INS and obesity due to melanocortin 4 receptor deficiency: Obesity is characterized by a chronic, low-grade inflammatory response28 and promotes autoimmunity through a variety of mechanisms including secretionof adipokines.29 Studies on the effect of excess body fat on the abundances of differentbacteria taxa in the gut generally show alterations in the gastrointestinalmicrobiota with effects on inflammation, insulin resistance, deposition of energy infat stores.30