Diabesity and microvascular disease: the impact of weight loss

There is increasing evidence that obesity is an independent risk factor for the development of microvascular disease. Addressing modifiable risk factors such as obesity may help prevent and even reverse microvascular complications, including neuropathy, nephropathy and retinopathy. In this review article, we examine the evidence for the impact of obesity on microvascular disease, as well as the effects of weight loss in individuals with and without type 2 diabetes mellitus (T2DM). Numerous studies have shown obesity to be an independent risk factor for neuropathy and nephropathy in patients with and without T2DM but the association between obesity and retinopathy is less clear. Addressing obesity through weight loss strategies can have beneficial outcomes. Although evidence for medical weight management is limited due to the lack of longitudinal data, there is growing recognition of the positive impact of surgical weight management. Recent studies have shown bariatric surgery to be protective against diabetic neuropathy despite previous concerns from older studies. Similarly, several studies have demonstrated improvements in renal measures after bariatric surgery. Improvements in retinopathy, however, have been less encouraging, with further research required to fully understand the impact of obesity. Overall, managing obesity and implementing weight loss through bariatric surgery has positive outcomes for reducing the burden of microvascular disease.