Obese adolescents with type 2 diabetes may have impaired cognition based on clinical research published in Diabetologia.
RESEARCH Eighteen obese children with type 2 diabetes and 18 obese with no evidence of diabetes or pre-diabetes, underwent extensive testing. The adolescents with diabetes performed worse on memory and spelling tasks as well as on tests of their overall intellectual functioning. This was confirmed by magnetic resonance imaging (MRI) scans that revealed changes in the white matter of the brains of obese children with diabetes. 
It is is not yet fully understood how type 2 diabetes interferes with learning, but "we know the brain uses sugar as a source of metabolism, and insulin resistance interferes with the body's ability to get more juice or sugar into the brain," says Antonio Convit, MD, professor of psychiatry and medicine at the New York University Langone Medical Center in New York City.
Treating Diabetes Through Weight Reduction
"Fitness is the best way to improve insulin resistance," Convit says. "These kids need to exercise and with exercise, weight loss will come." Parents should also encourage healthy eating.
For the morbidly obese, psychosocial or cosmetic considerations influence drastic measures for weight reduction like bariatric surgery. Yet, health concerns such as Type 2 diabetes generally provide the final stimulus and justification for the patient and surgeon. Food consumption in excess of energy requirements underlies the current pandemic. Calorie deprivation is fundamental in effective weight-loss regimens. Surgical caloric deprivation by malabsorption or gastric restriction is therefore highly effective in lowering blood glucose and reducing the need for other therapies. Even patients in whom diabetes treatment can be reduced or eliminated require long-term monitoring of glucose, lipids and blood pressure, and potential adverse surgical consequences. 
Bariatric surgery offers relief that was unavailable to previous medical generations. It can improve quality of life and confidence, as well as social and professional opportunities. Yet, it does not eliminate the risk of glucose, lipids and hypertension. 
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- Brain Changes in Obese Kids With Diabetes Hinder Learning, Denise Mann, WebMD, August 3, 2010
- The big fat bariatric bandwagon, Pinkney JH, et al. Diabetologia, 2010, Volume 53, Number 9, Pages 1815-1822