In a meta-analysis of 48 prospective non-randomized studies, the authors reported that BS decreases the low-grade inflammation associated with obesity as measured by C-reactive protein (CRP) and interleukin 6, but not by tumor necrosis factor α, after pooling groups at 6 and 12 months follow-up (36). Here, CRP is linked to obesity due to melanocortin 4 receptor deficiency.