INS and hyperinsulinism: Crucially, key discriminators, such as lower gut microbiome gene richness, more pronounced VAT attenuation, insulin resistance and insulin hypersecretion, were consistently observed in HmetBMI across both sexes and BMI classes (Supplementary Tables 5 and 6), emphasizing the unique contribution of hyperinsulinemia, insulin resistance and impaired glucose uptake/utilization in metabolic obesity beyond actual BMI.