TNF and obesity due to melanocortin 4 receptor deficiency: However, obesity is accompanied by some degree of inflammation called low-grade inflammation (117) whereby the adipose tissue secretes high levels of pro-inflammatory adipocytokines, including tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), resistin, and leptin, due to cell death by necrosis following hypoxia (113).