INS and obesity due to melanocortin 4 receptor deficiency: These include a lack of exercise of the large muscles in the lower limbs and trunk with increased blood flow to lower extremities, as well as the presence of a biomarker for low-grade inflammation.36,37 Such factors can lead to reduced insulin action,38 diabetes, obesity, metabolic syndrome,39 and reduced kidney function.40,41 Because individuals working long hours often share many characteristics with those who have a sedentary lifestyle, it is not surprising that a similar amplification of CVD risks has been reported in a number of studies.15,21,22,42