Although the sex differences in obesity and total adiposity may be seen as a limitation, it reflects the status of obesity within SA and the sub-Saharan African region (3), and adjustments for total body fatness and the calculation of z-scores were used in the analyses to determine whether these sex differences in adiposity were influencing the insulin- and glucose-related variables. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.