INS and obesity due to melanocortin 4 receptor deficiency: Metabolic assessments revealed that individuals with obesity exhibited metabolic dysfunctions, characterized by increased HOMA-IR (p < 0.0001), increased HbA1c (p < 0.0001), elevated levels of fasting insulin (p < 0.0001), leptin (p < 0.0001), free fatty acids (p < 0.0001) and reduced adiponectin (p < 0.0001) (Table S1).