Contents obesity is increase prevalence in the United Status and worldwide.In Taiwan men obesity prevalence was 19.2% nearlt South Korea12 times and Japan 8 times.in women obesity prevaence was 16.6% nearly South Korea and Japan 5 times. health hazard associated type II DM,heard disease, stroke, liver disease, obstructive sleep apnea, certan cancer, osteoarthritis and depression. cost of treatment obesity and complicattion in the United Status approximately 100 billion dollars per year. increase rate of death from all causes and from cardiovascular disease. this case 56 old male patient. past disease history type II DM ten years use OADs and insulin injection control. c-peptid: 3.94 ng/dL (102/5), CAD and DVD with drug eluting stenting. erythromatous gastritis and esophagitis regular PPI. old lacunar Infarction. BMI:38 visit GS OPD for batiatric surgery severe (laporoscopic sleeve gastrectomy: mechanism: restric) at102/6/26. pre-op and post op visit dietitian for nutrition consultation and follow up.post op two months pt weight reduction 11 kg. blood sugar control well (HbA1c: 10.3 (5/1) 8.0 (7/10) 7.7 (8/6).AC sugar : 189 mg/dL (5/1) 133 mg/dL (7/10) 113 mg/dL (8/6). insulin injection 20 u decrease 15 u then 10 u. lipid profil HDL: 40 mg/dL. LDL: 120 mg/dL. urea acid: 6.3 mg/dL. body fat: 34.3 reduction 30. pre-op waistine and hip 105 cm. for many study Bariatric surgery (Roux-en-Y bypass) treatment DM. Ghrelin peptide hormore secreted foregut (stomach and duodenum). that stimulates the early phase of meal consumption in laparscopic sleeve gastrectomy exaggerated respones peptide YY (PYY). may be also contribute to loss of appetit hormones such as glucagon-like peptid-1 (GLP-1) and cholecystokinin (CCK) which are increase after RYGB. may be promote anorectic state. in this case use laparscopic sleeve gastrectomy (LSG) and diet control and adequate excise. successful control DM and reduction body weight and metabolic syndrom.key word:moderate obesity. laporscopic sleeve gastrectomy. DM. metabolic syndrome. Bariatric surgery