POMC and obesity due to melanocortin 4 receptor deficiency: In addition, subtypes of both obesity and MDD and/or anxiety disorders are assumed to be related to stress, which is characterized by endogenous overproduction of adrenocorticotrophin (ACTH) and cortisol [37] This chronic hypercortisolism induces (abdominal) obesity and depressive symptoms, and severely reduced HR-QoL, conditions which are all known to improve in the majority of patients after treating the disease by surgery or medication [37].