NPPB and obesity due to melanocortin 4 receptor deficiency: Surprisingly, HF patients with a higher body-mass index (BMI) have a better prognosis than patients with a normal BMI, the so-called ‘Obesity-paradox.’75–78 What is even more interesting, is that subjects with a higher BMI also have lower BNP concentrations79–81 which leads to speculation about the origin of this phenomena.