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Case Report
Obes Facts 2022;15:730–735
First Account of Psychological Changes Perceived
by a Female with Congenital Leptin Deficiency
upon Treatment with Metreleptin
Johannes Hebebrand
a Stefanie Zorn
b Jochen Antel
a Julia von Schnurbein
b
Martin Wabitsch
b Gertraud Gradl-Dietsch
a
aDepartment of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen,
Germany; bCenter for Rare Endocrine Diseases, Division of Pediatric Endocrinology and Diabetes, Department of
Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
Received: February 17, 2022
Accepted: June 22, 2022
Published online: August 11, 2022
Correspondence to:
Martin Wabitsch, martin.wabitsch @ uniklinik-ulm.de
Gertraud Gradl-Dietsch , gertraud.gradl-dietsch @ uni-due.de
© 2022 The Author(s).
Published by S. Karger AG, Basel
Karger@karger.com
www.karger.com/ofa
DOI: 10.1159/000526169
Keywords
Leptin · Obesity · Anorexia nervosa · Preoccupation with
food · Antidepressant · Executive function
Abstract
Two psychiatric interviews of a 39-year old female with con-
genital leptin deficiency were conducted to define psycho-
logical changes 14 and 165 days after initiation of treatment
with human recombinant leptin (metreleptin). The most
pronounced initial experience related to the reduced preoc-
cupation with food. An improved mood was reported by the
patient, which she associated with this reduced preoccupa-
tion. Her mood remained elevated upon recontact, whereas
she was no longer preoccupied with food. Overall, the inter-
views provide a vivid account of the subjective experiences
upon the initiation of treatment. Some of the findings bear
a resemblance to those reported recently in patients with
anorexia nervosa who were treated with metreleptin for 1–3
weeks. This case report provides further evidence that me-
treleptin has strong psychopharmacological effects in pa-
tients with absolute or relative leptin deficiency. We strong-
ly recommend profound psychological examinations of pa-
tients with congenital leptin deficiency at baseline and after
intitiation of treatment with human recombinant leptin to
gain further insight into the functions affected by this hor-
mone. © 2022 The Author(s).
Published by S. Karger AG, Basel
Introduction
Psychological assessments of patients with congenital
leptin deficiency (CLD) have not yet been conducted to
any greater extent. Currently, a total of 67 patients have
been reported in the literature since 1997 [1]. In the first
case study, Montague and coworkers [2] described two
children aged 2 and 8 years who were constantly hungry
and continuously demanded food; their food intake was
substantially higher than that of their siblings. Apart from
the extreme obesity with an onset in infancy, most inves-
tigators have also focused on the eating behavior in de-
scriptive terms. The term hyperphagia is most common-
J.H. and S.Z., and M.W. and G.G.-D. shared first and last authorships,
respectively.
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Psychological Changes in CLD upon
Metreleptin Treatment
731
Obes Facts 2022;15:730–735
DOI: 10.1159/000526169
ly used to illustrate the excessive caloric intake [2–6]. In-
satiable appetite [7] or aggressive food seeking behavior
[8] represent other terms used to describe the overeating.
Treatment with recombinant human leptin (r-metHu-
Leptin; metreleptin) of patients with CLD entails an in-
creased satiety and satiation within 7 days after its initia-
tion; weight loss is pronounced over time [9–11]. A re-
duced irritability around eating was noted [11]. A
9-year-old female no longer secretly sought food or de-
manded food between meals [9]. We are aware of two
studies on individuals with CLD that report potential psy-
chological effects of metreleptin treatment that extend
beyond effects on satiety and satiation; (i) in three adults
with CLD, “non-ingestive behavior changed dramatically
within 2 weeks” of metreleptin treatment and prior to
substantial weight loss [10]. These adults did not have el-
evated depression or anxiety scores prior to treatment;
the authors thus precluded changes in mood or anxiety as
an explanation for the observed mental effects, which
they describe as a change in behavior and interpersonal
attitudes from infantile and docile to assertive and adult-
like. (ii) After metreleptin treatment of a 5-year-old boy
for a 2-year period, substantial increments in the rates of
development in neurocognitive domains were observed.
Due to leptin’s role in the adaptation to starvation [12],
we postulated that psychological symptoms of starvation,
as meticulously delineated in the Minnesota Starvation
Study [13], may result from the hypoleptinemia induced
by loss of fat mass [14]. Indeed, metreleptin treatment of
patients with anorexia nervosa (AN) has recently been
shown to entail beneficial and rapid-onset cognitive,
emotional, and behavioral effects [15–17]. Thus, preoc-
cupation with food declined within 3–5 days; sleep im-
proved. Mood also improved substantially within 2–4
days and became overly buoyant in 2 patients. Patients
became less withdrawn and were able to more readily en-
gage in social interactions. The urge to move and inner
tension were reduced; concentration improved. Accord-
ingly, more detailed psychological evaluations of patients
with CLD are required to assess if metreleptin induces
central effects that extend beyond the well-known effects
on eating behavior and body weight. Leptin receptor
(both short and long forms: Ob-Ra and Ob-Rb) mRNAs
have been detected in hypothalamic nuclei, Purkinje cells,
and dentate nuclei of the cerebellum, inferior olivary and
cranial nerves nuclei in the medulla, amygdala, and neu-
rons from both neocortex and entorhinal cortex [18, 19].
While in CLD, leptin deficiency is inborn, a reduced
leptin secretion in patients with AN results from an ac-
quired loss of fat mass. In acutely ill patients, serum leptin
levels are well below the normal range [20–22] with levels
typically ranging between <0.1 and 2.0 ng/mL upon refer-
ral for inpatient treatment. As in healthy controls, percent
body fat is a better predictor for serum leptin levels than
body mass index (BMI; kg/m2; [23]). Upon weight gain,
leptin secretion increases; however, it can take a number
of weeks prior to leptin levels reaching the lower normal
range [22]. Attempts have been made to correlate the in-
creased leptin secretion with reductions in physical activ-
ity and psychological variables [14, 24].
Case History
The female patient from the Arabian Peninsula developed ex-
treme obesity during infancy as a result of hyperphagia. Congeni-
tal leptin deficiency was diagnosed at age 38 by molecular genetic
testing using next-generation sequencing of the genes KSR2, LEP,
LEPR, MC4R, MRAP2, NTRK2, PCSK1, POMC, and SIM1 (Illu-
mina); her niece with a similar phenotype had initially been diag-
nosed with this disorder. Genetic sequencing of the leptin gene
revealed a novel biallelic homozygous rare variant. The annotation
tools MutationTaster and PolyPhen2 classified this variant as
probably damaging. Functional characterization has been per-
formed in our laboratory (MW) and is unpublished. Upon initia-
tion of metreleptin treatment by MW at the Division of Pediatric
Endocrinology and Diabetes at the University Medical Center in
Ulm, height, body weight, and BMI of the index patient were 167.4
cm, 128.8 kg, and 45.9 kg/m2. She had hypertension, hypothyroid-
ism, pancreas lipomatosis, steatosis hepatis, lipoedema grade 3,
Sjögren syndrome, and spondylolisthesis; she had been medicated
with L-thyroxin (125 μg/day), vitamin B12 (1,000 μg/day), and vi-
tamin D3 (50,000 IU/week). The patient was fully informed of the
well-known mechanism of action of metreleptin with respect to
suppression of hunger and subsequent weight loss. She was also
informed at length of potential side effects of metreleptin treat-
ment including the formation of leptin antibodies and the poten-
tial risk of development of T-cell lypmphoma; she provided writ-
ten informed consent.
An hour-long online interview was conducted by JH during
the morning of dosing day 14 during the patient’s stay at the Uni-
versity of Ulm; at this time the patient had lost 6.95 kg of body
weight. The patient was at home for the second online interview
five and a half months after initiation of treatment. The first in-
terview was transcribed according to the transcription rules of
Dresing and Pehl [25]. The interview pursued two aims: (i) focus
on the subjective experience of the patient upon the initiation of
metreleptin treatment and (ii) investigation of the extent of over-
lap of induced changes with those previously observed in AN pa-
tients [15–17]. Accordingly, the patient was asked to report all
observations she had made within the initial 14 days of metreleptin
treatment in a non-directive manner; in the second part of the in-
terview, she was systematically questioned as to potential changes
in preoccupation with food, sleep, mood, concentration, and
spontaneity. The 20-min long follow-up online interview was not
transcribed.
Both the patient and the interviewer are not native speakers of
the English language. Several direct citations were included to con-
Hebebrand/Zorn/Antel/von Schnurbein/
Wabitsch/Gradl-Dietsch
Obes Facts 2022;15:730–735
732
DOI: 10.1159/000526169
vey the statements of the patient. To enhance readability, single
citations were minimally altered (for instance, the tense of a word
was corrected). Words in parentheses within a limited number of
direct citations were introduced to better explain the context.
First Interview
In the non-directive part of the interview, the patient repeatedly
used the word “magic” to describe what had happened to her.
“When I started (treatment), magic.” Upon dosing day 3, she start-
ed thinking less about food and experienced a greater sense of con-
trol. “So I was realizing really starting from my breakfast and my
cup of coffee that, oh, things have been changed because before
starting with a cup of coffee, I had always been thinking what
would be my breakfast?” But during the morning of dosing day 3,
the immediate association of coffee with food dissipated. “I was
just having the cup of coffee and that’s it. After 3, 4 h, I was think-
ing, oh, I didn’t have my breakfast till now.”
She began to think more positively. Prior to metreleptin treat-
ment, she had felt punished by having to walk the medically pre-
scribed 10,000 steps. She had not really accepted this physical ac-
tivity in light of her experiencing it as too strenuous and painful.
While still experiencing pain during her walks, she was now enjoy-
ing them.
She had been unable to visit a café to just drink a coffee. She
would think of a piece of cake or cookies even if she was not hun-
gry; she just liked to eat. She now enjoys drinking her coffee and
looking around at other people. She now takes her laptop with her
and starts working while drinking coffee. She utilizes her time
more efficiently. “Everything has been changed in my mind. So it’s
like really restarting my lifestyle and it’s like … magic. Like every-
thing in my mind has been changed about thinking of food.”
She had telephoned with her mother on the day prior to the
interview. “Can you imagine I’ve been away for more than 2 weeks.
I didn’t eat chocolate.” Her mother had expressed her surprise; the
patient, too, was struck by this fact. She had always been the fam-
ily member, who had brought chocolate home. She now felt proud
to be able to stay abstemious, which previously had appeared im-
possible. She has “changed from inside” and not as a result of ex-
ternal pressure. In accordance with her personal aim she was be-
ginning to actually lose weight. “But there is another goal that
started with taking leptin... that I start changing my lifestyle,…start
changing my objectives, my goals, how I will think…” She envi-
sions herself traveling in the future, “not for treatments,” just en-
joying. “I will be another person, like I will maybe have another
kind of clothes, another kind of activities, that I will have not only
walking and shopping, sitting in the cafe and looking for more res-
taurants.” She would now be able to pursue novel activities as she
sees fitting in light of her goal to become more fit and healthy in
the future by losing weight.
In the second half of the interview, the patient was first queried
as to the previous extent of her preoccupation with food. She had
been thinking of food for 70–80% and 60% of her leisure and work
time, respectively. Prior to a meeting she had been thinking of the
potentially available food/snacks. Whereas she definitely had been
able to work, she had experienced the preoccupation with food in
the back of her head. She now no longer felt distracted. “I am re-
ally completely busy with what I’m doing.”
Did metreleptin affect her sleep? Before treatment, she woke up
briefly every 60–90 min. Now she wakes up every 2 h. “But it’s a
very slight change.” Total sleep duration of 4–5 h had not changed.
Did her mood change in any way? “To be honest, yes…OK, I’m
always a funny person, I’m smiling all the time... but I really feel
the changes… my mood has been changed a lot.” She was experi-
encing things “more from the positive side.” “Before I was like very
easy to get angry for anything, for even silly things… But now, no,
I’m just like passing it, I’m just taking it more positive, more funny,
more like no, I’m not really getting upset too much and I’m not
really getting disappointed too much, even if it’s like really disap-
pointing. But I’ll just put in my mind that that might be the best.
That might be something good. I might have the better chance next
time, but that’s OK. Pass it, go for the next step. So I really feel
that… in all the fields of my life.” She specifically lists her health,
her business, her work, and her relations with family members. “So
it’s really changing. Even they have noticed that.” She rated her
mood prior to dosing at three to four and at the time of the inter-
view at seven to eight on a scale from one (extremely depressed
mood) to ten (excellent mood).
To what extent did the metreleptin induced reduction of both
hunger and preoccupation with food improve her mood? “Oh, I
think there’s a strong connection.” She previously had not concen-
trated on whether she was hungry or not; she just ate. “Whenever
I feel like I’m upset or if I’m free or anything, I’m just trying to find
something here or there to grab a snack. But now, no, I’m not eat-
ing until I feel hungry... I’m trying to be more healthy… now it’s
from inside.” She is able to better choose between foods, to experi-
ence satiation and the satisfaction that goes along with having in-
gested a meal entailing a greater self-satisfaction.
Had the quality of her social interactions changed? She did not
perceive any change. “No, I think I was a good listener before. So
I don’t feel my personality has really changed.”
Did her ability to concentrate or focus on work or a specific task
change? “Yeah, a little bit. I really feel that I can concentrate more
on what I’m doing, what I’m thinking and coming up with a good
plan. Before… I had so much on my mind…” She had sometimes
compiled a to-do list in an attempt to structure her tasks. She now
feels more concentrated as to what she would like to do and what
she would want to accomplish during the day. She comes up with
goals for the day and is more satisfied upon their completion. She
relishes a greater perception of self-efficacy.
The patient confirms that she is now better organized and fo-
cussed. The patient was again asked to rate her current ability to
focus on a scale from one to ten. She had noticed that she was not
well organized and had been trying to find and use skills to become
more focused. “I’m really satisfied that I’ve reached (a score of)
eight, even before I started leptin.” She confirms having searched
for self-management strategies and that she had been quite suc-
cessful prior to metreleptin treatment. “But now, I feel it’s more
organized from my mind, like, OK, once I wake up in the morning,
it’s easier. I know the steps that I’m going to follow for the day and
that’s it. But before I had to still write it down and follow some skills
that I had learned.” Self-organization had now become a more au-
tomatic process and she no longer had to invest as much.
Are the improved self-management skills helpful for her work?
She points out that this is really helping in the context of defining
her own responsibility and that of others. “I’m trying to give more
responsibility to others, authorizing other people, delegating... De-
spite being on leave from home I’m really more concentrating on
what are the other things that I have to do for my work.” Her im-
proved ability to concentrate is related to the fact that she is not
thinking about food or losing weight as much. “So I have a chance
Psychological Changes in CLD upon
Metreleptin Treatment
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Obes Facts 2022;15:730–735
DOI: 10.1159/000526169
to think about other things more than before… I feel my mind is
like more clean, it’s like I have a better chance of categorizing
things in my mind and being more focused because I have enough
space in my mind.”
The patient is queried as to inattention and proneness to anxiety.
She does not have the perception that she had problems with inat-
tention. Anxiety does not in any way play a greater role in her life.
The next set of questions focus on perfectionism, obsessiveness,
and compulsivity. She has been perfectionistic and somewhat ob-
sessive in some situations. After initially negating a change upon
initiation of metreleptin treatment, she points to a greater flexibil-
ity: “sometimes I used to have my own thinking and I will stick to
that this is the right way and I know that this is the right way. I’m
not going to listen to anyone else. Maybe it’s (metreleptin) chang-
ing my way of thinking like with the nutrition.” Prior to treatment,
a nutritionist had cautioned her that she should adjust her diet to
control her hypertension and her hypothyroidism. Nevertheless,
she had thought to herself: “I would love to eat nice food and I
would like to have the chance to eat something nice or to enjoy my
life with eating and with going to a cafe and enjoy all these things.
I was really having that in my mind that I’m right. As a person I
have the right and I’m right.” But now, this perspective has shifted.
“I’ve changed that. This is a big change from my thinking before.”
Would you say that you’re more spontaneous now? “Oh, yeah.
Not sure, but I think yes.” She then asks for more explanations to
better grasp what the interviewer is aiming at. The interviewer spe-
cifically mentions her getting a phone call from somebody to see if
she will come along to a movie theater. Is she now more readily
able to deal with such a decision? She affirms that in some situa-
tions this is the case. Her sister, who had accompanied her to Ulm,
had persisted that they visit a particular place. The patient to her
own surprise had readily consented. Prior to treatment, she would
have had to go into more details to reach a decision. She now per-
ceives herself as being able to reach a decision much more quickly.
“It’s like a lesser level of hesitation. Before I was hesitating much
and taking time to reach some decisions… whether it’s serious or
not serious. But now I feel I’m better at taking decisions and not
hesitating too much or thinking too much. If it’s easier to take and
it will not harm me, then I will just go and try it.” She affirms hav-
ing perceived herself as more contemplative prior to metreleptin
treatment; the speed with which she is able to reach a decision has
increased.
She does not view this change as being related to the reduced
hunger and preoccupation with food. “I don’t think so. Maybe it’s
the medication itself, but not with the food. Again, maybe I will go
back to the main issues that my overweight, my pain, my kind of
food, I’m eating or like thinking of food was taking the full part of
my mind. And I was always thinking about it and looking for a so-
lution... Now, as I said, maybe I’m free or I’m more open for other
things to think and to enjoy my life more rather than thinking about
that part of my life that was taking up the whole way of my think-
ing, my searching. I was upset all the time that no one understands
me. No one knows what I’m feeling. No one knows my pain. Now,
I feel that they (team of Prof. Wabitsch) really know what I’m feel-
ing and they give me the right things to do and the right plan.”
The interviewer wraps up the exploration by repeating the
changes the patient had reported including an improved mood; an
improved ability to concentrate, focus, and self-organize; a more
spontaneous attitude; the capability to more readily reach a deci-
sion; and an altered attitude towards life. At the meta-level, me-
treleptin has apparently led to liberation from her total absorption
with everything related to food, weight and other issues that come
along with eating so much. The patient responded, “I don’t have
anything in mind except like, as I said from the beginning, it’s like
really working like a magic to my life. It’s switching off and on like
I was sometimes and I’m starting something else. Again going to
the main point, everything around my mind was like thinking or
concentrating more about my weight, my pain, my kind of food.
I’m already like 39 years old and I have not been living like normal
human beings before... And I was searching maybe more than 5
years for the right medication and for the right treatment plan…
I’m (now) starting correctly with everything, with the right plan.
So here comes the magic. I’m turning, I’m just putting all my old
life behind, and I’m just looking forward to everything.”
Psychiatric Assessment
The patient wearing a tightly fitting headscarf established a rap-
id contact with the interviewer; she seemingly relished being able
to speak of the psychological dimension of her treatment. Her
mood appeared buoyant, she smiled repeatedly and at times ges-
ticulated with her arms to underscore her statements. Despite her
not being able to speak in her native language she spoke without
hesitation and provided detailed answers to those questions, which
seemed to relate to her situation. In contrast, answers to questions
that she could not relate to were short (see paragraph on anxiety).
Cognitive abilities and memory performance appeared normal. A
mental disorder was not detectable. Recurrently, the patient spoke
of her preoccupation with food. During the interview the inter-
viewer spoke 1,616 words; the patient’s elaborate initial report and
the answers to the specific questions encompassed 4,161 words.
Follow-Up Interview
The patient now described herself as being a “normal person”
with respect to thoughts of food, appetite and hunger; she has con-
sistently been able to make healthier food choices; these thoughts
and her behavior were ego-syntonic “coming from inside,” she was
not “forcing” them on herself. Food was no longer a recurring top-
ic during the interview; preoccupation with food was no longer
evident.
She reported a loss of 32 kg since initiation of metreleptin treat-
ment. She found it easier to exercise and visited the gym regularly.
Her style of clothing had changed as a result of greater self-confi-
dence. She experienced the sagging skin folds associated with her
weight loss as bothersome.
She experienced her mood as continuously improved; within
this context she observed an increment in self-confidence and a
substantially reduced irritability; she had become more “accept-
ing.” She perceived herself as being more stress tolerant. Waken-
ings during the night occurred to a lesser extent; she estimated that
in total this accounted for her being able to sleep an hour longer
per night. Some of her acquaintances had remarked that her per-
sonality had changed describing her as “more flexible, humorous
and relaxed.” She described her way of thinking as “wiser” and
“more mature.” Whereas she had previously made fast decisions,
she now had “calmed down.” Problems no longer appeared to rep-
resent such a heavy load. She recently had begun to experience
openness for a relationship. She still was a rather forgetful person,
but now more organized and able to better prioritize. Her former
procrastination had given way to a more efficient completion of
tasks.
Hebebrand/Zorn/Antel/von Schnurbein/
Wabitsch/Gradl-Dietsch
Obes Facts 2022;15:730–735
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DOI: 10.1159/000526169
Discussion
This is the first detailed report of the psychological
changes experienced by a patient with CLD upon initia-
tion of metreleptin treatment. The initial interview was
conducted during dosing day 14; the accounts of the 39-
year old female are vivid and readily convey why she has
experienced these changes as “magic.” Content wise, the
amazement as to the reduced preoccupation with food
and the ensuing mental liberation were readily percepti-
ble. Throughout the interview, she repeatedly spoke of
the seemingly all-encompassing extent to which she had
been engaged with her preoccupation with food. Where-
as she viewed her improved mood as a consequence of
this reduced preoccupation, other changes were deemed
as not being directly related (see paragraph on self-orga-
nization). According to the patient’s recollection the ini-
tial psychological effects of metreleptin were experienced
within 3 days. The second interview in essence confirmed
the improved mood with reduced irritability, greater
stress tolerance and self-confidence and fewer awaken-
ings at night. The reduced preoccupation with food was
no longer a dominant topic. Due to the metreleptin in-
duced weight loss of 32 kg indirect effects resulting from
this weight loss cannot be excluded. However, overall the
initial improvement was confirmed in the second inter-
view suggesting direct central complex effects of me-
treleptin, which mainly pertain to mood and aspects of
executive functioning.
Limitations of this first report are numerous and include
the online conductance of both interviews 14 days and 165
days into dosing with metreleptin precluding a pre-post
comparison, the lack of any use of standardized psycho-
logical self or clinician ratings or of tests for the assessment
of executive functioning and potential bias of the interview-
er. As such, this case report can merely serve to point out
the potential gain in knowledge to be obtained by future
systematic psychological assessments of patients with CLD
prior to and after initiation of treatment with metreleptin.
Such assessments should ideally include a longer follow-up
to judge the (perceived) effects over time.
The interview also allows a rudimentary comparison
with the subjective experiences of patients with AN who
were treated with metreleptin for 6–24 days [15, 16]. In
these patients, the pronounced preoccupation with food
also decreased within a matter of days. It is unclear if the
strong antidepressant effect experienced within the same
time period is as directly related to the reduced preoccu-
pation with food as this case report of a patient with CLD
suggests. In contrast to the patients with AN, there was
no indication that the patient with CLD had been de-
pressed in a clinical sense prior to initiation of metreleptin
treatment. A direct assessment of mood upon use of the
Hamilton Depression Rating Scale in three adult patients
with CLD did not reveal scores qualifying for the diagno-
sis of a depressed mood [10]. The improved ability to con-
centrate and focus may also represent a finding common
to both AN and CLD upon metreleptin treatment.
We assume that metreleptin induced mental and be-
havioral changes reflect central effects. The rapidity of the
onset of an improved mood begs the question as to the
involved brain region(s) and the cellular mechanisms. In
light of the wide distribution of leptin receptors and dif-
ferent post-receptor pathways we can only speculate. The
long form of the leptin receptor has recently been found
to colocalize with brain-derived neurotrophic factor, a
key factor in depression, in the dentate gyrus of the hip-
pocampus [26].
In conclusion, this case report substantiates profound
psychological effects of treatment with human recombi-
nant leptin; in contrast to patients with AN who develop
hypoleptinemia as a result of loss of fat mass, patients
with CLD have inborn leptin deficiency. Systematic re-
search is definitely warranted to uncover the metreleptin
induced overlap in psychological changes and the under-
lying mechanisms via which metreleptin entails these
changes in both acquired and inborn leptin deficiency.
Acknowledgment
We thank the patient for sharing her experience.
Statement of Ethics
The patient provided written informed consent to the publica-
tion of the case report. Due to German law ethics approval is not
applicable for an off-label application of an otherwise approved
drug in an individual patient.
Conflict of Interest Statement
Johannes Hebebrand, Gertraud Gradl-Dietsch, and Jochen
Antel declare that they will be named as inventors in a patent ap-
plication that the University of Duisburg-Essen prepares to file on
the use of leptin analogs for the treatment of depression. Johannes
Hebebrand and Jochen Antel declare that they were named as in-
ventors in a patent application that the University of Duisburg-
Essen had filed on the use of leptin analogues for treating anorex-
ia nervosa and related conditions. Julia von Schnurbein and Mar-
tin Wabitsch received speaker’s honoraria from Amryt. Stefanie
Zorn has no conflicts of interest to declare.
Psychological Changes in CLD upon
Metreleptin Treatment
735
Obes Facts 2022;15:730–735
DOI: 10.1159/000526169
Funding Sources
No funding was received for this study.
Author Contributions
Johannes Hebebrand, Stefanie Zorn, Julia von Schnurbein, and
Martin Wabitsch made substantial contribution to data acquisition.
Johannes Hebebrand, Jochen Antel, Martin Wabitsch, and Gertraud
Gradl-Dietsch made substantial contribution to analysis and inter-
pretation of data. Johannes Hebebrand, Stefanie Zorn, Jochen Antel,
Julia von Schnurbein, Martin Wabitsch, and Gertraud Gradl-Dietsch
made substantial contribution to the conception of the work, manu-
script preparation, critical revision, and final approval.
Data Availability Statement
All data generated or analyzed during this study are included
in this article. Further inquiries can be directed to the correspond-
ing author.
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