Cluster 4 (denoted as hypometabolic obesity [LMO]): 134 (15%) patients characterized by high glucose (median glucose AUC: 1748 vs. 928-1030 mmol/l·min in other three subgroups) with decompensated insulin secretion (median insulin AUC: 8244 vs. 13775-47061 mU/l·min in the other three subgroups). Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.