IGF1 and obesity due to melanocortin 4 receptor deficiency: It has been well-described that abdominal and visceral obesity have strong influence on the suppression of GH secretion, and obese patients with the lowest GH secretion presenting the most severe metabolic complications; reduced GH and IGF-1 levels seen in patients with obesity, may be detrimental to both skeletal muscle and liver, contributing to ectopic fat storage [22].