In China, with the improvement of living standards, lifestyle and diet structure changes, especially the excessive consumption of fried food and carbonated beverages, the proportion of obesity is increasing year by year, the age of obesity is getting younger and younger, according to China’s nutrition and health status survey report, overweight and obese people have more than 280 million people. And as the severity of obesity increases, the incidence of diabetes, hypertension, hyperlipidemia, coronary heart disease, myocardial infarction, stroke, amenorrhea, depression and breast cancer have increased significantly, and the mortality rate has increased significantly. Obesity has been identified by the World Health Organization as the fifth major risk factor affecting human health. For women, especially young female patients, obesity has attracted the attention of weight loss experts, in addition to the above-mentioned serious threats to life and health safety and the accompanying appearance and other problems, such as sleep problems, psychological and emotional disorders, and endocrine diseases and reproductive dysfunction represented by polycystic ovary syndrome. Gynecological talk: the relationship between polycystic ovary syndrome and obesity The so-called polycystic ovary syndrome is a common endocrine disease in women of reproductive age, with an incidence of about 10%, manifesting as anovulation, hyperandrogenism and polycystic ovarian changes, with symptoms including irregular menstruation, anovulation, infertility, as well as hirsutism and acne, and an increased risk of endometrial cancer. Obesity is often accompanied by metabolic syndrome, including hypertension, dyslipidemia and hyperglycemia, and current advances in gynecologic research have demonstrated that metabolic syndrome (especially systemic insulin resistance accompanying type 2 diabetes) and polycystic ovary syndrome are causally related to each other. Among them, insulin resistance is the link between polycystic ovary syndrome and metabolic syndrome. It is well established that many patients with polycystic ovary syndrome have a family history of type 2 diabetes and about 75% of patients with polycystic ovary syndrome have insulin resistance. Since Dr. Burghen first proposed the involvement of insulin resistance in the pathogenesis of polycystic ovary syndrome in 1980, numerous studies have confirmed that insulin resistance is one of the main factors in the development of polycystic ovary syndrome. The latest data in China show that the incidence of insulin resistance in polycystic ovary syndrome is 63%, while it is not more than 25% in the general population. In addition to insulin, sex hormone abnormalities are also considered to be a potential risk for the development of metabolic syndrome, and the elevated androgens caused by polycystic ovary syndrome are considered to be the initiating factor for the development of metabolic syndrome, manifested by increased abdominal fat accumulation and insulin resistance. Therefore, polycystic ovary syndrome and metabolic syndrome are closely related in a causal and cyclic manner. In the past, polycystic ovary syndrome was simply considered to increase the risk of metabolic syndrome, but in fact the two can be considered as the same related disease development process. This is why there are various treatments for irregular menstruation, anovulation and hirsutism in patients with polycystic ovary syndrome, but they are less effective for their combined metabolic syndrome. Psychological talk: the relationship between psychological problems and obesity Obesity, especially heavy obesity often exists to varying degrees of negative emotions, this negative emotion can come from dissatisfaction with their own body shape, appearance, but also from the outside world to its strange eyes. For part of the heavy obese people, in social occasions or normal outside communication process, often appear shy, fear, mood impatience and other emotions. Although from the current situation, society generally maintains a tolerant attitude toward obese patients, but the psychological pressure of obese patients themselves is not reduced, in the severely obese adolescents, 48% have moderate to severe depression, 35% report more serious anxiety symptoms, and serious cases even appear anorexia. On the other hand, some psychological or psychiatric disorders can themselves cause obesity, or the medications used to treat them can cause obesity. If obesity is caused by these factors, bariatric surgery is not indicated. Then a psychological evaluation is needed to rule out that the patient has these psychological or psychiatric disorders or that the patient is using certain psychotropic medications that cause obesity. For example, some people have episodes of uncontrollable overeating several times a week and may suffer from bulimia; others have chronic alcohol dependence or abuse of certain addictive substances; or suffer from depression or mania; others may suffer from somatoform disorders, obsessive-compulsive disorder, anxiety disorders, schizophrenia, mental retardation, etc. Many of these disorders can themselves lead to obesity in patients, which then needs to be carefully evaluated by a psychologist and ruled out. Many weight loss centers nationally and internationally include substance abuse, alcoholics, schizophrenia, and mental retardation among the criteria for inoperability to operate. In addition, another purpose of the psychological assessment before bariatric surgery is to prepare the patient for the possible changes that may occur after the surgery and not to have unrealistic ideas. This is the criterion that many bariatric centers in China and abroad use the lack of proper knowledge about the surgery as a criterion for not being able to operate. To sum up, in order for patients eligible for bariatric surgery to arrive at the best possible outcome, please do not forget that a careful psychological evaluation must be performed before surgery. Sleep monitoring talk: obesity and sleep We often see the state of life of some obese people during the day: even if they get enough sleep at night, they are still tired and sleepy during the day, can’t raise their spirits, and have no interest in things around them. Often, they snore loudly in the meeting room and on the bus, making people laugh. The person is not too old, but seems to be an old man with a depressed spirit. Sometimes, the confusion brought by this abnormal sleepiness is more serious than obesity itself. Why are obese people more prone to doze off than normal people? The reasons for this are as follows: First, obese patients are prone to a disease called “obstructive sleep apnea syndrome”, or OSAS for short, which causes partial or complete airway blockage due to the accumulation of a large amount of fatty tissue in the soft tissues of the upper respiratory tract, which presses and blocks the airway during sleep. Family members may find that the patient snores intermittently during sleep, after intervals ranging from 10 to tens of seconds, ending with a ragged breath. Thereafter the patient resumes snoring, but soon this respiratory pause reappears. In severe cases, the repeated breath-holding can be hundreds of times a night. Thus sleep becomes intermittent, the body does not get sufficient rest, and although the sleep time is sufficient, the sleep quality is poor, and the phenomenon of drowsiness the next day occurs. Second, the process of breathing pauses, the body does not get oxygen from the outside world, and the oxygen saturation in the blood will quickly decrease. After the brain experiences repeated hypoxia, it is difficult to maintain the normal level of wakefulness the next day. If the lack of oxygen exceeds a certain severity or lasts for a long period of time, then the neurons of the brain will be irreversibly damaged. Third: We all have the experience that our body becomes fatigued and sleepy after a big, rich meal. This is because the intake of high-fat/high-calorie food will cause the body to increase the level of cholecystokinin, leptin and other hormones, and these hormones will reduce the degree of brain wakefulness. Recent studies have shown that the basal levels of these hormones in obese people are higher than in the general population. In addition, the accumulation of fat cells causes an increase in the level of certain factors in the body, which also reduce the excitability of the cerebral cortex. The damage caused by daytime sleepiness is self-explanatory. The lighter ones will fall asleep in a quiet public place, bringing social embarrassment, and the heavier ones will make mistakes at work or even have traffic accidents. A brain that is not awake enough can hardly function normally to receive information from the outside world. Long-term sleepiness can cause students’ grades to drop and adults’ job performance to be poor, putting them at a disadvantage in the current fiercely competitive society. In conclusion, obesity is not simply an image problem; attention should be paid to the accompanying respiratory impairment, daytime wakefulness and cognitive impairment. If you have a problem with obesity, it is recommended that you seek early diagnosis and treatment to reduce the disturbance to your health and life caused by secondary diseases. The role of bariatric metabolic surgery on female endocrine disorders and reproductive function and on depression and obstructive sleep apnea syndrome. Bariatric metabolic surgery is now recognized worldwide by gastrointestinal surgeons, especially endocrinologists, as the only method to achieve long-term stable weight loss in severe obesity and to effectively treat or control other related metabolic diseases, especially for type 2 diabetes and insulin resistance. The effectiveness of weight reduction metabolic surgery on depression, obstructive sleep apnea syndrome and polycystic ovary syndrome is also supported by reports in the domestic and international literature. Symptoms such as amenorrhea and hirsutism are improved, androgen levels are reduced, and some patients can conceive naturally in the short term after surgery. Even obese women and women with type 2 diabetes who do not have polycystic ovary syndrome are usually associated with irregular menstruation or infertility due to disorders in their systemic metabolic status, and women with metabolic syndrome are at extremely high risk of pregnancy, facing uncontrollable gestational diabetes, pre-eclampsia, impaired infant development and higher maternal mortality, and their children are at increased risk of metabolic diseases, so weight loss surgery It is of positive significance for such women to restore regular menstruation, improve pregnancy rates, and reduce risks during pregnancy and childbirth. The improvement of female endocrine metabolism and reproductive function is only a small aspect of the therapeutic effect of bariatric metabolic surgery. As mentioned earlier, bariatric metabolic surgery is considered to be the only method to achieve long-term stable weight loss in severe obesity, and has significant therapeutic effects on type 2 diabetes, hypertension, dyslipidemia, hyperuricemia, and sleep apnea syndrome, reducing the risk of cardiovascular events. Female patients with obesity, especially severe obesity, often have varying degrees of negative emotions, and in severe cases, even anorexia. On the other hand, many adverse negative emotions or psycho-psychiatric diseases themselves can lead to obesity. For female obese patients, the change in appearance brought about by weight loss metabolic surgery is also of great significance to the improvement of patients’ psycho-emotional disorders, especially for patients who require it after receiving weight loss surgery can also be supplemented by abdominoplasty, which can achieve an immediate effect on the shaping of the shape of the body. Therefore, weight reduction and metabolic surgery also has a good effect on the improvement of obesity-induced mood disorders and psycho-psychiatric diseases, and many patients who have undergone surgery have become positive, optimistic, cheerful and confident in life while obtaining good treatment results.