Use of Social Media, Satisfaction with Body Image, and the Risk of Manifesting Eating Disorders

Round 1

Reviewer 1 Report

I would like to congratulate the authors for the manuscript they present, but in my opinion it can be improved. My comments are organized below for your consideration. I hope my comments are useful for the study author(s) and editorial staff.

#1 Introduction:

This section seems adequate for the objectives of the study, but is not contextualised with the present theoretical background (about 65% the articles cited are over 5 years old), so i think the theoretical background could be improved by citing more articles less than 5 years old.

#4 Discussion

The discussion is very descriptive, not very analytical and not very consistent, in general, is not supported by recent studies, as the vast majority (about 56%) of the studies referred to are over 5 years old, so I think it would be important to cite more recent studies, less than 5 years old and the discussion should be more reflective and analytical.

# References

- The authors should update the references, as around 61% are more than 5 years old.

Author Response

1. Response to Reviewer1’s comments:

REVIEWER 1. Comments and Suggestions for Authors.

I would like to congratulate the authors for the manuscript they present, but in my opinion it can be improved. My comments are organized below for your consideration. I hope my comments are useful for the study author(s) and editorial staff.

Author´s Response: First of all, we would like to express our sincere thanks to reviewer1 for all his comments and suggestions, which have certainly enriched the text for the best understanding. Thank you very much. We have responded to reviewer1's requests and carefully considered his suggestions. We have made the necessary changes both in our responses to the specific comments and in the final manuscript, changes that are easily visible to the editor and reviewers.

#1 Introduction:

This section seems adequate for the objectives of the study, but is not contextualised with the present theoretical background (about 65% the articles cited are over 5 years old), so i think the theoretical background could be improved by citing more articles less than 5 years old.

Author´s Response: Following your recommendations, some of the cited works outdated by more than five years have been substituted with more current ones (references 2, 4, 35, 55). Also, fresh references have been incorporated (references 16, 17, 18, 19, 21, 47, 48, 49, 55, 57, 60, 61, 62, 63, 64, 65, 66, 67, 68, 74).

#4 Discussion

The discussion is very descriptive, not very analytical and not very consistent, in general, is not supported by recent studies, as the vast majority (about 56%) of the studies referred to are over 5 years old, so I think it would be important to cite more recent studies, less than 5 years old and the discussion should be more reflective and analytical.

Author´s Response: Thank you for your recommendation. We have added more detailed considerations in lines 293-297; 299-300; 308-312; 319-322,

We have also added more up-to-date references and replaced some old ones (those mentioned above) (references 2, 4, 35, 55, 16, 17, 18, 19, 21, 47, 48, 49, 55, 57, 60, 61, 62, 63, 64, 65, 66, 67, 68, 74).

# References

The authors should update the references, as around 61% are more than 5 years old.

Author´s Response: Following your recommendations, we have changed and/or added a total of 24 bibliographic references. According to your recommendations, they are less than 5 years old. References 2,4,35, 55, 16,17,18,19, 21, 47, 48, 49, 55, 57, 60, 60, 61, 62, 63, 64, 65, 66, 67, 68, 74).

We would like to express our sincere gratitude for all comments and recommendations. 

Reviewer 2 Report

Dear Authors,

The empirical article addresses an important social topic. It is interesting and extremely necessary to address the importance that social media use has on young people's self-esteem and self-image.

The work highlights three research questions. Previously, reports from the literature on the subject were indicated. I believe that research hypotheses should be included in the text, especially since in the discussion the authors point out that the research does not contribute anything new to knowledge in this area (p. 9).

Attention is drawn to the careful selection of respondents to the sample. The question arises about the justification for examining the time and methods of using social media. Why were specific time frames given, e.g. less than 5 hours a week; 2) 5 to 10 hours a week; 3) more than 10 hours a week? How do the authors justify this choice? As for the measurement of body satisfaction, it was assessed only using the questionnaire questions provided. I believe that it was worth using one of the psychological tools with established psychometric values for this purpose. However, I note that conducting EFA is intended to prevent methodological inaccuracies.

Care was taken to obtain consent for research in schools and on minors, which indicates the authors' professional approach to the project.

  I believe that the statistical tests were selected and applied correctly. I would like to point out that with such a large sample, performing the Kolmogorov-Smirnov test is redundant. When interpreting the results, I propose to assume that if the statistical test does not indicate the significance of the results, then one should not write about differences in the groups of women and men (see: Table 2). It is noted that the research results are clearly presented in tables. The advantage of the work is that in the discussion of the results it refers not only to the cognitive aspects, but also to the applied significance of the research results.

Author Response

1. Response to Reviewer2’s comments:

REVIEWER 2. Comments and Suggestions for Authors.

Dear Authors,

The empirical article addresses an important social topic. It is interesting and extremely necessary to address the importance that social media use has on young people's self-esteem and self-image.

Author´s Response: First of all, we would like to express our sincere thanks to reviewer2 for all his comments and suggestions, which have certainly enriched the text for the best understanding. Thank you very much. We have responded to reviewer2's requests and carefully considered his suggestions. We have made the necessary changes both in our responses to the specific comments and in the final manuscript, changes that are easily visible to the editor and reviewers.

#1 Introduction:

The work highlights three research questions. Previously, reports from the literature on the subject were indicated. I believe that research hypotheses should be included in the text, especially since in the discussion the authors point out that the research does not contribute anything new to knowledge in this area (p. 9).

Author´s Response: Thank you for your comment. It does indeed make the presentation clearer if the initial hypothesis is added. It can be found in the introductory section (lines 100-101).

The statement "the research does not contribute anything new" refers only to the observed relationship between body dissatisfaction and the risk of Eating Disorder. This is followed by a further elaboration of the findings observed and considered important in this regard.

#2 Materials and Methods:

Attention is drawn to the careful selection of respondents to the sample. The question arises about the justification for examining the time and methods of using social media. Why were specific time frames given, e.g. less than 5 hours a week; 2) 5 to 10 hours a week; 3) more than 10 hours a week? How do the authors justify this choice?

Author´s Response: Thank you for your comments. The criteria used are based on relevant research. Please refer to references 48 and 49 on line 139-140 for further justification.

As for the measurement of body satisfaction, it was assessed only using the questionnaire questions provided. I believe that it was worth using one of the psychological tools with established psychometric values for this purpose. However, I note that conducting EFA is intended to prevent methodological inaccuracies.

Author´s Response: Thank you for your comment. It is true, as you say, that the EFA obtained two distinct factors from our questions. However, these questions were derived from a scale developed by our team and their inclusion in this study was intended to further test the psychometric validity of the scale. It was an error not to include this clarification in the methodology section. Following your recommendations, this has been done. See line 135 and reference no. 47

Care was taken to obtain consent for research in schools and on minors, which indicates the authors' professional approach to the project.

  I believe that the statistical tests were selected and applied correctly. I would like to point out that with such a large sample, performing the Kolmogorov-Smirnov test is redundant. When interpreting the results, I propose to assume that if the statistical test does not indicate the significance of the results, then one should not write about differences in the groups of women and men (see: Table 2). It is noted that the research results are clearly presented in tables. The advantage of the work is that in the discussion of the results it refers not only to the cognitive aspects, but also to the applied significance of the research results.

Author´s Response: Thank you for your input. Table 2 has been deleted and a short description has been left in the text (lines 183 - 185).

We would like to express our sincere gratitude for all comments and recommendations. 

Reviewer 3 Report

For the sample size, “With a margin of error of ±3.95% and a confidence level of p and q= 95%, this results in a sample of 605.” was stated. Please write with which formula or program you used to calculate the sample size.

The sentence “Methodologies that share different standardized measurement scales to observe the disease in its incipient phase and the emerging dangers in-including - the Sick Control One Fat Food questionnaire (SCOFF), the Bulimic Investigatory Test Edinburgh (BITE), the Binge Eating Scale (BES), the Bulimia Test (BULT), the Eating Attitude Test-40 (EAT-40), the Eating Attitude Test-26 (EAT-26), and the Three Factor Eating Questionnaire (TFEQ/EI) [16 ], which serve as screening and study tools.” in introduction has missing  suitable references.

In statistical analysis and results section, the dependent variable and independent variables were not taken into account. Analyzes were seen to be incorrect. Table 4 is confusing. The statistics were incorrect. In results “However, the significance test shows that there are no significant differences (X2= 4.865a; p=.088).” was writen, but in correct comparison; X2= 4.68; p=.0.21.” and the percentage of being risk-free is low and the percentage of being high risk is high.

Tables were not suitable for an article presentation. It was copied verbatim from the statistics package program. An example of a table required for this manuscript is given below;

Author Response

1. Response to Reviewer3’s comments:

REVIEWER 3. Comments and Suggestions for Authors.

Author´s Response: First of all, we would like to express our sincere thanks to reviewer 3 for all his comments and suggestions, which have certainly enriched the text for the best understanding. Thank you very much. We have responded to reviewer3's requests and carefully considered his suggestions. We have made the necessary changes both in our responses to the specific comments and in the final manuscript, changes that are easily visible to the editor and reviewers.

For the sample size, “With a margin of error of ±3.95% and a confidence level of p and q= 95%, this results in a sample of 605.” was stated. Please write with which formula or program you used to calculate the sample size.

Author´s Response: Thank you for your recommendation. We have clarified the software used. Line 113.

The sentence “Methodologies that share different standardized measurement scales to observe the disease in its incipient phase and the emerging dangers in-including - the Sick Control One Fat Food questionnaire (SCOFF), the Bulimic Investigatory Test Edinburgh (BITE), the Binge Eating Scale (BES), the Bulimia Test (BULT), the Eating Attitude Test-40 (EAT-40), the Eating Attitude Test-26 (EAT-26), and the Three Factor Eating Questionnaire (TFEQ/EI) [16 ], which serve as screening and study tools.” in introduction has missing  suitable references.

Author´s Response: Thank you for your comments. We have added recent references to the use and validation of each of the questionnaires mentioned. Lines 62-63. References 16, 17, 18, 19, 20, 21.

In statistical analysis and results section, the dependent variable and independent variables were not taken into account. Analyzes were seen to be incorrect.

Author´s Response: Thank you for your feedback. We have added details about the dependent and independent variables in the Data Analysis section, lines 156-160.  We have also corrected the error relating to the dichotomous variables in both this section and the Results section, resulting in the Table 3 (previously Table 4) being amended as per your suggestion.

Table 4 is confusing. The statistics were incorrect.

Author´s Response: Thank you for your comment. Table 3 (formerly Table 4) has been modified according to your advice. Descriptive data for the dichotomous independent variables are now presented by defining a set of variables for multiple responses for each of them. No comparisons are made with respect to the dependent variable as the ANOVA test is carried out afterwards.

In results “However, the significance test shows that there are no significant differences (X2= 4.865a; p=.088).” was writen, but in correct comparison; X2= 4.68; p=.0.21.” and the percentage of being risk-free is low and the percentage of being high risk is high.

Author´s Response: Thank you for your input. Table 2 has been eliminated as it lacked significance (as proposed by reviewer 1).

Tables were not suitable for an article presentation. It was copied verbatim from the statistics package program. An example of a table required for this manuscript is given below;

Author´s Response: Thank you. We have removed Table 2 and made amendments to Tables 3 and 4 based on your advice. Changes have been made to lines 194 and 211.

We would like to express our sincere gratitude for all comments and recommendations. 

Reviewer 4 Report

Dear authors,

It was a pleasure to read and review this interesting research. The research paper deals with a very relevant and actual topic for a broad range of researchers. It aimed at investigating the degree of influence that body dissatisfaction and the use of social media might have on the risk of manifesting eating disorders.

Overall, the paper is well structured and written with a good level of readability. However, some minor revisions should be applied before the paper can be accepted for publication.

INTRODUCTION

Lines 32-37: Regarding the effects of social media use on youths, authors should consider mentioning the research “Digennaro, S.; Iannaccone, A. Check Your Likes but Move Your Body! How the Use of Social Media Is Influencing Pre-Teens Body and the Role of Active Lifestyles. Sustainability 2023, 15, 3046. https://doi.org/10.3390/su15043046” showing that an excessive use of image-centred social media might lead to a negative body satisfaction.

RESULTS

Table 3: correct “si” and “no”. Additionally, rather, than YES or NO, it would be more interesting to report only the YES but for male and female participants, separately.

Author Response

 Reviewer  4

It was a pleasure to read and review this interesting research. The research paper deals with a very relevant and actual topic for a broad range of researchers. It aimed at investigating the degree of influence that body dissatisfaction and the use of social media might have on the risk of manifesting eating disorders.

Overall, the paper is well structured and written with a good level of readability. However, some minor revisions should be applied before the paper can be accepted for publication.

INTRODUCTION

Lines 32-37: Regarding the effects of social media use on youths, authors should consider mentioning the research “Digennaro, S.; Iannaccone, A. Check Your Likes but Move Your Body! How the Use of Social Media Is Influencing Pre-Teens Body and the Role of Active Lifestyles. Sustainability 2023, 15, 3046. https://doi.org/10.3390/su15043046” showing that an excessive use of image-centred social media might lead to a negative body satisfaction.

The suggested reference (number 5) line 37 has been entered.

RESULTS

 Table 3: correct “si” and “no”. Additionally, rather, than YES or NO, it would be more interesting to report only the YES but for male and female participants, separately

The error has been corrected and the data for men and women has been added in Table 3 as suggested. In addition, the presentation has been modified according to reviewer 3's suggestions.

Reviewer 5 Report

The work presented addresses an interesting, relevant and necessary topic in the world of prevention and health promotion, such as eating disorders in young and adolescent populations and use of social media. In general, the article is well presented, both theoretically and methodologically. However, the following are some issues that could significantly improve the quality of the work:

1. Use of APA format for tables (horizontal lines) 2.

2. In the section on instruments, the alpha values of the instruments should be reported. In addition, given that this is an ad hoc questionnaire, a better description of the questionnaire used to measure the use of social media is needed, especially the type of response scale used. It is also recommended that this be included as an appendix.

2. Delete lines 181-183 of the results.

3. Revise the chi-squared data in row 188.

4. p-values in italics

5. Homogenise the number of decimal places; sometimes one is used, sometimes two, sometimes three...

6. Check the elimination of the initial "0" in the values that require it. Sometimes they are presented without zero (lines 188, 223...), sometimes with zero (table 5, line 251...).

7. Check the wording and explanation of "Data analysis". There are some points that are explained in a confusing way. Also explain in detail what was done during the data analysis. The analysis is mentioned in results that are not mentioned in the method (e.g. line 250).

Author Response

Reviewer 5

The work presented addresses an interesting, relevant and necessary topic in the world of prevention and health promotion, such as eating disorders in young and adolescent populations and use of social media. In general, the article is well presented, both theoretically and methodologically. However, the following are some issues that could significantly improve the quality of the work:

1. Use of APA format for tables (horizontal lines) 2.

The horizontal lines have been removed from Table 2 as suggested.

2. In the section on instruments, the alpha values of the instruments should be reported. In addition, given that this is an ad hoc questionnaire, a better description of the questionnaire used to measure the use of social media is needed, especially the type of response scale used. It is also recommended that this be included as an appendix.

Alpha values ​​have been added regarding the dimension used of the PETCA scale as well as the SCOFF questionnaire. More information has been provided on the questions used on the use of social media.

In reference n.48 the validation of the dimension used regarding satisfaction with body image appears.

3. Delete lines 181-183 of the results.

They have been eliminated according to your recommendations.

4. Revise the chi-squared data in row 188.

Values ​​have been revised

5. p-values in italics

They have been modified to italics based on your suggestions. See lines 112, 193, 242 and Table 2.

6. Homogenise the number of decimal places; sometimes one is used, sometimes two, sometimes three...

The decimals have been homogenized to 3 decimals. Except in the percentages of the descriptive tables

7. Check the elimination of the initial "0" in the values that require it. Sometimes they are presented without zero (lines 188, 223...), sometimes with zero (table 5, line 251...).

They have been eliminated in the text as well as in tab 5 and table 6

8. Check the wording and explanation of "Data analysis". There are some points that are explained in a confusing way. Also explain in detail what was done during the data analysis. The analysis is mentioned in results that are not mentioned in the method (e.g. line 250).

As recommended, the correct wording has been added in data analysis. Lines 159-163; 172-173; 175-176; 178-179.

Round 2

Reviewer 3 Report

The topic is original, but the data analysis and presentation are inadequate and erroneous. The article provides only descriptive information, and advanced analysis is missing. I would recommend that the authors receive a training in article writing and table preparation. First, binary analyses are conducted in line with the objective.

Table 1 is not necessary. Table 2 is confusing. Age can be categorized as early adolescence, generally ages eleven to fourteen, and middle adolescence, ages fifteen to seventeen (WHO).

Table 3 contains only descriptive data.

Table for this study can be prepared as below;

Table. Percentages of cases with No risk, Risk and High risk group for SCOFF index-ED by baseline characteristics........

Author Response

The topic is original, but the data analysis and presentation are inadequate and erroneous. The article provides only descriptive information, and advanced analysis is missing. I would recommend that the authors receive a training in article writing and table preparation. First, binary analyses are conducted in line with the objective.

Thanks for your appreciation. The analyzes in tabs 1, 2 and 3 have been modified, no longer being solely descriptive to offer more information.

The rest of the tables in the article correspond to more exhaustive analyses, as you recommend.

Table 1 is not necessary.

Table 1 has been deleted

Table 2 is confusing. Age can be categorized as early adolescence, generally ages eleven to fourteen, and middle adolescence, ages fifteen to seventeen (WHO).

Table 2 has been modified following their recommendations (it has become Table 1)

Table 3 contains only descriptive data.

Table 3 has been modified according to their recommendations (as explained for Tables 2 and 3). More information has been added than just the descriptive information.