“Which procedure do I want to choose?” Many patients who are ready to be admitted for metabolic surgery have this question. There are now 2 types of more established metabolic surgery – sleeve gastrectomy and gastric bypass surgery. The different surgical approaches may set patients on a different trajectory for the future. It is a great distraction for those who have difficulty choosing. First we need to understand what is the difference between the surgeries? 1. Sleeve gastrectomy: freeing the greater curvature of the stomach will inhibit the secretion of hunger hormone and lower the weight adjustment point; it will also reduce the volume of the stomach and decrease the caloric intake of solid food. But this surgery does not affect the absorption of the stomach. 2.Gastric bypass surgery: After reconstructing the digestive tract, it will stimulate its own hormone regulation and stimulate insulin secretion. After the operation, patients have obvious effect of sugar reduction and slightly better slimming effect than sleeve gastrectomy. The downside is that to prevent malnutrition, patients need to take micronutrients for life. Leaving aside the issue of having erosive atrophic gastritis, H. pylori positive and other precancerous lesions not suitable for gastric bypass surgery. The most critical point for both procedures is whether to interfere with the absorptive capacity of the obese patient. Absorptive capacity is a double-edged sword; it can cause patients to become over-nourished when they don’t need it, or it can be the most important thing for patients to rely on when they are weak. Some patients want to see quick results and ignore the future pitfalls; and of course some patients forgo better treatment options to prevent pitfalls. There is no good or bad difference between the two procedures, only which one is more suitable. If I have recommended gastric bypass, it is because I am very confident that the procedure can make patients significantly reduce or even get rid of type 2 diabetes and effectively improve their quality of life. It is a relief to be able to get rid of the days of daily insulin injections and monitoring blood glucose after every meal by taking daily micronutrient supplements. The potential risk of surgery is far less than the risk of diabetic complications. However, if I recommend sleeve gastrectomy, it may be slightly less lean than gastric bypass surgery. But it will ensure that future nutritional intake will not be compromised when needed. 2015 edition of World Health Statistics reports 74 years old for men and 77 years old for women in mainland China. It is inevitable that we will encounter unexpected situations along the road of life, so we should not be too eager. Post-operative patients can perfect themselves by working hard, changing their diet and increasing their exercise. Whether, the surgical results remain for years or decades, it is, after all, a moment. When I hand over the baton of health to my patients, I hope that they will improve their self-discipline and hold tightly to the future trajectory of their lives. By trusting the doctor and communicating with timely reviews, I hope that each of my patients will not only lose weight, but also find their own healthy lifestyles.