In both omental and subcutaneous fat, metabolic genes that were downregulated in obesity—IGF1, LPIN1, IDH1, PDE3A in omentum; IGF1, DUSP1, GPX3 and GLUL in subcutaneous fat—remained downregulated two years after surgery, while gene-set enrichment demonstrated persistent upregulation of TGFβ-linked fibrotic pathways and apoptosis-related programs [93]. Here, TGFB1 is linked to obesity due to melanocortin 4 receptor deficiency.