POMC and hyperinsulinemic hypoglycemia, familial, 4: In qualitative interviews, patients and caregivers of patients with POMC deficiency caused by biallelic variants in POMC or PCSK1, LEPR deficiency caused by biallelic variants in LEPR, or BBS reported that hyperphagia was always or nearly always present, led to negative emotions such as guilt and failure, and negatively affected friendships, family dynamics, and productivity at school or work [12, 14].