Review Reports - Relationship Between Emotional Eating and Adherence to the Mediterranean Diet Based on Body Weight in University Students and Individuals from Their Social Environment

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study aims to explore the relationship between emotional eating and adherence to the Mediterranean diet in normal-weight and overweight adults. The topic fits well within the scope of the journal and contributes to the existing body of literature by examining the potential association between emotional eating and dietary pattern adherence, including whether this relationship varies by BMI. While the study addresses a relevant and timely research question, its level of novelty is moderate rather than high.

Furthermore, I have many methodological concerns listed below that require clarification or editing.

The use of an open online survey raises methodological concerns related to data validity, including the lack of control over respondent identity, the possibility of multiple submissions by the same individual (potentially inflating the sample size), and vulnerability to trolling or other forms of non-genuine participation. In addition, self-selection may have resulted in an overrepresentation of respondents who are emotionally engaged with the study topic.The authors are encouraged to explicitly address these issues in the Methods section by describing any technical or procedural safeguards employed, and to discuss their potential impact on the results in the Study Limitations section.

While the exploratory nature of the study justifies the lack of an a priori power analysis, this limitation should be more explicitly reflected in the interpretation of the findings.
Given the cross-sectional design of the study, the manuscript would benefit from a more explicit assessment of potential sources of bias (e.g., selection bias, self-selection bias, and measurement bias). In addition, the authors do not describe how the required sample size was determined.
The participant recruitment was based on invitations to university students at the Campus Bio-Medico of the University of Rome and their family members. This sample is not representative of the general population. Students at a medical university are likely to have greater interest in health issues and higher awareness of the impact of diet on health, which may introduce selection bias and limit the generalizability of the findings. The authors briefly acknowledge this ascpect in the Study Limitations, but given this, it may be worth considering whether the title or the stated aim of the study should be refined to more accurately reflect the specific study population and avoid overgeneralization of the results.
It is unclear how other variables, such as age, sex, education level, or socioeconomic status, may have influenced the study results. The manuscript does not report whether these potential confounders were examined or controlled for in the analyses, which could affect the interpretation of the associations between emotional eating and adherence to the Mediterranean diet.
I suggest to clarify whether the study design, conduct, and reporting followed established guidelines for observational research, such as the STROBE statement for cross-sectional studies, and to supplement the Methods and Study Limitations sections accordingly.
line 181-185. The authors report differences in the distribution of emotional eating categories across BMI groups; however, no statistical test or p-value is provided to indicate whether these differences are statistically significant.
Throughout the manuscript, I suggest replacing the term “subjects” with more person-centered terminology such as “individuals,” “participants,” or “respondents.
Figure 1 – inconsistent font

Author Response

Dear Reviewer,

Thank you for your constructive and insightful comments. We have carefully addressed all your suggestions and revised the manuscript accordingly. Detailed, point-by-point responses to each comment are provided in the attached document.

Kind regards,
The Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This article investigates the relationship between emotional eating and adherence to the Mediterranean diet in normal-weight and overweight adults. The study is relevant and addresses a topic of interest in the field of nutrition and eating behavior. The methodology is generally correct, and the results are presented clearly. However, the manuscript requires major revisions to meet the publication standards of the journal Nutrients.

My recommendation is to:

1.Rewrite the abstract to conform to the MDPI format: Background/Objectives, Methods, Results, Conclusions.

2.Explicitly state the study's hypotheses at the end of the introduction. More robustly justify the choice of assessment tools within the context of existing literature.

3.The Methods section is too brief and does not provide sufficient detail to allow for the study's replication. Add details about the recruitment procedure, include a discussion on statistical power and its implications for interpreting the results, and expand on the justification and implications of combining the VEE and EE groups.

4.Expand the discussion to explore possible explanations for the lack of a significant association, which could be related to the specific characteristics of the study population (students and their relatives), the limitations of the MEDI-LITE tool, or other unmeasured confounding factors. Compare the results in more detail with those of other studies, highlighting both similarities and differences. Discuss the practical implications of the results for clinicians and researchers.

5.Rephrase the conclusions to better reflect the exploratory nature of the study and its limitations, and provide specific directions for future research.

6.Review the following minor aspects:

The citation style and bibliography formatting do not comply with the MDPI guide. References must be numbered in order of their appearance in the text and formatted accordingly.
The legends for figures and tables should be more detailed to allow for their understanding without consulting the main text. Figure 2 is difficult to read due to low resolution and overlapping text.
The "Author Contributions" section must be formatted according to MDPI instructions.
There are several minor grammatical and punctuation errors that need to be corrected.

Author Response

Dear Reviewer,

Kind regards,
The Authors

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I appreciate the opportunity to review the manuscript entitled "Relationship Between Emotional Eating and Adherence to Mediterranean Diet Based on Body Weight." The topic is relevant and well contextualized, especially considering the growing role of emotional factors in eating behavior and the declining adherence to the Mediterranean diet in populations that have traditionally followed it.

I recognize the strengths of the work, such as the use of validated instruments (EEQ and MEDI-LITE), the stratification by BMI, and the clear presentation of the results. In addition, the manuscript is well-structured and written in appropriate scientific language.

However, I identified several important limitations that need to be addressed before the article can be considered for publication. Below, I share my main comments and revision suggestions:

The EEQ assesses episodic and emotion-driven behaviors, while the MEDI-LITE measures long-term dietary patterns. This temporal mismatch between instruments may compromise the ability to detect meaningful associations. I suggest that this issue be discussed more thoroughly in the Discussion section, with methodological references that support this critique.
Although the use of non-parametric tests is justified, I believe the study would benefit from the inclusion of multivariate analyses (e.g., regression models) that could control for important covariates such as age, sex, and the presence of chronic conditions. Furthermore, most of the reported correlations were weak; I consider it important that the authors avoid overinterpreting these findings and present precision measures such as confidence intervals.
The sample, composed mostly of university students and their family members, is quite homogeneous, which limits the generalizability of the results and reduces variability in adherence to the Mediterranean diet. I recommend emphasizing this aspect as a significant methodological limitation.
The merging of the "Very Emotional Eaters" (VEE) category with the EE group is statistically reasonable, but unfortunately prevents a deeper analysis of the individuals with the highest emotional vulnerability. If possible, I suggest including a separate descriptive analysis or expanding the discussion on the potential implications of this limitation.
I agree with the authors’ brief mention of more sensitive approaches, such as ecological momentary assessment (EMA). I recommend expanding this discussion, perhaps by referencing recent studies that have used real-time methods to investigate the relationship between emotional states and food choices.
I recommend a final language revision to ensure consistency in terminology (e.g., “group” vs. “category”, or technical terms related to nutrition and psychology) and cohesion across sections.

In summary, I believe the manuscript has merit and potential to contribute to the literature in this field, but it requires substantial revisions to reach that goal. I encourage the authors to incorporate these suggestions to strengthen the methodological rigor, conceptual clarity, and practical relevance of the work.

Author Response

Dear Reviewer,

Kind regards,
The Authors

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I would like to thank the Authors for introducing revisions to the manuscript, particularly those addressing the previously raised methodological concerns. It should be emphasized that the presence of methodological limitations is common in questionnaire-based studies and does not, in itself, invalidate the work. However, a transparent and careful discussion of potential sources of bias and possible interpretational limitations is essential to allow readers to properly assess the scope and implications of the findings.

Following the revisions, I have only one remaining suggestion, which concerns the study title. Despite the modification and the use of terms such as "in a Sample of Adults" the title still does not adequately reflect the population that was studied. Specifically, it does not clearly indicate that the survey included medical students as well as individuals from their immediate social environment. I suggest considering descriptors in the title, such as: Medical University Community or Medical University–Associated Individuals.

The remaining issues and clarifications provided by the Authors do not raise any concerns.

Author Response

Dear Reviewer,

Thank you for your careful evaluation of the revised manuscript and for your constructive comments. We have addressed the remaining suggestions and revised the manuscript accordingly.

Kind regards,
The Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I have analyzed the document containing the point-by-point responses to the revision recommendations I formulated. In my opinion, you have demonstrated a serious, constructive, and exhaustive approach in addressing each point raised. The responses indicate that you have fully understood the nature of the recommendations and have made a considerable effort to improve the manuscript in accordance with them.

Author Response

Dear Reviewer,

Thank you for your careful evaluation of the revised manuscript and for your constructive comments. We have addressed the remaining suggestions and revised the manuscript accordingly.

Kind regards,
The Authors

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for submitting the revised version of your manuscript and the response to the reviewers’ comments. After careful evaluation, I am satisfied that the main concerns raised in the previous review have been adequately addressed.

The revisions have strengthened the methodological clarity and the Discussion, particularly regarding the conceptual differences between the EEQ and MEDI-LITE instruments, the cautious interpretation of the correlational findings, and the transparent acknowledgment of the study’s limitations. The manuscript is now clearer, more balanced, and better aligned with the exploratory nature of the study.

In light of these improvements, I consider the manuscript suitable for publication, subject only to minor editorial revisions if required.

Author Response

Dear Reviewer,

Thank you for your careful evaluation of the revised manuscript and for your constructive comments. We have addressed the remaining suggestions and revised the manuscript accordingly.

Kind regards,
The Authors

Author Response File: Author Response.pdf