The Importance of Gender in Body Mass Index, Age, and Body Self-Perception of University Students in Spain

Round 1

Reviewer 1 Report

I believe the topic the researchers are investigating is a very important one. However, to be honest, I do not really feel that this particular research would have filled a certain research gap. In the theoretical part the authors describe many related topics, the same happens in the discussion, but I don’t feel it explained why this research was necessary to carry out, what is the extra information which we did not know already. The title indicates that the study is about to find out that how much objective markers influence the body image. In other words, how objectively the participants evaluate their own figure (whether they have overweight for example). But the focus of the article was not what the title suggested, in fact, it should be hard to say what the exact focus was. Another thing, based on the reported results, the majority of the sample had a healthy BMI, this fact strongly limits the generalizability of the results.

Author Response

REVIEWER 1
I think the topic the researchers are investigating is very important. However, to be honest, I don't really feel that this particular research has filled a certain research gap. In the theoretical part the authors describe many related issues, the same goes for the discussion, but I don't feel that it explained why it was necessary to do this research, what is the extra information that we didn't already know. The title indicates that the study is about to find out how much objective markers influence body image. In other words, how objectively participants evaluate their own figure (if they are overweight, for example). But the focus of the article was not what the title suggested - in fact, it would be hard to say what the exact focus was. 

ANSWER: Thank you very much for your input and considerations, thanks to which we were able to refine the manuscript, give it a different focus and clarify the research gap that could be filled in such a changing world where every culture is constantly in flux.

Reviewer 2 Report

Overall, this manuscript is written simply and with care.  However, some corrections should be made.

Methods: Voluntary participation and commitment to ethical principles should be declared

Statistical Analysis170: Significant level (p) should be added. 

References: "Are the cited references mostly recent publications (within the last 5 years) and relevant?" This recommendation should be considered. The number of references used is too many, unnecessary consecutive references should not be used.

Author Response

REVIEWER 2
Overall, this manuscript is written with simplicity and care. However, some corrections need to be made.

ANSWER: Thank you very much for your input and considerations, which have allowed us to refine the manuscript.

Methods: Voluntary participation and commitment to ethical principles should be claimed.

ANSWER: Thank you, it has been added. The paragraph has been added in section 2.2 Procedure

Statistical analysis170: The significant level (p) should be added.

ANSWER: It has been added in section 2.4 Statical analysis, thank you

 

References: "Are the references cited mostly recent (within the last 5 years) and relevant publications?" This recommendation should be considered. The number of references used is too many, unnecessary consecutive references should not be used.

ANSWER: Thank you very much for your recommendation, we have reduced the number of references.

Reviewer 3 Report

I read the manuscript, titled "The Importance of Anthropometric Markers in the Body Self-Perception of University Students," with interest, since disturbed body image perception and related problems, mainly of a psychological nature, are a huge and growing social problem, especially among adolescents and young adults.

However, I believe that the title of the manuscript is not entirely appropriate, as the only "anthropometric marker" the authors considered in analyzing the results is BMI.

I have included comments on each section of the manuscript below:

Abstract section

The sentence "Statistical differences were found in some of the tests performed, varying between men and women." (lines 25-26) I consider too vague and not presenting the results obtained by the authors. Please include in the Abstract section some key findings of the study for inference.

The Introduction section is, in my opinion, too long, unnecessarily containing the history of the research on self-perception of the body. The other sections, which serve to justify the research undertaken, should be shortened.

Materials and Methods section

This section needs significant addition:

1. please insert the name of the country where the study was conducted (line 119)

2. placing Table 1 in this section is not correct. This table should be placed in the survey results section

3. please complete the information regarding the inclusion and exclusion criteria of the study

4. section 2.3 Instruments says that a questionnaire was designed to collect socio-demographic data from the subjects. Unfortunately, only age, gender, field of study and BMI were presented. Were only these data collected from the questionnaire? If so, I believe that these are insufficient data to characterize the study group. I believe that the authors should also include other data relevant to the inference, such as: physical activity, place of residence, economic status, marital status, ethnic group and others.

5. the authors did not state at all how they collected the subjects' BMI data. Did they weigh and measure the subjects themselves and calculate the value of this indicator on this basis? Or did they calculate the value of this indicator based on the weight and height data declared by the subjects? I believe that this is a very important question from the point of view of interpreting the results and making inferences

6. table 1

- in the column "Variable" item two "Education stage" - wrong name of the parameter

- why the results for BMI by age group, gender, field of education were not presented? Especially since the authors formulated their conclusions from this angle. In addition, the directions of education could have been presented according to gender, for example. I believe that this should be supplemented

- Why were the results on the age and BMI of the subjects presented only as a median? I believe that this is an insufficient presentation, with little characterization of the group, and needs to be supplemented. How was the IQR counted?

- The abbreviation BMI should be explained in a footnote to the table.

Results section

This section contains a very limited discussion of very sparse results. No discussion of the results of the MBSRQ questionnaire was included at all, perhaps not each question separately, but at least in individual dimensions.

In fact, the section was limited to providing a very vague sentence on the correlations found.

Discussion section

The first paragraph of this section should be deleted (lines 187-190).

In the first paragraph of this section, please insert a brief presentation of your own results.

This section is very long, the first two paragraphs (lines 191-213) need to be significantly shortened. These paragraphs actually present the results of other authors' studies, without reference to your own.

The rest of this section is also actually a presentation of other authors' results. It is even difficult to figure out which part of this section relates to the authors' own results; it is not specified.

In fact, this section does not contain an element of discussion or even a presentation of the authors' own results in relation to those of other authors. I think this section needs to be thoroughly improved. Also, please do not use the term "healthier BMI" (line 238) - it is incorrect.

Section Conclusions

The second sentence, "It is also important to highlight that undergraduates exercise less when entering university, that healthy habits change as well as their leisure time preferences and, of course, that their self-image is influenced by this" (lines 297-299) is questionable in terms of inference. On what basis, i.e. on which results of their study, did the authors insert this sentence in the inference section?

References section

This section needs to be standardized and adapted to the requirements of the journal, among other things: the insertion of journal titles should be standardized (they should be abbreviated journal names), unnecessary capital letters in article titles should be eliminated. Besides: in item 48, the name of the journal is missing and the page range should be corrected.

In addition, it should be noted that a very large part of the literature (47 items, about 45%) is dated before 2010, that is, it is relatively "old" literature. At the same time, the most recent items, i.e. from the last 5 years, account for only 11.5% of all items (12 items). I believe that such proportions are not favorable.

In addition, it is true that in the review form regarding the issue of "English language and style" I indicated that "I don't feel qualified to judge about the English language and style," however, it seems to me that English language and style are small spell check required. For example, I consider the following wording to be incorrect: "the sex to which the student belongs" (line 26), "the corporate image" in the sentence "In this context, it is necessary to identify the factors that positively or negatively condition the corporate image." (lines 61-62), or "it has been possible to find that researchers," in the sentence "In the dimension 3, "Self-rated physical attractiveness," it has been possible to find that researchers, have reported that women, compared to men of the same age and level of education, frequently wish to be thinner or lose weight, regardless of whether it is necessary [91,92], experimenting greater dissatisfaction with their bodies [93]." (lines 258-261).

Author Response

REVIEWER 3

I read with interest the manuscript, entitled "The Importance of Anthropometric Markers in the Body Self-Perception of College Students", as altered body image perception and related problems, mainly of a psychological nature, are a huge and growing social problem, especially among adolescents and young adults.

ANSWER: Thank you very much for your input and consideration, thanks to which the manuscript has been greatly improved.

 

However, I think the title of the manuscript is not entirely appropriate, as the only "anthropometric marker" that the authors considered when analysing the results is BMI.

ANSWER: Thank you for your appreciation, the title has been modified.

 

I have included comments on each section of the manuscript below:

ANSWER: Perfect, thank you.

Abstract section

 

The sentence "Statistical differences were found in some of the tests performed, varying between men and women". (lines 25-26) I consider too vague and do not present the results obtained by the authors. Include in the Summary section some key findings of the study for inference.

ANSWER: You are right, we have already detailed the results thoroughly.

 

The Introduction section is, in my opinion, too long, unnecessarily containing the history of body self-perception research. The other sections, which serve to justify the research done, should be shortened.

ANSWER: Thank you, we have deleted the history of body perception.

 

Materials and Methods Section

This section needs a significant addition:

1. insert the name of the country where the study was conducted (line 119).

ANSWER: Thanks, they are from Spain. It has modified.

 

2. Placing Table 1 in this section is not correct. This table should be placed in the results section of the survey.

ANSWER: It has been moved. Thank you very much.

 

3. Please complete the information on the inclusion and exclusion criteria for the study.

The inclusion criteria were:

- Be a student at the Early Childhood or Primary School level.

- To be of legal age

- Studying at the University of Extremadura

 

4. Section 2.3 Instruments states that a questionnaire was designed to collect socio-demographic data of the subjects. Unfortunately, only age, sex, field of study and BMI were presented. Were only these data collected from the questionnaire? If so, I believe these are insufficient data to characterise the study group. I think the authors should also include other data relevant for inference, such as: physical activity, place of residence, economic status, marital status, ethnicity and others.

ANSWER: Unfortunately we did not collect more data, it has been included in the limitations. However, we have introduced in the paragraph on participants, that they are Spanish and from urban schools.

5. the authors did not state at all how they collected the BMI data from the subjects. did they weigh and measure the subjects themselves and calculate the value of this indicator on this basis? or did they calculate the value of this indicator on the basis of the weight and height data declared by the subjects? I think this is a very important question from the point of view of interpreting the results and making inferences.

ANSWER: The BMI was obtained with a self-report where weight and height were recorded by the participant. And with the formula, we obtained the BMI; that is, the value of this indicator was extracted based on the weight and height data declared by the subjects.

 

6. table 1

- in the column "Variable" item two "Educational stage" - incorrect parameter name

ANSWER: Sorry, it was in English. It has been changed.

 

- Why were the BMI results not presented by age group, gender, field of education? Especially because the authors formulated their conclusions from this angle. Furthermore, the directions of education could have been presented according to gender, for example. I think this should be supplemented.

ANSWER: You are absolutely right, we have incorporated a table showing the median and interquartile range of BMI data as a function of the variables gender and field of education. In addition, a row has been included in table 3 with the correlations between BMI and the variable age as you suggest.

- Why were the results on age and BMI of the subjects presented only as a median? I believe this is an insufficient presentation, with little characterisation of the group, and needs to be supplemented. How was the IQR counted?

ANSWER: Results for continuous variables that did not fit a normal distribution were presented as median and interquartile range following the recommendations of various authors (e.g. https://scielo.isciii.es/pdf/asisna/v39n3/carta2.pdf). However, if you think we should present them as mean and standard deviation, please let us know and we will do so.  The IQR was calculated by subtracting the 25th percentile from the 75th percentile (IQR= 75th percentile - 25th percentile). It has been footnoted.

- The abbreviation BMI should be explained in a footnote to the table.

ANSWER: Thank you, it has been added.

 

Results section

This section contains a very limited discussion of very few results. No discussion of the results of the MBSRQ questionnaire was included, perhaps not each question separately, but at least on individual dimensions.

ANSWER: You are absolutely right, we have included paragraph describing and comparing that variable in the discussion.

In fact, the section merely provided a very vague sentence about the correlations found.

Discussion section

The first paragraph of this section should be deleted (lines 187-190).

ANSWER: Thank you for your suggestion, we have done so.

 

In the first paragraph of this section, insert a short presentation of your own results.

ANSWER: Perfect, thank you very much for your input.

 

This section is very long, the first two paragraphs (lines 191-213) should be shortened significantly. These paragraphs actually present the results of other authors' studies, without reference to your own.

The rest of this section is also in reality a presentation of other authors' results. It is even difficult to find out which part of this section relates to the authors' own results; it is not specified.

In fact, this section does not contain an element of discussion or even a presentation of the authors' own results in relation to those of other authors. I believe this section needs to be thoroughly improved. Also, do not use the term "healthier BMI" (line 238), it is incorrect.

ANSWER: Thank you very much for your suggestions. The discussion has been greatly improved.

Conclusions section

 

The second sentence, "It is also important to note that undergraduate students exercise less upon entering college, that they change healthy habits and leisure time preferences, and, of course, that this influences their self-image" (lines 297-299 ) is questionable in terms of inference. On what basis, that is, on what results from their study, did the authors insert this sentence in the inference section?

ANSWER: Thank you for your input. The paragraph has been modified in its entirety to make it more readable.

 

References section

 

This section needs to be standardised and adapted to the requirements of the journal, among other things: the insertion of journal titles should be standardised (they should be abbreviated journal names), unnecessary capital letters in article titles should be removed. Also: in item 48 the journal name is missing and the page range should be corrected.

ANSWER: Already amended, thank you for your intervention.

 

Furthermore, it should be noted that a very important part of the literature (47 articles, about 45%) is dated before 2010, i.e. it is relatively "old" literature. At the same time, more recent articles, i.e. from the last 5 years, represent only 11.5% of the total number of articles (12 articles). I think such proportions are not favourable.

ANSWER: Thank you for your input. We have introduced more up-to-date citations.

 

Also, it is true that in the review form on the topic of "English language and style" I indicated that "I do not feel qualified to judge on English language and style", however, it seems to me that English language and style require a little spell-checking. For example, I consider incorrect the following wording: "the sex to which the student belongs" (line 26), "the corporate image" in the sentence "In this context, it is necessary to identify the factors that positively or negatively condition the corporate image". (lines 61-62), or "it has been possible to find that researchers" in the sentence "In dimension 3, 'Self-assessed physical attractiveness', it has been possible to find that researchers have reported that women,

ANSWER: Thank you very much indeed for your proposals for change. The English has been improved with a native translator.

Reviewer 4 Report

Thank you for an interesting contribution to the literature on a topic of increasing importance

Author Response

Thank you so muuch for your consideration and time.

Round 2

Reviewer 1 Report

Dear Authors,

I appreciate the effort you made to improve the article further. However, looking through your corrections, unfortunately, I had the impression that you made them in a rush, without deep consideration and English language checking.

I support the fact that you deleted the Anthropometric Markers phrase from the title. Additionally, you added the „importance of gender” to the beginning of it. This implies that the focus will be gender differences in addition with BMI, age and self-perception. This would mean that you should write much more in the literature review part about gender differences, basically the whole review should discuss how gender relates to the listed variables in the title. This is not at all the case now.

I also disagree with adding the word Spanish in the title (if you insist on it, please, change it to Spanish university students). The main idea is that you investigate university students, the fact that they are only Spanish students, is a limitation which decreases the generalizability level of your results. If you put Spanish in the title, one would expect that Spanish population has an issue connected to this topic, e.g. little number of P. E. lessons or something specific to them. However, in the theoretical background I did not find anything which would underline that Spanish adolescents and young adults are more threatened in the problems you outline. In the Discussion part you mention some existing studies, though. If you decide to leave the word Spanish in the title, I believe this part should belong to the Introduction.

I welcome that you tried to make the aim of the research clearer and more exact. Nevertheless, justifying the necessity of your research by saying „it would be interesting to know the relationship” is quite far from being elegant, this is not a strong claim. Also, you continue the sentence like that: „it would provide information on the current state of university students in Spain (this is true so far) and thus promote healthy lifestyles at this age” – how can this be a research aim? It sounds like you anticipated that based on the results healthy lifestyle promotion should be more accentual. You can anticipate it but, in this case, you should use a hypothesis.

The language style of the Conclusion part is unfortunately particularly poor. You use short, very roughly phrased sentences with attributes like starting a sentence with an „And”. Moreover, the Conclusion is not in line with the title.   

Leaving a mistake like this in the text „A significance level was set at p<0” gives me again the impression that this was not an accurate revision.

I did not go into deeper details; these are just core problems with the article. I am sorry to say that, but I still have the feeling that this paper does not have a clear focus and in general not well-written enough to fit in a high-standard journal like Sustainability.

I hope you will manage to implement some fundamental changes on it and be able to publish your study at some point.

Author Response

REVIEWER 1

Dear Authors,

I appreciate the effort you made to further improve the article. However, when reviewing your corrections, unfortunately, I had the impression that you made them in haste, without thorough consideration and without checking the English language.

ANSWER: Sorry, we have revised the paper and improved the English. Thank you very much.

I support the fact that you removed the phrase Anthropometric markers from the title. Also, you added the "importance of gender" at the beginning. This implies that the focus will be on gender differences in addition to BMI, age and self-perception. This would mean that you should write much more in the literature review part about gender differences, basically the whole review should discuss how gender relates to the variables listed in the title. This is absolutely not the case now.

ANSWER: Thank you very much, we have added a paragraph in the introduction about gender and BMI.

I also do not agree with adding the word Spanish in the title (if you insist, please change it to Spanish university students). The main idea is that you research university students, the fact that it is only Spanish students is a limitation that decreases the level of generalisability of your findings. If you put Spanish in the title, one would expect the Spanish population to have a problem related to this topic, e.g. few physical education lessons or something specific to them. However, in the theoretical framework I did not find anything that underlines that Spanish adolescents and young people are more threatened in the problems you raise. However, in the Discussion part you mention some existing studies. If you decide to leave the word Spanish in the title, I think this part should belong to the Introduction.

ANSWER: Thank you very much for your suggestion. We have added the title as instructed by the academic editor.

I am pleased that he has tried to make the aim of the research clearer and more accurate. However, justifying the need for your research by saying "it would be interesting to know the relationship" is rather far from elegant, it is not a strong statement. Furthermore, you continue the sentence like this: "it would provide information on the current state of university students in Spain (this is true so far) and thus promote healthy lifestyles at this age" - how can this be a research objective? You seem to anticipate that, based on the findings, the promotion of a healthy lifestyle should be more accentuated. You can anticipate it but, in this case, you have to use a hypothesis.

ANWER: You are right. We have modified the sentence, giving it a more clarifying meaning.

Unfortunately, the language style of the Conclusion part is particularly poor. It uses short, roughly worded sentences with attributes such as starting a sentence with "And". In addition, the Conclusion is not in line with the title. 

ANSWER: Thank you for your honesty, we have modified the conclusion paragraph, bringing it in line with the title.

Leaving an error like this in the text "A significance level was set at p<0" again gives me the impression that this was not an accurate review.

ANSWER: Sorry, we have reviewed it again and improved the manuscript. Thank you

I didn't go into deeper detail; these are just central problems with the article. I'm sorry to say that, but I adhere to the feeling that this paper lacks a clear focus and is generally not well-written enough to fit in a top-tier journal like Sustainability.

I hope you manage to implement some fundamental changes and can publish your study at some point.

ANSWER: This study shows that BMI may influence the body self-perception of Spanish university students, especially in women. In addition, age is also a variable that could affect BMI, being more significant in men. Therefore, it would be important to instil a healthy lifestyle throughout life, as well as non-sexist education and appropriate motivators to improve their body image. It is necessary to involve all administrations, the media and family members in order to achieve this.

Reviewer 3 Report

Dear authors, thank you very much for your response and the work you put into improving the manuscript. Most of my comments and suggestions have been incorporated, for which I thank you.

I have only three issues that I will ask you to consider before preparing the final version of the manuscript:

- I would ask you to add to the Materials and Methods section the exclusion criteria for the study. You have not done so, does this mean that there were none?

- please move the sentences: "42.9% (N = 134) were male and 57.1% (N = 178) were female. The median age was 21 years (IQR = 4)." (lines 158-159) to the Results section, as that is where they should be.

- Table 1 - you have left one of the variables to be specified: "Education stage." In your response you wrote that: "ANSWER: Sorry, it was in English. It has been changed.", but unfortunately you did not change it. Also, in line 222 there is a term: "stage education" and in the heading of Table 2 is the term: "educational specialty". I will ask you to standardize this term. "Educational specialty" seems to be the most accurate.

- the References section has not been fully adapted to the editorial requirements of the journal.

Author Response

REVIEWER 3

Dear authors, thank you very much for your response and the work done to improve the manuscript. Most of my comments and suggestions have been incorporated, for which I thank you.

ANSWER: Thank you very much for your appreciation.

I have only three issues that I will ask you to consider before preparing the final version of the manuscript:

- I would ask you to add to the Materials and Methods section the exclusion criteria for the study. You have not done so, does this mean there were none?

ANSWER: Study exclusion criteria.

- Move sentences: " 42.9% (N = 134) were male and 57.1% (N = 178) were female. The median age was 21 years (IQR = 4). "(lines 158-159) to the Findings section, as that is where they should be.

ANSWER: It has been amended, thank you very much.

- Table 1 - You have left one of the variables unspecified: "Stage of studies". In your answer you wrote that: " ANSWER: Sorry, it was in English. It has been changed. ", but unfortunately you did not change it. Also, in line 222 there is the term: "stage education" and in the heading of Table 2 there is the term: "teaching speciality". I will ask you to standardise this term. Educational speciality" seems to be the most accurate.

ANSWER. That's fine. You are right. It has already been changed.

- The References section has not been fully adapted to the editorial requirements of the journal.

ANSWER: Sorry, we have changed some of the typos.