Subgroup analyses based on baseline BMI showed that reduction in VAT due to the SGLT-2 inhibitor was significant for the obesity group (SMD = − 1.93; 95% CI [− 2.86, − 1.01]; I2 = 96%; p < 0.0001), as compared with the overweight group (SMD = − 0.68; 95% CI [− 1.22, − 0.15]; I2 = 78%; p = 0.01; Fig. 4B). Here, SLC5A2 is linked to obesity due to melanocortin 4 receptor deficiency.