Some studies propose at a molecular level a higher clearance of BNP in obesity due to increased expression of natriuretic peptide receptor on adipose tissue, which binds BNP and leads to its internalization and degradation (51) A reduced release of natriuretic peptides from myocardial tissue in obese individuals have also been pustuled as an alternative hypothesis (52) Therefore, a combination of increased degradation and decreased release may contribute to relative deficiency of natriuretic peptides in obesity. This evidence concerns the gene NPPB and obesity due to melanocortin 4 receptor deficiency.