Patient description: The patient is a 32-year-old obese woman who came to the clinic with weight concerns. She is 165 cm tall and her weight is 113 kg. She is complaining of sleep apnea, PCO and dissatisfaction with her body shape. She is a high-school teacher married for 5 years. She doesn't use any contraceptive methods for the past 4 months and she had no prior pregnancies. She doesn't smoke or use any drugs. She likes to try diets and exercise to lose weight. She completed the four square step test in 14 seconds. Her BP: 130/80, HR: 195/min and her BMI is: 41.54. Her labs: FBS: 98 mg/dl TG: 150 mg/dl Cholesterol: 180 mg/dl LDL: 90 mg/dl HDL: 35 mg/dl Her cardiac assessment is normal. Her joints and ROM are within normal.

Clinical trial eligibility criteria: eligible ages (years): 18.0-65.0,  Morbid Obesity Patients who are morbidly obese. 1. Female, age 18-65 years 2. Meeting the as outlined in Part 2 A (Synopsis) of a medically underserved, rural, poor or underrepresented minority. 3. BMI > 40 and < 55, or BMI > 35 and <55 with one or more significant comorbidities. Co-morbidities are defined as diabetes, pulmonary disease, cardiac disease, or hypertension [systolic blood pressure of ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg (or both) or on treatment for hypertension] 4. History of obesity for at least 2.5 years 5. History of failure with non-surgical weight loss methods 6. Agree to comply with the substantial dietary restrictions and exercise program required by the procedure 7. Signed approval by physician and psychologist of subject's physical and mental suitability for bariatric surgery 8. Understands risks of procedures, agree to follow protocol requirements, including signing informed consent, returning for follow-up visits and completing all required testing, completing diet and behavior modification counseling. 9. Subject is a resident within the state of California or the city of Bangkok, Thailand and will likely remain so for a 2 year period of time. 10. Willingness to participate in weekly visits with Weight Watchers International local program  Subject history of inflammatory disease of the gastrointestinal tract including Crohn's disease or ulcerative colitis 2. Significant known esophageal disease including grade 3-4 esophagitis, active gastric ulcer disease or active duodenal ulcer disease 3. Severe coagulopathy, upper GI bleeding conditions such as esophageal or gastric varices, congenital or acquired telangiectasia 4. Congenital or acquired anomalies of the GI tract such as atresias or stenoses. 5. Severe cardiopulmonary disease or other serious organic disease including HIV or cancer 6. Currently pregnant or nursing. Potentially childbearing (i.e. not post-menopausal or surgically sterilized) and not willing to use an effective method of contraception for the next 12 months 7. Current alcohol or drug addiction 8. Mentally retarded or emotionally unstable, or exhibits psychological characteristics which, in the opinion of the investigator or psychologist/psychiatrist, make the subject a poor candidate for this procedure 9. Previous gastric, esophageal, pancreatic, or bariatric surgery 10. Infection anywhere in the body at the time of the procedure 11. Subject history of scleroderma, amyloidosis 12. Thyroid disease which is not controlled with medication 13. Hormonal or genetic cause for the obese state. 14. History of cancer other than localized basal cell carcinoma. 15. Myocardial infarction or cerebrovascular accident within past year. 16. Angina pectoris. 17. Severe coagulopathy (prothrombin time > 3 seconds over control or platelet count < 100,000) 18. Gastroparesis or pyloric stenosis. 19. Lesions with increased risk of bleeding. 20. Severe cardiopulmonary disease or other serious organic disease, including HIV or cancer. 21. Congestive heart failure. 22. Uncontrolled hypertension (systolic > 150 or diastolic > 100). 23. Severe or advanced liver disease (such as cirrhosis, chronic hepatitis, portal hypertension, etc.). 24. Severe reflux disease. 25. Active, continuous alcohol consumption (> 80 gm/day of ethanol) or chronic illicit drug use within the last 3 years. 26. Currently on prescription or over the counter diet drugs. 27. Chronic therapy with aspirin, NSAID or anticoagulants. 28. Not ambulatory. 29. Participating in another ongoing clinical trial in which concomitant diagnosis or therapeutic intervention would adversely affect the integrity of the clinical trial. -