MC4R and obesity due to melanocortin 4 receptor deficiency: Sixty (21%) patients had a decreased mREE (mREE ≤90% of pREE), of which 3 patients with non-syndromic genetic obesity (a pathogenic heterozygous MC4R variant in 2 patients and a heterozygous PCSK1 variant in one patient; Table 5), 6 patients with syndromic genetic obesity (two 16p11.2 deletion syndrome, 1 Bardet-Biedl syndrome, 1 Cohen syndrome, 1 PHP1b, 1 Temple syndrome; Table 5), 6 patients with obesity caused by hypothalamic dysfunction, 2 patients with medication-induced obesity, and 43 patients with multifactorial obesity.