The main factors that cause this syndrome are obesity, sedentary lifestyle and genetic factors.74 IR is characterized by pathological changes in several steps of insulin metabolic pathway,75 with simultaneous increase in endogenous production of hepatic glucose, leading to chronic hyperglycemia.76 Today, obesity, especially visceral obesity, is recognized as one of the main risk factors of IR.77 Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.