INS and obesity due to melanocortin 4 receptor deficiency: Neither type of the 16-week lifestyle intervention was effective in changing primary obesity BMI outcomes. However, interventions improved secondary metabolic outcomes (e.g. insulin sensitivity, hepatic fat, inflammation). Hispanic ethnicity responded well to nutrition education, which contrasted the counterproductive response found in African Americans. The latter may benefit from a more direct approach involving multiple exercise and nutritional components. Culturally contextualised and ethnically tailored lifestyle intervention approaches are needed.