Therefore, we believe that insulin clearance deserves assessment in the ward, in addition to sensitivity and secretion, when a young patient with obesity is screened for comorbidities at the pubertal transition, as well as a lab investigation as far as the role that sex and other pivotal hormones may play in the modulation of this under-investigated metabolic path. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.