GHRL and obesity due to melanocortin 4 receptor deficiency: Furthermore, it has been suggested that malabsorptive procedures might also have additional effects on gut hormone profiles, reducing ghrelin, enhancing Glucagon-like peptide-1 (GLP1) secretion and facilitating early ileal exposure to nutrients, alongside reduced expression of peptide YY (PYY) and oxyntomodulin obesity-related genes and altered bile metabolism [14,158].