However, the hypertrophic expansion of adipose tissuein obesity is often accompanied by inadequate angiogenesis leading to reducedcapillary density and local hypoxia.14 Hypoxia is one of the first pathological changes to occur in adipose tissueduring obesity and is thought to be a main driver of fibrosis via the activation ofhypoxia-inducible factor 1 (HIF1α) and contributes to local inflammation anddyslipidemia (Fig.1).12,15,16. This evidence concerns the gene HIF1A and obesity due to melanocortin 4 receptor deficiency.