الفهرس 
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Abstract
Obesity is an excess of body fat that frequently results in a significant impairment of health. It is a chronic, lifelong, genetically related, and life-threatening disease of excessive fat storage. In a practical setting, it is difficult to determine this directly. Therefore, obesity is typically assessed by BMI (body mass index) and in term of it distribution by the waist circumference.
The Most widely accepted measure of obesity is the body mass index (BMI) which equals patient weight in Kilograms divided by the square of his or her height in meters. A normal BMI ranges from 18.5 – 24.5 Kg /m2 , overweight equals BMI between 25- 29.5 Kg/ m2 , obesity equals BMI 30 Kg/ m2 or higher ; This is further subdivided into class I with BMI between 30- 34. 9 Kg / m2 with high risk , class II obesity with BMI between 35 – 39.9 Kg / m2 with very high risk & obesity class III with BMI more than 40 Kg / m2 with extremely high risk.
The reasons for obesity are multiple and complex. The underlying causes of severe obesity are not known. There are many factors that contribute to the development of obesity including genetic, hereditary, environmental, metabolic and eating disorders. There are also certain medical conditions that may result in obesity like intake of steroids and hypothyroidism.
Obesity is associated with progressive, serious and debilitating comorbidities such as type II diabetes, hypertension, hyperlipidaemia, accelerated atherosclerosis, debilitating arthritis of weight – bearing joints, hypoventilation, sleep apnea syndrome, gastroesophageal reflux disease, infertility & urinary stress incontinence in females, certain cancers, immobility, psychological and economic problem.
long-term effects of obesitytreatments on body weight, risk factors for diseaseand diseasefound that weight loss from surgicaland non-surgical interventions for people sufferingfrom obesity was associated with decreased risk ofdevelopment of diabetes, and a reduction in LDLcholesterol,total cholesterol and blood pressure,in the long term. The effects of bariatric (weightloss) surgery on weight and Type 2 diabetes havealso been reviewed.
Treatment possibilities include diet restriction, behavioral therapy, medical treatment and surgery. All non surgical treatment regimens have an extremely high rate of failure and surgery is therefore today the option for morbid obesity, yet studies have shown that all of theseoptions except surgery have been ineffective in long-term weightcontrol.
Surgical treatment seems to be more effective in the management of morbid obesity with acceptable rate of complications. The surgical modalities used in the bariatric surgery initially used in treating other conditions, and these modalities was found to cause weight loss post- operatively as a side effect.
Primary operations forWeight Loss Surgery(WLS) are either restrictive,mal-absorptive or a combination of both. Mostmal-absorptive procedures fall into the latter category. The 2most commonoperations in the United States today are the adjustable gastric band (AGB) and Roux-en-Ygastricbypass (RYGB). Other approaches include sleevegastrectomy (SG),biliopancreatic diversion (BPD) with or without a duodenal switch (DS), vertical bandedgastroplasty (VBG), and jejunoilial bypass (JIB). Very few VBGs are performed due tonumerous complications. JIB has been abandoned altogether for the same reason.
Complications can be divided into 3 major categories:intra-operative, early postoperative,and late postoperative. Some apply to all WLS surgeries, whereas others areprocedure specific. Complications that are germane to all WLS operations are: Deep Venous Thrombosis/Pulmonary Embolism,pulmonary/cardiovascular complications, gallstone formation, malnutrition, psychiatric, failure to lose weight, and death.
Laparoscopic bariatric surgery take place in the last few years strongly, due to the greatly diminished post-operative complications. It is indicated in severe obesity especially if it is associated with the severe co-morbidities.
Comparison between surgery and non-surgical management reveals statistically significant weight loss followingsurgery compared with nonsurgical management at 2 yfollow-up, losing between 23 and 37 kg more weight and 21 kg weightloss maintained at 8 y following surgery. Quality of life is shown to improve significantly following surgery comparedto nonsurgical management on many somatic symptoms,psychological symptoms and social factors. Surgery had a statisticallysignificant beneficial effect on hypertension,and diabetes compared to nonsurgical management. The effects on diabetes weremaintained at 8 y.
Obesity-related illness costs the U.S. economy an estimated$100 billion a year, making itsecond only to smoking for overall annual medical expenditures. Obese patients are 2to 5 times more likely to miss work and cost employers over $2200 more every yearthan their normal weight colleagues (in 2005 dollars). WLS is likely to reduce costsvia reduced absenteeism and presenteeism, and increased productivity.
The proliferation of obesity has grave consequences for health care systems and theeconomics of providing care due to the increasingnumbers with obesity and more severediseases. Health care spending on obesity-related conditions among people50–69 years old is expected to increase by 50% by 2020. There are obvious implicationsfor public health policy and the need to educate the providers. The projectionsfor gainful employment and contributions to society must also be consideredin contemplating the economic effects of this disease. Most distressing is the prognosisfor severely obese individuals. No effective long-term medical therapy currentlyexists. Effective surgical methods may be excluded or limited by health insuranceproviders, creating inequities. The thrust of research and public interventionmust be toward identifying the cause and preventing the development of obesity.
The economic impact of WLS, outcomes showedthat the initial cost of bariatric surgery is approximately $17,000 to $26,000, and that forpayers, all costs would be recouped within 2 years for laparoscopic surgery patients andwithin 4 years for open surgery patients. The cost of diabetes alone is an estimated $10,634 annually.
The benefits and costs of the surgical treatment raise the questionof whether weight loss surgery is cost-effective forobesepeople with or without co-morbidities. Bariatric surgery in general is cost-effectivefor obese people with BMI greater than 35 kg/m2, as incremental cost-effectiveness ratio (ICER) are less than US$4000 per quality-adjusted life years (QALY) gained. It is even cost-saving forthose severely obese patients whose BMI is greater than 50 kg/m2and who have at least one or more obesity-related co-morbiditiesbefore surgery.Bariatric surgery is more cost-effectivefor younger people with higher initial BMI.
Laparoscopic Roux-en-Y gastricbypass (LRYGB), Laparoscopic sleeve gastrectomy(LSG), and Laparoscopic adjustable gastric banding (LAGB) are the most commonly performed bariatric procedures. These procedureslikely reduce healthcare expenditures related to the resolution of co-morbid conditions, they havedifferent rates of peri-operative risks and differential rates of associated weight loss.