IGF1 and obesity due to melanocortin 4 receptor deficiency: The "early protein hypothesis" 24 further elucidates this process: protein intake exceeding physiological requirements augments insulin and insulin-like growth factor-1 (IGF-1) secretion, thereby inducing adipocyte differentiation and lipogenesis while suppressing lipolysis — ultimately driving adipose tissue expansion,25 potentially via obesity-related pathways given its established role in adversely impacting respiratory health through multiple mechanisms: diminished lung volumes,26 impaired pulmonary function,27 and aggravated symptom burden including wheezing.28