Introduction to obesity and bariatric surgery Obesity has become a serious social problem due to changes in people’s diet and lack of exercise, resulting in excessive energy intake. It is estimated that 300 million people worldwide suffer from obesity and European statistics suggest that 135 million people in Europe suffer from obesity (BMI >30), of which 10-27% are men, 38% are women and 6 million suffer from morbid obesity (BMI >40). More alarming is the fact that 24% of children are overweight and these statistics are increasing, it is estimated that the number of overweight and obese people in most European countries has increased by 10-40% in the last 10 years. In China, obesity patients are increasing year by year, at the same time heart disease, hypertension, diabetes, hyperlipidemia, gastroesophageal reflux, bile duct stones, degenerative arthritis, sleep apnea, as well as socio-economic and psychological problems, and so on many diseases due to obesity reasons are plagued by people, China’s obesity disease is also a serious situation: in 2001 the national survey of overweight for 21.51%, obesity for 2.92 The obesity rate of women (3.73%) is higher than that of men (2.11%). (Chinese Journal of Epidemiology, 2001, 22(2):129-132) The information shows that the current WHO diagnostic criteria are mainly developed for the health risks of obesity to Caucasians. Asians are more inclined to abdominal obesity or visceral obesity, which increases the risk of related diseases when BMI is low. Some scholars have proposed that the BMI cut-off point for overweight and obesity in Asians is 23 and 25 as appropriate. If this standard is adopted, the current obesity rate in China has reached a high level of 24.54%. In 2002, the survey on the nutrition and health status of Chinese residents showed that the prevalence of overweight and obesity among adults over 18 years old in China was 22.8% and 7.1% respectively, and the prevalence of overweight and obesity among people in large cities was 30.0% and 12.3% respectively, while the obesity rate among children had reached 8.1%. At present, nearly 1/5 of the world’s overweight or obese people are Chinese. Some experts warn that the number of obese people in China has exceeded 70 million. And studies have also found that people in Asia develop diseases, including diabetes and high blood pressure, at relatively low BMIs. This is because, after people in Asia are obese, fat is mainly concentrated in the body, while people in Europe and the United States are obese after fat is mainly concentrated in the subcutaneous, compared to the obese people in Asia are more likely to complicate internal diseases, which is related to the genetic constitution of Asians. Obesity is no longer a mere external image problem, it has become the source of many dangerous diseases, obesity can make health deteriorate, quality of life is reduced, life expectancy is shortened. Overweight and obesity is a serious chronic disease. It can bring about many related chronic and wasting diseases such as: diabetes, heart disease, certain cancers, sleep apnea syndrome, and osteoarthritis. As BMI increases, the risk of premature death from a range of diseases also increases. In Europe, 320,000 people die each year from diseases directly related to obesity. Very severe obesity is associated with an even greater risk of shortened life expectancy. People who weigh more than 50 percent of their normal ideal weight are at twice the risk of premature death. Recent studies have concluded that obesity in adults can cause a variety of diseases directly related to life expectancy, causing a reduction in life expectancy of about seven years in both men and women. So why do people need to lose weight? (1) In 1997, the WHO officially declared obesity to be a disease. (2) Obesity damages mental health, obesity is not beautiful:: obese people experience less happiness and positive emotions than people of normal weight. While experiencing negative emotions than those with normal weight, the incidence of depression and anxiety disorders is particularly high. Obesity can reduce self-esteem, resulting in reluctance to attend parties, go to the store to buy clothes and go to public bathrooms. Women are also reluctant to undergo gynecological examinations. (3) Obesity increases morbidity: including cardiovascular diseases (such as hypertension, atherosclerosis, cerebral infarction, coronary heart disease, congestive heart failure and cerebral infarction), metabolic diseases (such as non-insulin-dependent diabetes, hyperlipidemia, cholelithiasis and gout), cancer (such as breast cancer, endometrial cancer, gallbladder cancer and colon cancer), fertility abnormalities (such as abnormal menstruation and increased risk of pregnancy) and other diseases (such as stress arthritis, obstructive disease). such as stress arthritis, obstructive sleep apnea, and hypoventilation syndrome). (4) Obesity increases mortality: overweight increases mortality moderately, while obesity increases mortality highly. Body mass index of the elderly is not closely related to mortality, but in the range of obesity still increases mortality. (5) Obesity is both discriminatory and costly: In the West, obese people are discriminated against in college, housing, and marriage. Society and the health care professions also have negative attitudes toward obesity. Obese people get paid less money, but health care costs more. In the U.S., this alone costs$100 billion annually. Large case studies have shown that compared to non-surgical obese patients, obese patients who underwent gastric bypass weight loss had a 40% lower overall risk of death, including a 56% lower risk of death due to cardiovascular disease, a 60% lower risk of cancer-related death, and a 92% lower risk of diabetes-related death. Medically, there is a distinction between medical and surgical methods of weight loss. Internal weight loss methods generally refer to a combination of diet control, dieting, exercise, medication, acupuncture and other methods to achieve weight loss, but for severe obesity, the weight loss effect is often not obvious or the effect is easily rebounded, often ending in weight loss failure. Therefore, the internal medicine method is only applicable to mildly obese people, serious obesity using internal medicine to lose weight after the effect is not obvious, it is recommended to take the method of surgery to lose weight. The main judgment of mild obesity and serious obesity is based on body mass index (BMI), BMI = weight (kg)/height (m).2 Chinese people with BMI below 28 are not advocated for surgical treatment. Surgical bariatric surgery includes local bariatric surgery and total body bariatric surgery. Local bariatric surgery refers to liposuction plastic surgery, etc. The initial effect is obvious, but it is easy to rebound and cannot reduce the various complications caused by obesity, so it is not advocated. At present, there are three types of classic surgical bariatric surgery: restrictive surgery, malabsorptive surgery, and hybrid surgery, with common surgical procedures such as gastric bypass surgery, gastric reduction surgery and gastric banding surgery. The most used is gastric bypass surgery, whose main principle is to reduce weight by modifying the gastrointestinal tract. The main weight loss principle is to modify the gastrointestinal tract, so that a section of the stomach and small intestine does not work, so that the capacity of the gastrointestinal tract and digestion and absorption capacity to achieve the effect of general weight loss, this surgery was originally started in Europe and the United States, since 1967 has been 42 years of history, now the United States to carry out 120,000 to 150,000 cases of this surgery each year. Because gastrointestinal surgery is a physical transformation of the gastrointestinal tract, the weight loss effect can be well maintained, and the treatment of complications caused by obesity also has a very good effect, and the current medical research has confirmed: gastric bypass surgery can cure 90% of type 2 diabetes. Laparoscopic bariatric surgery was first introduced in China in 2000, and laparoscopic gastric bypass surgery was introduced in 2004, because with the improvement of life treatment and westernization of diet and living habits: often eating high-energy foods and reducing exercise, obesity is becoming more and more of a problem, and with it the number of metabolic diseases such as diabetes, hypertension and heart disease is gradually increasing. The desire to lose weight is imminent. Bariatric Surgery Considerations Since all bariatric surgeries have risks associated with them, it is advisable to decide on a surgical approach to weight loss only after a thorough evaluation of your case by your doctor. In addition, you will need to carefully discuss the following points with your doctor before deciding: 1. 2. Surgery does not suck out or remove your fat. 3. The benefits and possible risks of the surgery must be evaluated before deciding on the procedure. Each step in the surgery must be handled with care. 4, The proposed surgical procedure may be irreversible. 5, Successful weight loss surgery must also depend on long-term lifestyle changes and proper exercise. 6, Problems may arise after surgery that require secondary surgery. 7, Successful surgical weight loss must first set a realistic goal and then choose a well-designed and repeatedly proven surgical method.