UC and OCD are both associated with gut microbiome alterations (14, 40) and it is possible that in the setting of longstanding OCD, the emergence of UC triggered an inflammatory cascade resulting in neuroinflammation, dramatic worsening of OCD, and a bidirectional feedback loop of gut-systemic-neuro inflammation which impaired insulin signaling and resulted in carbohydrate craving, progressive obesity, and central adiposity. This evidence concerns the gene INS and obesity due to melanocortin 4 receptor deficiency.