TNF and obesity due to melanocortin 4 receptor deficiency: An important way that obesity causes low inflammation involves macrophage activation and migration, which can release various inflammatory factors such as interleukin and tumor necrosis factor, creating an inflammatory environment that blocks insulin from doing its job in fat cells and leading to IR, while the Mediterranean diet reportedly improved IR in NAFLD and obese patients, possibly by lowering their inflammation levels [45, 46].