INS and obesity due to melanocortin 4 receptor deficiency: Current insulin use; HbA1c concentration of ≥12% (≥108 mmol/mol); Recent significant weight loss (>5 kg in the past 6 months); Severe or unstable heart failure, known cancer, or recent myocardial infarction; Learning difficulties, eating disorders, or pregnancy considerations; Estimated glomerular filtration rate (eGFR) <30 mL/min/1.732 m2; Participation in another clinical trial; Substance abuse; Current anti-obesity drug treatment; Hospital admission for depression or use of antipsychotic drugs.