INS and obesity due to melanocortin 4 receptor deficiency: Areas meriting additional investigation and quality improvement initiatives include an examination of the factors contributing to the gender disproportion in our cohort (80% female), further inquiry into dietary aspects such as food insecurity that may contribute to the high observed prevalence of obesity (30.8% with BMI ≥ 30), and better understanding barriers to insulin utilization since 38% of patients with uncontrolled diabetes were not prescribed insulin.