INS and obesity due to melanocortin 4 receptor deficiency: The elevated BMI as the main determinant of the insulinemic potential of lifestyle is a major effective factor in insulin metabolism and its related problems; because it has been reported that weight gain and adiposity are independently related to the risk of hyperinsulinemia, IR, and metabolic disorders [35], therefore, the remarkable part of the insulinemic effect of ELIH in increasing risk of obesity phenotypes can be caused by high BMI levels of participants.