The Role of Stress and Mental Health in Obesity

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article addresses a timely and important issue – the interplay of psychological factors and obesity. The bidirectional relationship between obesity and mental health is well-established, and this paper contributes to the existing literature. The paper provides a reasonably comprehensive overview of the psychological mechanisms linking stress, mental health, and obesity. It covers various pathways, including stress-induced eating, emotional regulation difficulties, and the impact of mental health conditions. Moreover, the paper appropriately discusses various interventions, including stress management techniques, cognitive behavioral therapy (CBT), and other therapeutic approaches. This is crucial for translating research into practical applications. However, there are key points that need to be improved or added for the paper to have the potential to be published.

1. The paper is presented as an "Opinion" piece, lacking original data or a novel methodology. This significantly limits its impact in a scientific journal. To be publishable in a peer-reviewed journal, it needs to present either original empirical research or a systematic review of existing research with a novel synthesis or perspective. What is the objective? What's the real purpose of this opinion piece?
2. A thorough review of the literature is needed to present a more robust argument and avoid potential biases or oversimplifications. The current literature is insufficient. I recommend conducting a more comprehensive literature review to cover a broader range of relevant studies and perspectives. Transform the opinion article into a systematic review or a scoping review.
3. Certain claims, particularly regarding the effectiveness of specific interventions (e.g., MBIs), should be better supported with more robust evidence from randomized controlled trials (RCTs). Meta-analyses summarizing the effectiveness of interventions would significantly strengthen the claims.
4. While the paper presents various perspectives, a more critical analysis comparing and contrasting different approaches and their limitations is required. It needs to address the strengths and weaknesses of different interventions more explicitly. You could add a section with this information or add an explanatory table.
5. The conclusion could be more impactful by highlighting the main implications of the findings and proposing future research directions. It should summarize the key findings more concisely and offer specific recommendations for clinicians and researchers.

Based on the previous assessment, the article in its current form is not ready for publication in a high-impact scientific journal. It requires substantial improvements in the areas noted, primarily the addition of original data or transformation into a systematic review with a more in-depth critical analysis and a solid evidence base. 

Author Response

Response 1.

My manuscript is intentionally framed as an opinion piece. Its purpose is to offer a synthesized, perspective-driven discussion of the complex interplay between stress, mental health, and obesity rather than to serve as a systematic or scoping review. I believe that this format allows us to provide novel insights and a unique framework that may not emerge from the more rigid structure of a systematic review.

Response 2.

While a broader literature review can be valuable, my goal was to focus on the most critical studies that highlight the bidirectional links between psychological stress and obesity. The selected references support my central arguments, and a comprehensive review beyond this scope would dilute the paper’s concise, opinion-based perspective. Nonetheless, I have enriched the discussion by incorporating additional evidence and nuances where necessary.

Please find new paragraphs highlighted in red that were added based on other reviewers suggestions

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I think this is a very interesting review of an exceptionally important topic.

The authors do a particularly good job of showing the relationship between obesity and stress and depression.

 

While I recognize that not everything can be included in a review, I think including the following would add to the scope and impact of the review

 

1. How general anxiety disorder is linked to obesity
2. What are the effective screening tools for depression and anxiety
3. How sleep plays a role in mental health and obesity
4. How mental health medications can add to obesity risk and how that can be managed
5. How mental health providers can be of help in treating mental health issues

Author Response

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding corrections highlighted in the re-submitted file.

Response 1.

Thank you for pointing this out. I agree with this comment. Therefore, I have added a new subsection discussing the link between Generalized Anxiety Disorder (GAD) and obesity. This change can be found on page 3, lines 121–127

Response 2.

Thank you for pointing this out. I agree with this comment. Therefore, I have added a subsection detailing effective screening tools for depression and anxiety. This update is located on page 3, lines 128–134 of the revised manuscript.

Response 3. 

Thank you for pointing this out. I agree with this comment. Therefore, I have incorporated a discussion on the role of sleep in linking mental health and obesity. This revision can be found on page 2, lines 67–73 of the revised manuscript.

Response 4.

Thank you for pointing this out. I agree with this comment. Therefore, I have added a section discussing how certain mental health medications can contribute to obesity risk and outlined strategies to manage this issue. This change appears on page 5, paragraph 1, lines 200–206 of the revised manuscript.

Response 5.

Thank you for pointing this out. I agree with this comment. Therefore, I have expanded the discussion on the role of mental health providers in the management of obesity. This revised text can be found on page 4, lines 175–182 of the revised manuscript.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The opinion paper effectively addresses the relationship between stress, mental health and obesity, adequately highlighting the psychological mechanisms involved and possible therapeutic strategies. However, it would be useful to specify at the outset what is innovative or original in comparison to the vast literature already available on the subject. Furthermore, it could be enriched by briefly addressing the role of individual variability in stress responses, which could significantly influence the effectiveness of the proposed interventions. I also suggest considering the actual sustainability and accessibility of the therapeutic approaches discussed, such as cognitive-behavioural therapy and mindfulness, particularly in the general population. Finally, the inclusion of more recent references (last 5 years) and a brief discussion on the impact of obesity-related stigma on mental health would further enhance the comprehensiveness and relevance of the text.

Author Response

Thank you for pointing this out. I agree with this comment. Therefore, I have made several changes to emphasize the innovative aspects of this opinion paper relative to the existing literature, to address individual variability in stress responses, and to discuss the sustainability and accessibility of the proposed therapeutic approaches. Additionally, I have briefly discussed the impact of obesity-related stigma on mental health and updated the references to include more recent publications where applicable. These changes can be found in the revised Introduction (page 2, lines 39–47) and in the Mental Health section (page 9, lines 124–132).

 

 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The doubts have been clarified. And the paper has been significantly improved with the added paragraphs.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have done a nice job of addressing all the reviewer's concerns.

Reviewer 3 Report

Comments and Suggestions for Authors

the author has addressed all my concerns