The Relationship between Sarcopenic Obesity, Weight-Loss and Maintenance Outcomes during Obesity Management: Are Additional Strategies Required?
Round 1
Reviewer 1 Report
The authors assessed the relationship between sarcopenic obesity and the % of weight loss. It is an interesting study but there are some points that need to be improved.
In the introduction, it is not clear what is the obesity treatment used in each study cited.
The authors should include what is known in terms of the effects of bariatric surgery in patients with SO, in the introduction and in the discussion section.
Are the groups similar in terms of obesity comorbidities presence? The authors should include this information in the manuscript.
How was ASM evaluated? Include this information.
Basal metabolic rate assessment would improve data interpretation.
The WL management protocol is poorly described. Please extend this section. In addition, did the authors fill in a food diary during the WL management protocol? Does the protocol include physical exercise?
Calculate the % excess of weight loss and include it in table 2.
Include the standard deviation or the standard error of the mean in the graph.
Patients with SO have higher BMI, weight, BF and WC. The weight loss between the two groups is similar, and the differences found in the %WL may be due to the higher baseline weight and therefore, it may not support the manuscript conclusions. Why didn’t the authors include paired groups?
Author Response
Please find in attachment
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments
Authors present a manuscript addressing the relationship between sarcopenic obesity, weight-loss and maintenance outcomes during obesity management: Are additional strategies required?. The aim of the study was to investigate the relationship between SO at the baseline, and WL and WL maintenance at the six-month follow up and after more than 12 months in a “real-world”, clinical setting involving treatment-seeking patients with obesity. The general conclusion demonstrates that new strategies should be adopted for these patients in order to improve this clinical outcome especially during the weight maintenance phase. This is an interesting manuscript but demonstrates few major and minor issues:
Minor modification of the grammar is required.
1) Introduction
In the introduction abbreviation SO, should be explained (line 31).
2) Methods
- a) The major limitation of this study is that the analysis was performed in a limited number of cases (46 patients): the authors should perform the analysis in a larger population to provide conclusions.
- b) First and second paragraphs need heading e.g. Study Design
- c) Manuscript needs clearly presented inclusion and exclusion criteria
3) Results:
a) Authors need to point out more strongly that it is likely that the sample size is too small to provide conclusions.
4) Discussion
Authors should extend discussion including more studies.
5) Conclusions
Due to small study population. Authors should provide conclusions as suggestion or speculation not general conclusion.
Author Response
Please find in attachment
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Maybe I was not clear in the last comment of my previous report, so I will try explain it better:
At baseline, patients with SO have significantly higher BMI /weight when compared with patients without SO. In my opinion, those differences influence the results obtained regarding the % of weight loss in the following timepoints.
The authors need to prove that the differences obtained are not due to the anthropometric differences of the groups, at baseline.
Author Response
Maybe I was not clear in the last comment of my previous report, so I will try explain it better: At baseline, patients with SO have significantly higher BMI /weight when compared with patients without SO. In my opinion, those differences influence the results obtained regarding the % of weight loss in the following time points. The authors need to prove that the differences obtained are not due to the anthropometric differences of the groups, at baseline.
Response: We thank the reviewer for her/his valuable comment. We will try to clarify this point as follows:
- Firstly, usually the use of the variable “WL%” overcomes the difference of in baseline body weight (i.e. BMI), since it is considered a “standardized entity” which express the weight loss per 100 Kg. Please check: https://pubmed.ncbi.nlm.nih.gov/24797705/
- Secondly, if it is true as valuably mentioned by the reviewer that the “higher baseline” BMI/weight in patients with SO (vs. with Non SO) may have influenced the clinical outcome (WL in Kg), it will be expected that SO group will loss more weight (since they had higher body weight at baseline), but this was not our case.
- Finally, the paired analysis across each group, demonstrated that the SO group experienced a significant weight regain from 6-month to 12-month of follow up, this clearly implies that patients in this group were not able to maintain the weight loss achieved during the early weight loss phase. On the other hand the Non SO group did not show statistically significant changes in body weight between two time points of follow up, meaning that they have succeed in weight-loss maintenance.
These points put together, and already clearly mentioned in the manuscript, is the proof that the difference in clinical outcomes at the follow-up time-points between SO vs. Non SO patients are not due to baseline anthropometric differences of the two groups.
Reviewer 2 Report
Definitely, Authors have made substantial improvement in manuscript content. Thus I endorse to publish this manuscript in current form.
Author Response
Definitely, Authors have made substantial improvement in manuscript content. Thus I endorse to publish this manuscript in current form.
Response: We sincerely thank the reviewer for his/her endorsement.
Round 3
Reviewer 1 Report
In my opinion, the manuscript can be accepted.
