“Previous studies have shown frequent remission of type 2 diabetes in adults following bariatric surgery, but until now, no research had been done to provide information about outcomes of adolescent diabetics who are considering surgical weight loss,” said lead researcher Dr. Thomas H. Inge, an associate professor of surgery and pediatrics at Cincinnati Children’s Hospital Medical Center.

“Our study found that, in most cases, teens can lose one-third of their weight and come off diabetes medications with remission of their diabetes one year after bypass surgery. This is certainly not the case for similar diabetic teenage patients who did not undergo surgery,” Inge noted.

The report is published in the January issue of Pediatrics.

For the study, Inge’s group looked at 78 teens with type 2 diabetes. Eleven patients underwent gastric bypass surgery, while the other 67 patients received usual care for their diabetes.

For the teens who had surgery, not only did they have an average 34 percent reduction in their weight, but their diabetes went into remission. Teens that did not have surgery saw an average weight loss of less than two pounds and still needed their diabetes medication.

“In addition to the impressive weight loss and type 2 diabetes results, patients undergoing the gastric bypass surgery also showed significant improvement in blood pressure, insulin, glucose, cholesterol and triglyceride levels,” Inge said.

Type 2 diabetes takes a huge toll on the body, and the earlier it starts, the more of an impact it can have, Inge explained.

“These early surgical research findings suggest that diabetes may not be a diagnosis kids have to live with for the rest of their lives,” Inge said. “They may not have to face diabetic retinopathy, progressive coronary heart disease and renal failure. In fact, there is good reason to be optimistic about their future cardiovascular health.”

“If you are a type 2 diabetic and morbidly obese, gastric bypass surgery should be considered in the treatment pathway,” Inge added.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, thinks that while surgery is effective it does not deal with the cause of the obesity epidemic among teens.

“Bariatric surgery is clearly effective in treating severe obesity, preventing and reversing type 2 diabetes, and even extending survival when applied to adults,” Katz said. “That similar benefits ensue when the procedure is applied to adolescents is important, but by no means surprising.”

Despite the success of surgery, these results should be viewed with caution, Katz said.

“A large and growing proportion of all children and adolescents are subject to obesity, and its complications,” Katz said. “Surgery can mitigate those complications, but can we really condone ushering more and more young people through the OR doors for a major surgical procedure to fix what policies and programs that foster healthful eating and regular activity could have prevented in the first place?”

Gastric bypass surgery is an effective last resort for severe obesity in adolescence, as in adulthood, Katz said. “But a last resort it should be, and we should do all we can to minimize the need for this procedure by combating the root causes of obesity in our society.”

Exercise has long been touted as the panacea for everything that ails you. For better health, simply walk for 20 or 30 minutes a day, boosters say — and you don’t even have to do it all at once. Count a few minutes here and a few there, and just add them up. Or wear a pedometer and keep track of your steps. However you manage it, you will lose weight, get your blood pressure under control and reduce your risk of osteoporosis.

If only it were so simple. While exercise has undeniable benefits, many, if not most, of its powers have been oversold. Sure, it can be fun. It can make you feel energized. And it may lift your mood. But before you turn to a fitness program as the solution to your particular health or weight concern, consider what science has found.

Moderate exercise, such as walking, can reduce the risk of diabetes in obese and sedentary people whose blood sugar is starting to rise. That outcome was shown in a large federal study in which participants were randomly assigned either to an exercise and diet program, to take a diabetes drug or to serve as controls. Despite trying hard, those who dieted and worked out lost very little weight. But they did manage to maintain a regular walking program, and fewer of them went on to develop diabetes.

Exercise also may reduce the risk of heart disease, though the evidence is surprisingly mixed. There seems to be a threshold effect: Most of the heart protection appears to be realized by people who go from being sedentary to being moderately active, usually by walking regularly. More intense exercise has been shown to provide only slightly greater benefits. Yet the data from several large studies have not always been clear, because those who exercise tend to be very different from those who do not.

Active people are much less likely to smoke; they’re thinner and they eat differently than their sedentary peers. They also tend to be more educated, and education is one of the strongest predictors of good health in general and a longer life. As a result, it is impossible to know with confidence whether exercise prevents heart disease or whether people who are less likely to get heart disease are also more likely to be exercising.

Scientists have much the same problem evaluating exercise and cancer. The same sort of studies that were done for heart disease find that people who exercised had lower rates of colon and breast cancer. But whether that result is cause or effect is not well established.

Exercise is often said to stave off osteoporosis. Yet even weight-bearing activities like walking, running or lifting weights has not been shown to have that effect. Still, in rigorous studies in which elderly people were randomly assigned either to exercise or maintain their normal routine, the exercisers were less likely to fall, perhaps because they got stronger or developed better balance. Since falls can lead to fractures in people with osteoporosis, exercise may prevent broken bones — but only indirectly.

And what about weight loss? Lifting weights builds muscles but will not make you burn more calories. The muscle you gain is minuscule compared with the total amount of skeletal muscle in the body. And muscle has a very low metabolic rate when it’s at rest. (You can’t flex your biceps all the time.)

Jack Wilmore, an exercise physiologist at Texas A & M University, calculated that the average amount of muscle that men gained after a serious 12-week weight-lifting program was 2 kilograms, or 4.4 pounds. That added muscle would increase the metabolic rate by only 24 calories a day.

Exercise alone, in the absence of weight loss, has not been shown to reduce blood pressure. Nor does it make much difference in cholesterol levels. Weight loss can lower blood pressure and cholesterol levels, but if you want to lose weight, you have to diet as well as exercise. Exercise alone has not been shown to bring sustained weight loss.Just ask Steven Blair, an exercise researcher at the University of South Carolina. He runs every day and even runs marathons. But, he adds, “I was short, fat and bald when I started running, and I’m still short, fat and bald. Weight control is difficult for me. I fight the losing battle.”

The difficulty, Dr. Blair says, is that it’s much easier to eat 1,000 calories than to burn off 1,000 calories with exercise. As he relates, “An old football coach used to say, ‘I have all my assistants running five miles a day, but they eat 10 miles a day.’”

In Brief:
- While exercise can boost mood, its health benefits have been oversold.
- Moderate exercise can reduce the risk of diabetes in people at risk. Exercise may reduce the risk of heart disease and breast and colon cancers.
- Though the evidence is mixed, exercise may also provide benefits for people with osteoporosis.
- Physical activity alone will not lead to sustained weight loss or reduce blood pressure or cholesterol.

The latest findings about caffeine come from a small study by Duke University researchers who set out to determine if caffeine consumption can undermine a patient’s effort to manage diabetes. The researchers studied the effects of caffeine in 10 patients with Type 2 diabetes. The patients were already regular coffee drinkers and were trying to manage their diabetes without using insulin.

Small glucose detection devices implanted under the abdominal skin tracked the rise and fall of patients’ blood sugar levels. On various days, study participants took either caffeine pills containing the equivalent of about four cups of coffee or identical placebo pills. Neither the patients nor the person giving them the pills knew which capsules contained the caffeine and which contained the placebo.

When the patients ingested caffeine, their average daily blood sugar levels went up by 8 percent. After meals, their blood sugar levels rose even higher, shooting up as much as 26 percent after dinner.

The researchers don’t know exactly why caffeine appears to drive up blood sugar. Caffeine may interfere with the movement of glucose through the body, or it could stimulate the release of hormones known to boost blood sugar levels.

However, the data don’t necessarily mean that people with diabetes or at risk for it should stop drinking coffee. Several large observational studies have shown that coffee drinkers have a lower risk for diabetes. Researchers speculate that other compounds in the coffee have a beneficial effect and may blunt some of the negatives of caffeine.

The data suggest that people with diabetes probably shouldn’t drink caffeinated soft drinks or other caffeine-containing beverages. Coffee drinkers who are having trouble managing their diabetes should consider quitting or switching to decaf to see if it helps, study author James Lane, a professor of medical psychology at Duke University, told HealthDay news. “It’s a simple thing that might make their diabetes better,” said Dr. Lane.

Earlier this month, another study showed that too much caffeine during pregnancy raises the risk for miscarriage.