It is well recognized that in obesity, the adipose tissue secretes a distinct quantity of inflammatory cytokines, and some of these, such as tumor necrosis factor-a, (TNF-a) interleukin-1 (IL-1) and interleukin-6 (IL-6), escape into the general circulation provoking systemic symptoms (36). Here, TNF is linked to obesity due to melanocortin 4 receptor deficiency.