to set a parental example of eating healthy and leading a more active lifestyle.
Q: Are there any weight loss pitfalls you suggest that patients avoid?
Absolutely. Here are my top three:
- Patients need to avoid trying to do too much too quickly. This often leads to burnout. My goal is to help patients find a lifestyle that could last.
- Patients should avoid sugary drinks which pack on calories without providing satiety. Staying hydrated with water is very important. In fact, one serving of soda a day could add up to 15 pounds a year.
- I implore patients not to weigh themselves daily. There are many reasons why the scale may be off a couple of pounds, such as water weight, time of day or hormonal shifts. Daily weigh ins can lead to discouragement. If patients want to check the scale at home, I usually recommend no more than once a week unless needed due to another medical condition.
Q: How do you help instill weight loss as an investment for long-term health?
By the time most patients come to me, they often have tried so many things and may be dealing with regain. I help patients learn to avoid the fad diets.
I, honestly, don’t love the word “diet.” I prefer “healthy eating plan” and “healthy lifestyle” because that word “diet” usually restricts. I like to focus on what we can add as opposed to focusing on what we are taking away.
I want something sustainable for my patients that includes foods the patient enjoys eating. Forcing patients to eat foods they don’t enjoy is not going to help in the long run. So, I do education on nutrition labels, preferred food choices and how schedules can impact weight.
I frequently discuss the hunger scale which is eating when hungry and stopping when satisfied. We discuss the best way to learn how to listen to our bodies to build that trust again.
Q: What do you love most about your job?
My favorite part of my job is celebrating non-scale victories with patients. I love supporting and empowering patients to be their own advocate. They are not passive passengers in this journey to health. They are in the driver’s seat.
It is their body. It is their life. It is always their choice.
