LEP and obesity due to melanocortin 4 receptor deficiency: The metabolic and haemodynamic hypothesis as described by le Roux et al. [29] may explain the beneficial surgical effects in morbid obesity; metabolites such as leptin and other adipokines are reported to induce ventricular hypertrophy in obesity and lead to increasing circulating blood volume contributing to ventricular dilatation and hypertrophy [30].