Mitigating Weight Stigma: A Randomized Controlled Trial Addressing Obesity Prejudice through Education among Healthcare Undergraduates

Round 1

Reviewer 1 Report

- The theoretical framework presented in the introductory section is extremely short and poor. Nothing is explained about the current state of the question, about how to measure fatphobia, about the repercussions of maintaining stigma among professionals, about the current state of research in the field, about measurement instruments, etc. It should be extended to at least three times its initial size.

- The participants and design section does not define the number of participants in the study, which is the most important concept to include. 

- The participants and design section talks about control and experimental groups with a pre-post measure, but does not explain what the control measure is for comparison with the experimental measure.

- Both the description of the sample and the research procedure are scattered among several sections, making it difficult to understand the research. The contents dedicated to the sample should be unified in a single section and the contents dedicated to the research design in another section in order to give coherence to the text.

- A section dedicated to the variables included in the study is necessary, as it is not clear why the control measure is a control measure (perhaps it has to do with the poor theoretical framework).

- A final limitations section is needed before the conclusions, highlighting that caution should be exercised with the results of the study, since the study is not followed up and since changes in attitudes are unlikely to be achieved with one-hour interventions.

Author Response

Thank you very much for your support in the process. The authors agree with the comments generated and consider all of them relevant to the improvement of the manuscript. We addressed your observations in a new version of our manuscript (obesities-observations). 

 Reviewer 1

- The theoretical framework presented in the introductory section is extremely short and poor. Nothing is explained about the current state of the question, about how to measure fatphobia, about the repercussions of maintaining stigma among professionals, about the current state of research in the field, about measurement instruments, etc. It should be extended to at least three times its initial size.

R= Thank you for your comment. The introduction section has been changed and undoubtedly improved the quality of the manuscript.

- The participants and design section does not define the number of participants in the study, which is the most important concept to include.

R= Thank you for your comment. The following statement has been added at the end of the section: “Ultimately, the educational intervention was provided to 242 randomly allocated participants”.

- The participants and design section talks about control and experimental groups with a pre-post measure, but does not explain what the control measure is for comparison with the experimental measure.

R= Thank you, we agree with your observation. The section was completely reconstructed and integrates specific statements that answer this and other questions. As example: “A randomized controlled trial was conducted employing a pre-post intervention experimental design to assess alterations in healthcare undergraduates' perceptions, beliefs, and biases

regarding obesity. … The intervention aimed to reshape participants' views on obesity through a 60-minute lecture, with one group focusing on individual responsibility for weight (control group), while the second group emphasized the complexity of obesity, its multifaceted nature, weight stigma, and associated consequences (experimental group)”.

- Both the description of the sample and the research procedure are scattered among several sections, making it difficult to understand the research. The contents dedicated to the sample should be unified in a single section and the contents dedicated to the research design in another section in order to give coherence to the text.

R= Thank you. According to your observation, both sections have been reconstructed to ensure congruence of the ideas expressed.

- A section dedicated to the variables included in the study is necessary, as it is not clear why the control measure is a control measure (perhaps it has to do with the poor theoretical framework).

R= Thank you for your observation. Section 2.2 has been renamed 2.2 Variables analyzed and intervention procedures. At the beginning of the section, the following is stated: “The main variables analyzed were conceptions, beliefs, and prejudices about obesity. These variables were analyzed through the Natural Semantic Networks methodology, the Beliefs About Obese Persons (BAOP) scale and the Fat Phobia Scale - short form (F-scale)”.

- A final limitations section is needed before the conclusions, highlighting that caution should be exercised with the results of the study, since the study is not followed up and since changes in attitudes are unlikely to be achieved with one-hour interventions.

R= Completely agree. The Study limitations section was added to the manuscript. It includes the next paragraph: “The study's main limitations are the lack of knowledge of the permanence of the changes reported in this research, because the population was not followed up over time. In turn, the influence of multiple sessions on students' future conceptions, beliefs and prejudices is unknown. These key points are presented as an area of opportunity for future research”. 

Author Response File: Author Response.pdf

Reviewer 2 Report

I’ve read with attention the paper of Lopez-Lara et al. that is potentially of interest. The background and aim of the study have been clearly defined. The methodology applied is overall correct, the results are reliable and adequately discussed. The conclusions are consistent with the evidence and arguments presented and they address the main question posed. The references are also appropriate as well as tables and figures. I have no ethical concerns regarding experiments, nor on plagiarism or publication ethics. I’ve only some minor comments:

- The abstract is not informative. It should include some quantitative data and, at least, the number of subjects involved

- Statistics should be clearly described in the method section

- The limitation of the study are not listed nor discussed. 

Beyond some small typos the text quality is quite accebtable.

Author Response

Thank you very much for your support in the process. The authors agree with the comments generated and consider all of them relevant to the improvement of the manuscript. We addressed your observations in a new version of our manuscript (obesities-observations). 

 - The abstract is not informative. It should include some quantitative data and, at least, the number of subjects involved

R= Thank you for your comment. The abstract section was rewritten to a more informative version.

- Statistics should be clearly described in the method section

R= Thanks for your observation. The section has been integrated into the manuscript.

- The limitation of the study are not listed nor discussed.

R= Completely agree. The Study limitations section was added to the manuscript. It includes the next paragraph: “The study's main limitations are the lack of knowledge of the permanence of the changes reported in this research, because the population was not followed up over time. In turn, the influence of multiple sessions on students' future conceptions, beliefs and prejudices is unknown. These key points are presented as an area of opportunity for future research” 

Author Response File: Author Response.pdf

Reviewer 3 Report

This study analyzed changes in awareness and concepts of obesity and is considered to be important information for preventing and treating obesity. However, correction and supplementation of the following perspectives are required.

1. Please explain the necessity of this study in more detail.

2. The method of this study applies the survey technique targeting undergraduate students, but supplementation is required to specifically present these aspects in the title and purpose of the study. In particular, in the case of the title, please supplement it so that it can be presented specifically in a form that can express the content of the study well.

3. Please add an explanation of how the results of this study will be used in the discussion.

Minor editing of English language required.

Author Response

Thank you very much for your support in the process. The authors agree with the comments generated and consider all of them relevant to the improvement of the manuscript. We addressed your observations in a new version of our manuscript (obesities-observations). 

 Reviewer 3

1. Please explain the necessity of this study in more detail.

R= Thank you for your comment. The introduction section was rewritten into a more informative version that states both the current panorama of weight stigma by health professionals and its consequences on healthcare and individual health.

2. The method of this study applies the survey technique targeting undergraduate students, but supplementation is required to specifically present these aspects in the title and purpose of the study. In particular, in the case of the title, please supplement it so that it can be presented specifically in a form that can express the content of the study well.

R= We agree with your observation, the title has been changed to “Mitigating Weight Stigma: A Randomized Controlled Trial Addressing Obesity Prejudice Through Education Among Healthcare Undergraduates”.

3. Please add an explanation of how the results of this study will be used in the discussion.

R= Thanks for your observation. In the discussion section the following statement was added:

“The significance of the results presented here is pertinent to the enhancement of healthcare provision. Continuous education for healthcare professionals that embraces non-weight-centric perspectives and adopts empathetic approaches not only promotes respect and trust between the individual and the healthcare provider but also establishes an effective communication pathway to reduce absenteeism in weight-related medical consultations, enhance treatment adherence, and improve the overall health of individuals living with obesity”.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The manuscript has been considerably improved, so I agree with its publication in the journal.

Reviewer 3 Report

You did a good job. Entirely, paper revised a good process.

Minor editing of English language required.