Regarding SHBG, our results showed that plasma SHBG levels increased after 1 month BS in all patients which has also been described previously in women with polycystic ovary syndrome and obesity [20] and recently reported in several meta-analysis, where SHBG rise from 25 to 130% [43, 50–52]. This evidence concerns the gene SHBG and obesity due to melanocortin 4 receptor deficiency.