This was a recurrent theme with genes related to metabolic stress such as SOCS3, CHI3L1, and CSF3. Our data suggest that the same genes that are in involved in obesity/diabetes might also be relevant to ESAM, possibly causing a mirrored molecular response to the availability of nutrient energy sources that utilizes similar pathways. Here, CHI3L1 is linked to obesity due to melanocortin 4 receptor deficiency.