INS and obesity due to melanocortin 4 receptor deficiency: In a prospective study, Trico et al. found that insulin hypersecretion in adolescents with obesity, but without diabetes, was associated with increased triglyceride synthesis in subcutaneous adipose tissue, adipocyte hypertrophy, ectopic fat accumulation, and greater body fat gain (≈2% of total fat mass) during the 2-year observation period [56].