Watching Others Play

An Issue of Disparities Embedded in the SELECT Trial

Subtly buried in the excitement about results of the SELECT trial is an issue of disparities. The fact is that this is largely a study of White males. Less than four percent of persons in this study were Black, ten percent were Hispanic, and 76 percent were non-Hispanic White. Males comprised 72 percent of the study enrollment.

Let’s be clear. This is a robust study of 17,604 individuals. So we have little doubt that this study population will yield robust findings. But the under-representation of Black and Hispanic persons in the study sample is telling us something about the potential for disparities in access to advanced obesity medicine.

Right now, obesity medicine does not well serve the populations where obesity takes the greatest toll on health. White and wealthy patients are first in line.

Persistent Disparities for Persons Most Affected

The irony is overwhelming. At present, obesity, cardiovascular disease, and diabetes take the biggest toll in the U.S. on Black and Hispanic persons. And yet, these communities seem to be last in line for access to care that could reduce this impact.

Tiffani Bell Washington and colleagues summarized the situation recently in Gastroenterology Clinics of North America:

“Disparities in disease prevalence mirror similar inequality in access to quality obesity care and stem from many places, including poor access to care, inability to access quality obesity care with obesity-trained physicians and clinicians, and decreased rate of receiving a diagnosis of obesity. Despite research supporting the use of lifestyle modification in addition to weight loss medications and surgery, when necessary, there is decreased utilization in persons with lower socioeconomic status or who are ethnic minorities.”

The disparities overlap and reinforce each other. Populations that suffer the most with these interrelated diseases get the poorest access to care. In turn, poor access to care guarantees that their health will suffer even more.

Let’s Reduce, Not Amplify, This Problem

The problem with disparities in health and access to care is well documented. The lopsided enrollment of White men in the SELECT trial is a red flag, suggesting that this breakthrough might go last to those who need it most – thus amplifying the disparities that plague us.

Let’s not stumble into doing that.

Click here for more about the population that enrolled in the SELECT trial, here and here for more about disparities in access to obesity care.

Watching Others Play, photograph by Sankarshan Sen, licensed under CC BY-SA 3.0

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August 13, 2023

One Response to “An Issue of Disparities Embedded in the SELECT Trial”

  1. August 13, 2023 at 7:57 am, Nancy Browne said:


    To continue what left out of your thought…women in general but also subgroups of pregnant, childbearing age, menopause), children, adolescents, those with psychiatric disease ( gamut from anxiety to psychosis), elderly ( over 50… sigh), AI/AN, Pacific Islander., … basically any non-white male 25-45. FDA approval for indication needs major overhaul but so does FDA approval for population. Oh yes, did I mention those with disease of obesity not included in most trials unless trial specifically for “weight loss?” Same for other health conditions. Leaving the potential for additional bias to “withhold medications from untested groups for their safety… not to mention no payment from insurance companies… as if they need more excuses.