الفهرس 
DEFINITION OF OBESITYOnly 14 pages are availabe for public view
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Abstract
The prevalence of obesity is increasing worldwide at an alarming rate. In 2006, the number of overweight and obese people in the world overtook the number of malnourished.
Obesity is usually defined using the BMI, generally speaking, a BMI 30 kg/m2 defines a state of obesity while BMI 40 kg/m2 is defined as severe or morbid obesity.
At its simplest, obesity is caused by an excess of energy intake over energy expended. Any excess energy intake over and above an individual’s daily requirement will result in that energy being stored. Energy is stored as fat and deposited subcutaneously and viscerally.
Etiology of obesity includes genetic and familial, psychological, endocrinal, environmental, hypothalamic factors and drugs.
There are different methods of body measurements for obesity such as body mass index, body circumferences and skin fold thickness beside measurement of body composition using densitometry and measurement of fat distribution using computed tomography and magnetic resonance imaging.
Obesity related comorbidities are variable, widespread and sometimes serious. It includes osteoarthritis, hypertension, non insulin dependent diabetes mellitus, dyslipidemia, coronary heart diseases, cardiovascular dysfunction, neurological disorders, thromboembolic diseases, respiratory problems, sleep apnea, genital disorders, gastrointestinal complications, endocrinal dysfunction, renal complications, cancers, hernias, skin infections, social and psychological problems and increased risk of mortality at all ages. So, one can easily see the seriousness of the problem in today’s society medically, socially and economically.
The primary goal of treatment is to improve obesity related comorbid conditions and reduce the risk of developing future comorbidities.
A multidisciplinary team approach involving a physician with a special interest in obesity, a dietitian, a psychologist or psychiatrist interested in behavior modification and eating disorders and a surgeon with experience in bariatric procedures is optimal.
¬Practical assessment requires a comprehensive history, physical examination and appropriate further investigations. The aims are to assess the severity and degree of health risk associated with obesity, to identify possible underlying causes of obesity and the presence of any comorbidity or complication of obesity.
Medical treatment of obesity includes therapeutic management, behavioral modification, dietary modification, exercise programs and appetite suppressant. All of these measures have not been effective in patient with marked obesity as the problem in medical treatment of morbid obesity is not only to lose weight but also to maintain the weight loss and high relapse after 1-2 years.
Surgical treatment is the only proven method to achieve long term weight control for morbid obesity.
Bariatric surgery now offers a validated approach that has a much greater objective success rate of maintaining weight loss (up to 50% of original weight).
Actually surgical treatment of morbid obesity is gaining in popularity and there is obviously increased interest and acceptance of bariatric surgery as a golden way to achieve stable reduction of body weight in morbidly obese patients.
Bariatric surgical techniques are divided into malabsorptive procedures such as biliopancreatic diversion with gastrectomy or duodenal switch, restrictive procedures such as gastroplasty, gastric banding and sleeve gastrectomy and combined malabsorptive and restrictive procedures as Roux-en-Y gastric bypass.
Many authors consider Roux-en-Y gastric bypass the ‘‘gold standard’’ surgical treatment for morbid obesity. It combines a restrictive and malabsorptive mechanism that has long term efficacy in the reduction of excess weight.
Laparoscopic bariatric surgery is a major advance because it improves outcomes by reducing operative morbidity and recovery.
The weight loss in laparoscopic Roux-en-Y gastric bypass is superior to other gastric restrictive procedures. Laparoscopic Roux-en-Y gastric bypass reduces the incidence of early postoperative complications in patients considered to be high risk. There is also a significant reduction in hospital stay in patients submitted to the laparoscopic procedure.
In conclusion, Laparoscopic Roux-en-Y gastric bypass offers major benefits with quite satisfactory results over most alternative procedures.
In this study, we have found that the Laparoscopic Roux-en-Y gastric bypass provides an innovative approach to one of our major health problems.
Our data, which includes follow up of two years, indicates that Laparoscopic Roux-en-Y gastric bypass is:
• An effective procedure for the treatment of morbid obesity,
• Technically feasible,
• Safe operation with a low rate of major postoperative complications without mortality,
• Has a significant reduction in patient’s hospital stay,
• Helps in the achievement of a significant weight loss and improvement of obesity related metabolic comorbidities,
• Efficient in loosing excess weight and in maintaining the weight loss,
• Is a promising bariatric procedure.