Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review

Abstract

Obesity remains a persistent public health and health disparity concern in the United States. Eliminating health disparities, particularly among racial/ethnic minority groups, is a major health priority in the US. The primary aim of this review was to evaluate representation of racial/ethnic sub-group members in behavioral weight loss interventions conducted among adults in the United States. The secondary aims were to assess recruitment and study design approaches to include racial/ethnic groups and the extent of racial/ethnic sub-group analyses conducted in these studies. PubMed, PsycInfo, Medline, and CINAHL were searched for behavioral weight loss intervention trials conducted in 2009–2015 using keywords: weight, loss, overweight, obese, intervention and trial. Most of the 94 studies included a majority of White participants compared to any other racial/ethnic group. Across the included studies, 58.9% of participants were White, 18.2% were African American, 8.7% were Hispanic/Latino, 5.0% were Asian and 1.0% were Native Americans. An additional 8.2% were categorized as “Other”. Nine of the 94 studies exclusively included minority samples. Lack of adequate representation of racial and ethnic minority populations in behavioral trials limits the generalizability and potential public health impact of these interventions to groups that might most benefit from weight loss. Given racial/ethnic disparities in obesity rates and the burden of obesity and obesity-related diseases among minority groups in the United States, greater inclusion in weight loss intervention studies is warranted.

Impact of a 12-month Inflammation Management Intervention on the Dietary Inflammatory Index, inflammation, and lipids

“…Participants were mostly White females; however, the participant sample was much more diverse than many other previous behavioral nutrition/exercise interventions. In a recent systematic review of 94 weight loss interventions, African Americans comprised just 18% of samples, compared to 34% in the IMAGINE study [72]. In addition, the percentage of men in the IMAGINE study (22%) is similar to what has been found among 244 other previous lifestyle intervention studies (27%) [73].…”

Using targeting to recruit men and women of color into a behavioral weight loss trial

“…However, most areas of research have groups that are underrepresented. Within the area of behavioral weight control, samples are predominately female [2][3][4][5] and non-Hispanic White [5,6].…”

Sociocognitive factors associated with lifestyle intervention attrition after successful weight loss among participants with prediabetes—The PREVIEW study

“…Similarly with younger age, non‐Caucasian ethnicity was also associated with higher expected disadvantages of PA. Previous research has suggested that while ethnic minorities are often underrepresented in lifestyle trials, this does not necessarily mean lower likelihood of completing (Haughton et al, 2018; Shrager, 2018). Our current results indicated that ethnicity was associated with attrition, but only during later stages of behavior change.…”

“…Women and those with a more affluent life situation tend to be overrepresented, even though men, ethnic minorities, as well as those from lower social‐economic background tend to have higher risk of developing, for example, T2D (Gavarkovs, Burke, & Petrella, 2016; Harreiter & Kautzky‐Willer, 2018; Siegel et al, 2018; Sortsø, Lauridsen, Emneus, Green, & Jensen, 2018). Similarly, higher lifestyle intervention attrition has been associated with sociodemographic and cognitive factors such as lower educational achievement, ethnicity, younger age, higher BMI, unemployment, and lower self‐efficacy (Burgess, Hassmén, & Pumpa, 2017; Goode et al, 2016; Haughton et al, 2018; Leung, Chan, Sea, & Woo, 2017).…”