INS and obesity due to melanocortin 4 receptor deficiency: Additional obesity-related characteristics that may modify epigenetic regulation processes include hyperglycemia, uncontrolled endocrine disruptors, hypoxia, oxidative stress, and inflammatory processes, with the resulting secretion of adipokines and cytokines, which could be involved in epigenetic changes that affect insulin sensitivity and adipogenesis [14,15,16,17,18].