This ultimately results in the surviving hypertrophic adipocytes having decreased adiponectin70 and increased leptin secretion.71, 72 Obesity also impairs adiponectin exocytosis73 and decreases adiponectin receptor surface expression,74 while increased adipocyte leptin secretion is associated with changes in insulin regulation75 and IL-6 expression in AT.76 Despite such advances, further studies are needed to establish direct molecular mechanisms underlying adiponectin and leptin secretion in obesity. This evidence concerns the gene LEP and obesity due to melanocortin 4 receptor deficiency.