Osteoarthritis (OA) is one of the major health problems that's development and progression is obesity related. We believe that higher levels of insulin may explains this link especially. High levels of insulin in obesity and metabolic syndrome can induce numerous complications. Insulin can increase proliferation of chondrocyte but simultaneously, it prevents their differentiation. Moreover, hyperinsulinemia reduces the circulating level of serum T4 and conversion of T4 to T3, mimicking hypothyroidism, because thyroid hormones are necessary for the maturation of chondrocytes. So maybe decreasing insulin levels, prevents OA progression or improve the treatment process. (C) 2016 Elsevier Ltd. All rights reserved.