INS and obesity due to melanocortin 4 receptor deficiency: Individuals with obesity classes 4 to 5 had significantly higher median fasting insulin levels (43.42 μIU/mL [IQR, 32.32-61.02 μIU/mL]) compared with those with obesity classes 1 to 3 (21.75 μIU/mL [IQR, 15.05-30.78 μIU/mL]) and those without obesity (9.77 μIU/mL [IQR 6.97-13.85 μIU/mL]) (Figure 3C and eFigure 5 in Supplement 1).