الفهرس 
Definition, Causes and Complications of Morbid ObesityOnly 14 pages are availabe for public view
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Abstract
Morbid obesity is a serious health problem, with co morbidities such as hypertension, diabetes, dyslipidemia and atherosclerotic cardiovascular diseases. Statistically significant improvements have been observed in both diabetes and hypertension, with about 10% weight loss, and in cardiovascular conditions with 5% weight loss.
Leptin hormone is secreted by the adipose tissue to signal the status of body energy stores to the central nervous system. Adequate leptin levels permit energy costly neuroendocrine functions, and suppress appetite. Negative energy balance decreases leptin levels, increasing the drive to eat and limit energy expenditure.
Over secretion of insulin and peripheral resistance to its action is commonly associated with overweight and obesity, and improved insulin sensitivity following weight loss leads to reduction in insulin secretion. Yet, the observed improvement in glucose homeostasis after weight reduction in obese people suggests that insulin secretion is not reduced as much as would be anticipated by the improvement of insulin sensitivity.
At present, bariatric surgery is the most effective method used to achieve long term weight loss, the major goal in obesity treatment. It has been documented that postsurgical weight loss improves almost all obesity related comorbidities.
The aim of our study was to detect the changes in insulin level, glucose and Leptin plasma level after Vertical band Gastroplasty (VBG) in Morbidly Obese patients.
This is a prospective controlled clinical study which included 60 patients, who were admitted to Ain Shams University Hospitals and Ahamed Maher Hospital, Cairo, Egypt with a diagnosis of Morbid Obesity with BMI > 40 kg/m2, in the period between 2009 to 2011
All patients were subjected to preoperative full medical history taking, clinical examination, calculation of BMI, laboratory investigations including fasting (blood sugar, serum insulin and leptin hormone) and HOMA-IR calculation. All these parameters were reassessed after two, four and six month postoperatively.
This prospective study showed that VBG is associated with significant reduction of BMI, fasting serum glucose, serum insulin, leptin hormone when compared to preoperative results.
Also our study showed highly significant reduction in HOMA-IR (insulin resistance) postoperatively in comparison to preoperative period which can be explained by decrease caloric intake postoperatively and decrease of adipokines production from fat cells.
Finally, we can say that Vertical Band Gastroplasty is not only restrictive bariatric procedure for weight reduction in morbid obesity but also it is way for management of metabolic complication associating morbid obesity as diabetes, insulin resistance, hyperglycemia and hyperleptinemia.