Three and Twelve Month Body Mass Outcomes After Attendance at a Community-Based Weight Management Intervention in the North West of England
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsRecognizing the importance of the NHS to the UK population – how could the program be incorporated and developed by the system? I bring this reflection in view of the impact that systemic approaches have on people's lives.
Doesn't the fact of testing a commercial proposal in some way represent a conflict of interest? I believe that the evidence generated can drive better commercialization of the proposal. It is worth reflecting and better describing the conflict of interest, in relation to the commercial partners, the local leisure trust and the research team.
I believe that generalizations should be considered, since the Covid-19 pandemic period has brought certain changes in ways of living and lifestyles. What precautions should be taken when implementing this strategy in the current context?
Author Response
Thank you to reviewer 1 for the time you have invested in reviewing our manuscript. We have acknowledged and amended all your comments which we believe has further improved our manuscript.
Recognizing the importance of the NHS to the UK population – how could the program be incorporated and developed by the system? I bring this reflection in view of the impact that systemic approaches have on people's lives.
Re: Thank you for this important point. We have included references on the importance of whole system approaches in the discussion and have included the following reference:
Whole systems approach to obesity: a guide to support local approaches to promoting a healthy weight https://assets.publishing.service.gov.uk/media/5d396e7140f0b604de59fde9/Whole_systems_approach_to_obesity_guide.pdf/preview
Doesn't the fact of testing a commercial proposal in some way represent a conflict of interest? I believe that the evidence generated can drive better commercialization of the proposal. It is worth reflecting and better describing the conflict of interest, in relation to the commercial partners, the local leisure trust and the research team.
Re: Noted and we have therefore updated the competing interest statement to be more transparent about the relationship between slimming world, the local leisure trust and the research team.
I believe that generalizations should be considered, since the Covid-19 pandemic period has brought certain changes in ways of living and lifestyles. What precautions should be taken when implementing this strategy in the current context?
Re: We have included more information in the discussion regarding this following the discussion related to whole systems approaches and embedded the following reference:
Tison, Geoffrey H et al. Worldwide physical activity trends since COVID-19 onset. The Lancet Global Health. 2022, 10(10), e1381 - e1382.
Reviewer 2 Report
Comments and Suggestions for AuthorsBroom and colleagues present a compelling analysis of body mass outcomes following a community-based weight management intervention in North West England, showing significant reductions at both 3 and 12 months post-intervention. Their study effectively highlights the potential benefits of combining commercial slimming programs with tailored physical activity sessions, though the lack of a control group limits the ability to make definitive causal inferences.
When mentioning the chronic health conditions associated with obesity, provide a brief overview of the mechanisms by which obesity contributes to conditions like type 2 diabetes and cardiovascular diseases.
Provide more context on the evolution of NICE guidelines regarding weight loss. Why were the initial recommendations changed? When discussing NICE’s recommendations for multi-component lifestyle programs, briefly summarize the evidence base that supports this approach.
Comparing commercial programs to those in primary care settings, teh author could make a critical comparison on how these programs differ in their approaches such as frequency of sessions, duration of the program, types of support provided, clinical support. And also consider demographic details such as age, gender, or socio-economic status.
Clarify recruitment strategies beyond marketing campaigns; highlight demographic diversity
Break down the multi-component program components; clarify integration of physical activity, healthy eating, and behavior change. also include professional competence factors such as qualifications and training of slimming world facilitators
please provide details on physical activity options and their tailoring for different fitness levels
Adding effect sizes for each comparison might be good for understanding of the clinical significance of results
please acknowledge limitations such as the retrospective design, potential selection bias, and reliance on self-reported measures.
Author Response
Thank you to reviewer 2 for the time you have invested in reviewing our manuscript. We have acknowledged your comments but have provided some rebuttals where we don’t believe change is warranted or we apologise that we cannot provide the information due to the authors not being involved with the primary data collection. The changes we have made based on your comments we believe has further improved our manuscript thank you.
When mentioning the chronic health conditions associated with obesity, provide a brief overview of the mechanisms by which obesity contributes to conditions like type 2 diabetes and cardiovascular diseases.
Re: Whilst do not want to completely ignore reviewers comments the author team do not think describing mechanisms is necessary or would add value to the manuscript. This paper is not intended to be mechanistic, merely providing findings of a community based weight loss intervention. Uninformed readers would be better placed reading experimental mechanistic papers for this information. However, if the reviewer feels strongly we will of course add some detail if afforded the opportunity to provide further revisions.
Provide more context on the evolution of NICE guidelines regarding weight loss. Why were the initial recommendations changed? When discussing NICE’s recommendations for multi-component lifestyle programs, briefly summarize the evidence base that supports this approach.
Re: Thank you for this important point as the guidance we presented was out of sync with current timelines. We have now better presented the evolution of weight loss guidance at the time of implementation of the intervention in our introduction section. We have also now updated the reference to include the most NICE guidance which has been published as follows:
NICE: Obesity: identification, assessment and management. National Institute for Health and Care Excellence; 2023. https://www.nice.org.uk/guidance/cg189/resources/obesity-identification-assessment-and-management-pdf-35109821097925 Accessed 14 Oct 2024.
Comparing commercial programs to those in primary care settings, the author could make a critical comparison on how these programs differ in their approaches such as frequency of sessions, duration of the program, types of support provided, clinical support. And also consider demographic details such as age, gender, or socio-economic status.
Re: Noted and whilst we believe we alluded to some of these points in the original submission, we have made a conscious effort to address these points in the introduction from line 71 onwards. We hope this is to the reviewers satisfaction.
Clarify recruitment strategies beyond marketing campaigns; highlight demographic diversity
Re: We were informed by Wigan Leisure trust that this is the approach to recruitment. We apologise but as this is secondary data analysis we cannot provide any further details.
Break down the multi-component program components; clarify integration of physical activity, healthy eating, and behavior change. also include professional competence factors such as qualifications and training of slimming world facilitators.
Re: We apologise but as this is secondary data analysis we cannot provide any further details. We have addressed this as limitation.
Please provide details on physical activity options and their tailoring for different fitness levels.
Re: We apologise but as this is secondary data analysis we cannot provide any further details. We have presented all that we know from lines 162 onwards. We have made explicit the lack of actual PA reporting is a limitation.
Adding effect sizes for each comparison might be good for understanding of the clinical significance of results
Re: Due to time constraints for the rapid return of the revised manuscript and the reviewer suggesting this is not a stipulation, it has not been possible to calculate effects sizes. We hope that providing significance of findings as well as presenting data on those that have achieved clinically meaningful weight loss will suffice.
Please acknowledge limitations such as the retrospective design, potential selection bias, and reliance on self-reported measures.
Re: Thank you for these suggestions. These have all now been included in the limitations section.
Reviewer 3 Report
Comments and Suggestions for AuthorsThe topic chosen in this study is interesting as it addresses strategies to reduce a very prevalent problem in the world such as obesity.
The introduction is correct and is based on an extensive bibliography (30 references) which, despite being correct, shows a very high rate of obsolescence, as we will see at the end (13 years). The objectives are well defined.
The methodology is well elaborated and allows any researcher who replicates it to obtain similar results.
The results, although brief, respond to the proposed objectives and can be easily followed thanks to the table and figure.
The discussion is well elaborated and based on extensive literature, which, like the introduction, is outdated.
The conclusions are brief and concise as befits this section.
The great handicap of this article is the bibliography, which despite being adequate is quite obsolete as the obsolescence index (median age of the references) is very high, specifically 13 years, and in addition only one reference is less than 5 years old and less than 3 years old.
I think it is interesting that some references should be replaced by more recent ones
Author Response
Thank you to reviewer 3 for the time you have invested in reviewing our manuscript. We have made significant changes to the references. Updating them has improved the quality of the manuscript thank you.
The great handicap of this article is the bibliography, which despite being adequate is quite obsolete as the obsolescence index (median age of the references) is very high, specifically 13 years, and in addition only one reference is less than 5 years old and less than 3 years old. I think it is interesting that some references should be replaced by more recent ones.
Re: Thank you for the comment. You have our assurances that we have checked each reference and where possible have included more recent guidance and / or evidence. This should be evident in the large number of track changes in the reference list.
Please note that even though references 11-25 are dated they are the most relevant research to this manuscript to provide relevant comparison and contrasts of the previous research evidence.
We have also made sure to check all web links and document availability and have updated the date at which these sources were accessed to be more recent.
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors,
The manuscript has been thoroughly revised. In some comments, particularly the first, the rebuttal statement is explanative, and the changes were advised at the authors’ discretion. The paper is now in better shape, and I would recommend publishing it in its current form at the academic editor’s discretion.
Author Response
Thank your for investing the time in your subsequent review and for recommending publication of our manuscript. We have acted on one final change suggested by the editor.
Reviewer 3 Report
Comments and Suggestions for AuthorsThe authors have responded adequately to the requested requirements.
Author Response
Thank your for investing the time in your subsequent review and for recommending publication of our manuscript. We have acted on one final change suggested by the editor.
