Taken together, compared with “negative energy balance matched with decreased insulin secretion” i.e., diet, it might be this discrepancy that “negative energy balance matched with increased insulin secretion and VLDL output” makes metabolic surgery much more efficient in visceral/ectopic fat depletion and (hence) beneficial in T2DM remission and prevention of cardiovascular/renal complications. The gene discussed is INS; the disease is type 2 diabetes mellitus.