INS and obesity due to melanocortin 4 receptor deficiency: It is true that insulin use has been found to be associated with an increased risk of hypertension (Tseng, 2006), obesity (Tseng, 2007), peripheral arterial disease (Tseng, 2003) and several types of cancer (Hsieh et al., 2012; Tseng, 2013a; Tseng, 2015b; Tseng, 2015c) in our previous studies.