INS and obesity due to melanocortin 4 receptor deficiency: However, since data were collected retrospectively, we could not evaluate the importance of confounding factors such as body mass index, obesity, smoking history, lifestyle, dietary habits, family history, pregnancies, parity and menopause status or directly measure clinical parameters such as insulin levels or insulin resistance; therefore, the linkage between hyperinsulinemia and cancer incidence could only be inferred from the medication–cancer associations.