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Diet has a massive impact

But there is little doubt that the morbidly obese patient has developed bad eating habits that include unhealthy foods which are high in saturated fat, high in carbohydrates, high in processed sugars, and high in calories

Subgroup analysis of those subjects having reduced corneal nerve fibers, and therefore more definitive evidence of small fiber neuropathy (37), show that ARA 290 treatment is associated with an increase in corneal nerve fiber density, analogous to the improvement seen after improved metabolic control (42) and after simultaneous pancreas and kidney transplantation (43)

But the one study that really hit home for me was this milkshake experiment