Imagine battling congestive heart failure, obstructive sleep apnea, gastroesophageal reflux disease with ulcers in your esophagus — and depression.

UAB employees Tonya Wright, left, Alicia Leggett, Amy Stevens and Foster Stevens have lost a combined 476 pounds after undergoing gastric bypass surgery at UAB. Read the story to learn more about their journey and the surgery offered at UAB.

Now imagine that you are a 5-foot-2 inch 28-year-old female who weighs more than 250 pounds and has body mass index (BMI) of 45.

Alicia Leggett doesn’t have to imagine that scenario. She’s lived it.

“I was plagued with obesity,” Leggett says.

She turned to UAB and Ronald Clements, M.D., for help. Clements, an associate professor in the Department of Surgery whose specialty is minimally invasive surgery and bariatric surgery, uses laparoscopic techniques to perform gastric bypass operations for morbidly obese patients.

Leggett, a patient-services coordinator in Clements’ office since May, completed the rigorous pre-screening process and was a candidate for laparoscopic gastric bypass. She has lost 103 pounds since her operation nearly three years ago.

“The results of this surgery are beyond my wildest dreams,” she says. “I’m amazed at the level of joy I’ve been experiencing. I love taking care of myself, and I have so much more to offer to my family and friends — it’s just unbelievable. I cry sometimes because it’s so much to take in.” 

Highest accreditation
UAB Hospital is the first health-care institution in Alabama to receive the highest available level of accreditation from the American College of Surgeons: Level 1A Bariatric Center of Excellence.

The certification, awarded in January, brings UAB into the ACS Bariatric Surgery Network Program, which comprises fewer than 30 institutions nationwide. The designation means that UAB Hospital provides a full-service, comprehensive weight-loss surgery program, and that it has a proven record of providing the highest quality care for the most challenging and complex bariatric patients, with optimal opportunity for safe and effective outcomes.

Clements directs the bariatric program and says the surgery is only for a very specific group of people — the morbidly obese. The term refers to patients who are at least twice their ideal body weight.

Alternatively, a BMI value greater than 39 may be used to diagnose morbid obesity. For those patients who have developed the severe complications of obesity (diabetes, obstructive sleep apnea, high cholesterol, etc,), a BMI of 35 or greater defines morbid obesity.

Only about 1 to 2 percent of those who are morbidly obese are able to use diet and exercise to lose weight and keep it off, according to National Institutes of Health statistics. As a result, the NIH recommends bariatric surgery as a means for beginning a transition to a healthier lifestyle.

“The only reason to consider a bariatric operation is your health,” Clements says. “This is not to look good for bikini season or to help you become a body builder. I’m talking about correcting serious, underlying health problems.”

Finally free
Foster Stevens and his wife Amy, both nurses at UAB, wanted the surgery and desperately needed it to improve their health.

Amy Stevens was hypertensive, and her family has a history of arthritis, a condition made much worse by obesity. Foster Stevens was hypertensive, pre-diabetic and suffering from sleep apnea.

Foster says both he and his wife tried conventional weight-loss diets through the years. He lost 80 pounds on Weight Watchers once, and she lost 120 pounds on the same plan. Both gained the weight back and didn’t have any answers for what to do next. After consulting with Clements they laid out a plan. Amy Stevens had her surgery more than a year ago. Foster Stevens had his this past May. Amy Stevens has dropped 153 pounds. Foster already has lost 50 pounds.

“All my life I’ve been fat,” Foster Stephens says. “As a child I was a little chunky, then I got older and I was husky, then obese, and then I moved to morbidly obese.

“I never in my life thought I’d be free from the chains of hunger, and I am now,” he says. “It’s amazing. I’ll be doing something, and I have to stop to think ‘Have I eaten anything today?’ I’ve never had that happen before. It’s surreal.”

Tonya Wright, an information services consultant with the Health Services Foundation, wasn’t facing an imminent life-or-death decision when she began seriously considering having gastric bypass surgery. In fact, she took more than a year researching bariatric surgery before talking with Clements, and then it was almost another year before she had the surgery.

While Wright had high blood pressure and some back problems, her primary reason for following through with the procedure was her lack of mobility, specifically trouble with her knees. Wright’s primary care doctor told the 35-year-old she was walking on knees that were more befitting of a 55-year-old.

“My weight was making my knees worse,” she says. “I’ve never been skinny. I’ve always been a big girl, and I’ve always embraced that. I was actually concerned the surgery would make me smaller than I wanted to be.”

Instead, Wright says, it’s been better than she could have imagined. She’s lost nearly 170 pounds since her surgery in October 2005 and maintained some of her features she didn’t want to lose.

“It’s funny – Dr. Clements can look at you and tell you where you’re going to be after surgery,” she says. “I know some people want to be really small. I wanted to be healthy. I told him where I come from a big backside and hips are OK. He said, ‘I don’t see you more than the low 200s.’ I’m 5-11 and I swing between 199 and 210 pounds. He promised me that, and he was absolutely right.”

Just a tool
The patients say Clements and his staff did an excellent job of educating them about the elective procedure. One point the surgeon and all four patients stress is that the surgery is just one step on the path to major lifestyle change. It should not be viewed lightly by those contemplating having it, Clements says; it is a major operation, and there are significant risks.

However, if a person is morbidly obese, it may be their last chance at living a healthy life.

“Bariatric surgery is not a miracle cure for obesity,” Clements says. “There are people who don’t lose as much as they want to and there are people who re-gain the weight. However, it is still the most effective treatment for morbid obesity. If your objective is becoming a healthier person, bariatric surgery is very effective.”

His patients concur.

“This is a tool to help you get where you need to be, it’s not a cure-all,” says Foster Stevens. “When you go into it you have to have that mindset. It’s going to help me accomplish what I haven’t been able to accomplish on my own, but I have to do my follow-ups. I have to take my vitamins and follow the correct procedures.”

That means those large portions that were once the norm are acceptable no more — unless you want to be sick.

“You can’t hold the large amount of food anymore,” Wright says. “If you don’t follow the process, you will gain the weight back.”

People wanting more information on the UAB bariatric surgery program may call 996-6984. Information online can be found here or and www.facs.org/cqi/bscn/index.html.