When considering that almost 50% of all HF patients display a preserved EF phenotype (3) and that obesity is closely associated with HFpEF (21, 22), caution must be taken when excluding a HF diagnosis on the basis of a BNP measurement of <35 pg/mL or a NT-proBNP <125 pg/mL as recommended in current guidelines (4). Here, NPPB is linked to obesity due to melanocortin 4 receptor deficiency.