In 2013, the prestigious Cleveland Medical Center in the United States announced the top ten medical innovations of the year, and weight loss surgery for diabetes topped the list. Many patients with sugar fat disease, the effect of lowering sugar through medication is often unsatisfactory. If the patient’s weight is lowered through the treatment of obesity, many diabetic conditions will be controlled and even reach clinical cure. This is undoubtedly a new way of thinking. Obesity brings a series of related metabolic diseases, diabetes is only one of them. In addition, obesity can induce and aggravate hypertension, hyperlipidemia, gout, gallstones, joint lesions and other diseases. Even some young obese women can’t get pregnant for a long time due to the endocrine influence. As a result of long-term sufferers of different eyes, about half of the obese patients have psychological problems. In the long run, obesity is very destructive to the body and mind. How to judge obesity? The world’s most common standard is BMI, that is, body mass index, BMI = weight (kilograms)/height (meters)2. BMI over 28 is obese. Body fat ratio, i.e. the ratio of fat to body weight, body fat ratio should be professionally tested in the hospital, which is more accurate than BMI. Different levels of obesity have different treatment measures. Diet, exercise and medication, are the traditional means of treating obesity. So far, surgery is the only means to achieve long-term and stable weight loss in patients with severe obesity. Obesity not only affects their physical appearance, but also greatly threatens their lives. In the domestic and international guidelines for the treatment of diabetes, “big fat people” with a BMI of more than 35 are listed as an adaptable population for the surgical treatment of diabetes. “Redecorating the gastrointestinal tract” In 2013, about 480,000 people underwent weight-loss surgeries around the world, including 250,000 cases in the United States. In China, the number of weight loss surgeries exceeded 10,000 last year. The mechanism of weight loss and diabetes surgery is, firstly, to reduce food intake and absorption; secondly, to reduce the patient’s body weight; and thirdly, the reconstruction of the gastrointestinal tract changes the secretion of hormones of the intestinal-insulin axis, which improves glucose metabolism. The current weight loss surgery is minimally invasive, through laparoscopy, a few small holes in the stomach, less trauma, less bleeding, faster recovery and relatively few complications. There are two dominant approaches to laparoscopic weight loss and diabetes surgery, both of which pay little and get good results. One is the sleeve gastrectomy. In obese people with large stomachs, a large portion of the stomach is removed with this procedure, reducing its volume considerably. This results in a feeling of fullness even when a small amount of food is ingested, thus reducing the amount of food consumed. Another type of surgery is gastric bypass. The upper part of the small intestine, which is connected to the stomach, is the main site of food absorption, and if a portion of the small intestine is left unattended, the absorption of food will be significantly reduced. Through surgery, not only is the stomach reduced, but one-third of the small intestine is left open, connecting the stomach to the distal small intestine. In this way, absorption of food will be greatly reduced. For type 2 diabetes, weight loss surgery can be very effective, even more effective than all previous diabetes treatments. 83% of people who are obese and have type 2 diabetes not only lose weight, but also normalize their blood sugar through surgery. Overall, the results are superior to those of insulin and hypoglycemic drugs. It also improves other metabolic disorders such as high blood pressure, high blood cholesterol, and sleep apnea. When is weight loss surgery appropriate? Patients with severe obesity should see a specialist in a hospital for an assessment of their suitability and the type of surgery to be performed. Why is weight loss surgery effective? As an analogy, weight loss surgery is equivalent to adjusting the body’s hardware so that our gastrointestinal tract is better suited to the new situation. Healthy eating habits and exercise habits, on the other hand, are equivalent to software. A combination of software and hardware is needed to achieve the desired results, otherwise, it is difficult to achieve good results even if the hardware is changed simply by surgery. Surgical safety and the price the patient has to pay is, after all, surgery, and there are certain risks associated with weight loss surgery. However, with the accumulation of experience, the risk of surgery has become lower and lower. The lesser of two evils, for the severely obese, the risk of death without surgery is 90% higher than for those who undergo surgery. Surgery, what is the price to pay? Both of the aforementioned mainstream surgical procedures have certain drawbacks. The first type of sleeve gastric surgery, in which a portion of the stomach is cut out, cannot be restored once the stomach has become smaller. The second type of gastric bypass surgery, due to the absence of part of the small intestine, some nutrients are not fully absorbed, for example, vitamin B12 and iron absorption will be significantly affected, so long-term vitamin and micronutrient supplementation is required. Gastric bypass works better than sleeve gastric on average. In general, sleeve gastric surgery is recommended for lesser degrees of obesity and less severe metabolic disease. If you are super obese, it is risky to do gastric bypass surgery directly, so you can do the sleeve gastric first, and then do gastric bypass surgery a second time after you have lost weight. Gastric bypass surgery is relatively more risky than sleeve gastric surgery, but the result is better than sleeve gastric surgery. The exact choice of surgery depends on the patient’s physical condition. Generally, weight loss can be minimized one to two years after surgery, after which it will stabilize chronically. Weight change is also closely related to lifestyle. If there is a dietary disorder and lack of exercise, the weight will rebound again, which can be maintained in the long term if care is taken.