Surgical treatment of obesity What is obesity? Overweight has become a global epidemic. The most accurate way to express the relationship between body weight and height is the body mass index (BMI).BMI = weight (kg) M height O (kg / m2) is the weight divided by the square of the patient’s height. According to the characteristics of the Asia-Pacific population, adult BMI is classified as follows. (1) healthy: 18.5-22.9, (2) overweight: 23.0-24.9, (3) 1st degree obesity: 25.0-29.9, (4) 2nd degree obesity: 30.0-34.9, (5) 3rd degree obesity: >35.0. What are the harmful effects of obesity? Obesity increases the incidence of diseases such as coronary artery disease, cardiac arrest, arterial hypertension, peripheral vascular disease, hyperlipidemia, diabetes mellitus, pulmonary insufficiency, sleep apnea, osteoarthritis, cholelithiasis, skin infections, chronic venous stasis ulcers, gastroesophageal reflux, sex hormone imbalance leading to dysmenorrhea, hirsutism, infertility and urinary urgency and frequency. Many patients with obesity suffer from severe psychological and social disorders. In addition, the incidence of endometrial, colon, prostate and breast cancers is likely to be higher in obese patients. Why surgery? Weight loss is the only way to treat severe obesity, prevent and reduce the development of obesity complications, and allow patients to return to society, return to work and life, improve quality of life, and extend life expectancy. Exercise therapy, diet control, medication, Chinese herbal medicine treatment and conservative therapies such as food therapy can all serve the purpose of controlling or even reducing weight. At present, all conservative therapies are usually ineffective in maintaining weight loss in the long term, and surgery is the only means to achieve long-term and stable weight loss in severely obese patients. Bariatric surgery has become the most effective treatment for obesity and its complications. In addition, surgical procedures are constantly being improved in order to increase the effectiveness and duration of weight loss. More than 90% of patients with combined diabetes have remission of their comorbidities after surgery. What is the surgical approach? Depending on the principle of weight reduction, surgical procedures for the treatment of severe obesity are divided into three categories: restriction of intake, reduction of absorption, or both. Currently, there are five clinically proven surgical approaches for the treatment of morbid obesity, namely: adjustable gastric banding (restriction of intake), gastric short-circuiting (restriction of intake and reduction of absorption), vertical banding gastric reduction (restriction of intake), sleeve gastrectomy (restriction of intake) and biliopancreatic openings with duodenal transposition (mainly reduction of absorption). Is minimally invasive surgery feasible? Since the first laparoscopic duodenal switch was performed by Dr. Gagner in New York in September 1999, to date, various open bariatric procedures can be performed laparoscopically. The safety and benefits of laparoscopic bariatric surgery, both simple and complex, have been reported in the literature. The complication rate of laparoscopic bariatric surgery is approximately 1% for simple procedures and up to 5% for complex procedures. Weight loss with laparoscopic bariatric surgery is similar to that with open bariatric surgery; however, laparoscopic surgery is less painful and has better lung function than open surgery. In Europe and the United States, the science of obesity surgery matured long before the advent of laparoscopic technology, and the development of laparoscopic technology has injected great vitality into the development of obesity surgery. In China, the situation is just the opposite, obesity surgery is still in the initial stage, while the laparoscopic surgery technology is already mature, the rise of obesity surgery provides a new opportunity for the development of laparoscopic surgery. Why do most obese patients not understand surgical treatment? Obesity surgery in China is still in its infancy. The establishment of medical regulations, the training of physicians and the dissemination of information to the public have just begun. Advocacy has made obese people aware that obesity is not just a social image problem, but one of the most devastating diseases, and that surgery is the most effective (if not the only) means of treating obesity and its associated comorbidities. The benefits of bariatric surgery extend far beyond those with co-morbid diabetes. It is well documented that hypertension, hyperlipidemia, respiratory disorders (such as apnea), reproductive abnormalities, osteoarthritis, skin disorders, and many other obesity comorbidities can be alleviated with bariatric surgery. Therefore, through cooperation with related disciplines, health education can be purposefully provided to people who are suitable for bariatric surgery, so that they can receive the surgery as soon as possible, get rid of obesity, avoid further aggravation of comorbidities, return to society and return to work, improve the quality of life and prolong life expectancy.