TNF and obesity due to melanocortin 4 receptor deficiency: Hypertrophic or apoptotic adipocytes in individuals with obesity increased the pro-inflammatory status, due to the secretion of several molecules such as leptin, resistin, interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) that can activate M1 macro-phage-response [91, 92].