A previous study showed that weight loss by 31.2% was observed after 16 weeks of laparoscopic greater curvature plication in class 111 obesity subjects associated with parallel decreases in leptin and circulating immune cells CD4+ and CD8+ T lymphocytes compared to their preoperative values.22 These data parallel the current study of decreased BMI by 32.6%, leptin, and CD4+ T lymphocytes. Here, CD4 is linked to obesity due to melanocortin 4 receptor deficiency.