الفهرس 
DEFINITION, COMPLICATION AND MANAGEMENT OF OBESITYOnly 14 pages are availabe for public view
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Abstract
O
besity has become a national and worldwide epidemic, classified as overweight or obese Although dietary and lifestyle modifications have traditionally been the mainstay of treatment for obesity, their lack of success at longterm weight reduction and the paucity of effective pharmacologic agents led to a comprehensive evaluation of surgical management to find a perfect solutions to satisfy the patient and make his life more comfortable.
Guidelines established at that time recommend bariatric operation for morbidly obese patients, defined as those with a body massindex (BMI)- 40 or patients with a BMI - 35 who have associated comorbidities.
Current surgical options: restrictive procedures like vertical banded gastroplasty (VBG), adjustable gastric banding (AGB), sleeve gastroectomy (SG), malabsorptive procedures like: jejunoilealbypass, biliopancreaticdiversion, duodenal switch procedure (DS) and combined procedures like gastric bypass, minigastric bypass.
The doctor choose the suitable operation to his patient according general condition and acceptability of patient body to the operation type.
Postoperatively, patients experience rapid weight reduction, typically peaking in the first 18 to 24 month and gain heightened self-confidence and mood, in addition to substantial medical benefits.
The body contouring surgery can be used as an adjuvant to the bariatric surgery to repair the deformities following bariatric surgery.
The ideal time to perform body contouring procedures is when the weight is stable which is typically 12 to 18 months after weight reduction surgery to reduce post-operative complications.
Evaluation of most body-contour deformities consists of determining two factors: degree and quality of skin excess or deficiency, and degree of fat excess or deficiency.
Areas of moderate fat excess with minimal skin excess is adequately treated with minimally invasive procedures, such as liposuction, In contrast, areas of major skin excess, such as those seen in the MWL patient, necessitating excisional procedures.
The most common order for treating such problems is to address the lower trunk first, followed by the arms or overall thoracic region, and with the thighs treated last.
Traditional abdominoplasty technique must often modified for the MWL patient. Cicumferential lower body lift has a powerful effect on the lateral thighs, buttocks, and anterior trunk in a single operative setting.
Vertical thigh lift is best perfomed in a separate operative setting on the lower body lift. This will complete the aesthetic contouring of the thighs.
Brachioplasty performed using a segmental resection method can avoid over resection.
The total parenchymal reshaping and dermal suspension technique is indicated to correct these severe deformities in the form of reshaping of the deflated breast parenchyma and aug¬mentation with autologous tissue to restore projection.
The optimization of results in body contouring requires simultaneous visualization of all body regions. This goal is achieved through circumferential and balanced surgical approach. There are several factors affecting choice of the technique such as, gender of the patient, age, general condition, general adiposity, skin condition, and patient’s wishes.
Body contouring for the massive weight loss patients differs from non massive weight loss patients, so it is challenging to qualify the ideal technique for the specific deformity at the proper timing with the least complication