Diet and Physical Activity Interventions in Severely Obese Adults—Reply

In Reply: Drs Gondoni and Liuzzi raise questions about the participants excluded from our trial. We agree that there are many contributing factors to the development of obesity, including racial disparities and socioeconomic influences.¹ However, many men and women of all racial, socioeconomic, and educational groups who are predisposed to develop obesity will not or cannot participate in a clinical weight loss trial. Participation in our trial required a substantial time commitment from the volunteers; thus, many were initially excluded simply because they could not commit owing to child care issues or taking unpaid time from work. Assuming that those who did not want to participate were simply not interested in losing weight is likely not correct, but it is likely that many factors contributing to their obesity are reasons why they would not or could not commit to our trial. We stand by our assertion that a strength of our study was that we targeted recruitment to African American women, a minority group with particularly high rates of severe obesity.² Indeed, additional clinical trials are needed, focusing on lifestyle modification interventions in other racial and socioeconomic groups and in those who are perhaps less healthy than those in our trial.