Furthermore, previous human studies have demonstrated that low insulin clearance may be the primary mechanism of hyperinsulinemia in black African compared with white European [12,13] and decreased insulin clearance is a risk factor for obesity [14,15], metabolic syndrome [16], and nonalcoholic fatty liver disease (NAFLD) [17,18,19]. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.