Objective: Despite efforts to enhance inclusion, underrepresentation of minorities in research has been documented. 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.

Methods: PubMed, PsycInfo, and Medline were searched for behavioral weight loss intervention trials conducted in 2009-2015 using keywords: weight, loss, overweight, obese, intervention and trial.

Results: The majority of the 87 studies reviewed included a majority White sample. Across the included studies, 61% of participants were White, 18% were Black/African American, 9% were Latino/Hispanic, 2% were Asian and 1% were American Indians. An additional 7.8% were categorized as “other”. Nine of the 87 studies enrolled exclusively minority samples. More than half (59.8%) of the studies did not report an intention, approach or specific site/location to recruit a sample that was racially or ethnically diverse. Of the 54 studies that included more than one racial/ethnic group, 8 included sub-group analyses of weight loss outcomes by race/ethnicity.

Conclusions: Lack of adequate representation of racial and ethnic minority populations in behavioral trials limits the generalizability and potential public health impact of these interventions. Given persistent racial/ethnic disparities in obesity in the U.S., the high morbidity, mortality, and economic costs associated with obesity and obesity-related conditions among racial/ethnic minority groups, findings from this review emphasize the need to maximize representation of some underrepresented racial/ethnic groups in behavioral lifestyle weight loss trials.