Obesity is not only a matter of appearance. It is also a serious health concern. The Faculty of Medicine of The Chinese University of Hong Kong has achieved to apply laparoscopic surgery to treat morbid obese patients and the results are very promising.

　　Westernized and sedentary lifestyles have made obesity an important health issue in Hong Kong. According to the criteria (Asian health risk) of the World Health Organization, "overweight" is defined as the body mass index (weight/height2, BMI) greater than 23, while "obese" is defined as BMI over 25. About 29% of Hong Kong adults are obese. Obesity is associated with many diseases, such as high blood pressure, high blood lipid, diabetes, obstructive sleep apnea, coronary heart disease and degenerative arthritis. Moreover, it is also associated with psychosocial disability. "Morbid obesity" is referring to patients with body weight doubling the ideal body weight or BMI exceeding 40. The life expectancy of these patients will be severely affected by their obese-related diseases and their mortality rate is twice that of the healthy people.

　　There are five weight reduction therapies: dieting, exercise therapy, behavioral modification therapy, pharmacological therapy and surgery. For overweight or obese patients, non-surgical methods may help solve the problem. However for morbid obese patients, the success rate is less that 5%. Even they achieve the ideal weight, it is difficult to maintain in the long run. Surgical therapy is the only effective long-term weight reduction treatment for these patients, which the United State National Institution of Health also agreed. By surgical treatment, obvious reduction of about 50% excessive body weight can be achieved.

　　Based on the experience of western countries, potential candidates for surgery are those with a determined will of losing weight and

1. BMI >40 or BMI >35 and suffering from severe obese-related disease;
2. at least 5 years of obesity, and have failed in previous weight reduction therapies;
3. no alcohol or drug abuse problems, and does not has major psychiatric disease; and
4. aged between 18-55, and has no endocrine cause of obesity.

　　There are two main types of weight reduction surgery. "Malabsorption" surgery reduces the absorptive capacity of alimentary tract with appropriate gastric and small bowel bypass and can achieve great weight reduction. However, it is associated with more operative morbidity and postoperative complications. "Restrictive" surgery subdivides the stomach into a small proximal partition and thus, reduces the amount of food intake through limiting the capacity of the gastric reservoir. This method is more physiological and associated with fewer complications.

　　Obesity surgery is rapidly developing in the recent years with the advancement in laparoscopic surgery and the invention of "adjustable gastric band". This kind of surgery places a silicon band around the proximal stomach and implants a subcutaneous injection port to control the size of the proximal gastric partition. This surgery has been adopted by Europe, Australia and the United States with the efficacy and safety verified.

　　CUHK has introduced this new surgery at Prince of Wales Hospital for the management of morbid obesity. Five patients whose mean body weight is 138kg and mean BMI 50 have undergone the surgery. With minimally invasive laparoscopy, their postoperative recovery is faster than that of a traditional open surgery. The mean hospital stay is only 3 days and they have only a few key-hole scars left in their tummy.

　　After operation, patients need to adopt a new diet regimen on the dietitian's advice. In the first month, they can only take fluid food in order to allow the fixation of the gastric band. Then they can start to intake solid food gradually. As the residue capacity of the gastric pouch is only about 20ml, patients have to eat small amount of food slowly, or they will develop vomiting and distending pain. Fluid can be added or removed from the band through the subcutaneous injection port in order to adjust the size of the gastric outlet according to the weight reduction rate and the degree of side effects. The target excessive body weight loss is about 40-50% in one year, and in the first 3 months, our patients have lost about 25% of their excessive body weight already. Moreover, some obese-related conditions like hypertension and sleep apnea began to improve in these few months.

　　The ultimate success of surgical treatment for morbid obesity depends heavily on the will of the patient, and the collaboration among the "obesity management team" (physicians, psychiatrist, anesthetist, dietitian, psychologist and physiotherapist etc). Morbid obesity is not only a matter of appearance, and it seriously affects the physical and psychological well being of the patient. For these obese people to be able to receive appropriate care, we should give positive support and care rather than discrimination and despise.