Lifestyle Interventions for the Treatment of Obesity in Workers: An Integrative Review
and Magno Merces Weyll Pimentel 1,2,3,*
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsDear Authors,
Thank you for the opportunity to review your manuscript investigating lifestyle interventions for the treatment of obesity in workers using an integrative review methodology. The topic you address is both timely and relevant, and I appreciate the effort you have put into this work.
However, I would like to share a few methodological concerns that I believe are important to consider to strengthen the manuscript. My primary concern relates to the literature search strategy. Conducting an integrative review based on results from a single database—PubMed—while methodologically possible, carries a significant risk of overlooking relevant studies and may result in a less comprehensive and reliable synthesis. Please find my comments referring to the manuscript and suggestions for improvement in the following. I hope you will find my comments useful.
Sincerely
Introduction section:
As medicine and surgery play an important role in obesity treatment, I would consider including a rationale for why non-invasive interventions are of particular interest for this review.
Materials and Methods:
In addition to PICO, I find it necessary to provide definitions for dietary interventions, physical activity, and behavioral modification. Both dietary and physical activity have a substantial behavioral component inherited. Setting a clear frame for the terms would help the reader and increase the transparency of the paper.
To further strengthen the methodological rigor and transparency of your review, I would recommend providing more detailed information about the review process itself. Specifically, it would be helpful to clarify how many researchers were involved in each stage of the work—such as the literature search, screening, data extraction, and synthesis—and how decisions were made in cases of disagreement.
This level of detail is important for readers to assess the reliability and reproducibility of the review, and it aligns with best practices for review reporting. Using, e.g., a PRISMA checklist when preparing your manuscript will be very useful.
Search Strategy:
PubMed, although widely used, has certain limitations, particularly in terms of search specificity. I was surprised by the relatively low total number of hits (n=99), given the vast volume of obesity-related publications globally. I have noticed you report exclusively on using MeSH terms. A comprehensive literature search must incorporate both MESH terms and keywords. Additionally, you need to adjust your search terminology to the MESH catalogue of the database and other possible variations as keywords. Here, MeSH terminology of PubMed spells lifestyle as “Life Style”. The common word “lifestyle” will be used as a keyword to capture all relevant publications. The term “behavioral intervention” does not align precisely with PubMed’s MeSH terminology, where it is titled “Behavioral Modification”. I believe such nuances could have limited the scope of your search.
To enhance the robustness of your review, I strongly recommend consulting a librarian or information specialist to help refine the search strategy, including database-adjusted MESH terms, keywords, and relevant synonyms. This is especially important when relying on a single database. Alternatively, using MEDLINE may offer a more suitable platform for your investigation.
Methodological quality assessment:
Given that your eligibility criteria include experimental, quasi-experimental, and longitudinal studies, with or without comparison groups, the exclusive use of the Newcastle-Ottawa Scale (NOS) may not be fully appropriate. The NOS is primarily designed for assessing the quality of non-randomized observational studies. It may not adequately capture the methodological strengths or limitations of experimental or quasi-experimental studies.
To ensure a more accurate and comprehensive appraisal of study quality, I recommend considering additional or alternative tools that are better suited to the diversity of study designs included in your review. For example, ROBINS-I for quasi-experimental studies, and Cochrane Risk of Bias 2 Tool for randomized controlled trials, or relevant JBI tools. Using a more nuanced approach to quality assessment would enhance the credibility of your synthesis and provide readers with a clearer understanding of the strength of the evidence base.
Results, Discussion, and Conclusions:
My comments in the above lead me to think that your manuscript will change substantially. This is why these chapters will only be attributed with a few general comments.
I would propose you include the subheading Limitations and provide the readers with a comprehensive overview of limitations linked at this time, i.e., to the literature search strategy, methodological quality assessment, and transparency of the review process, as mentioned above.
In the Conclusions section (and Abstract, accordingly), definitive statements regarding the findings should be tempered to reflect the scope and limitations of the review.
General comment:
I suggest a thorough check of spelling and formatting (e.g., language and font color consistency) throughout the manuscript to ensure clarity and professionalism.
Author Response
Cover Letter to the Editor and Reviewers.
We sincerely appreciate the opportunity to review our manuscript, titled "Lifestyle Interventions for the Treatment of Obesity in Workers: An Integrative Review." We are grateful for the constructive feedback provided by you and the reviewers, which greatly contributed to improving the quality, clarity, and scientific depth of our work. In this revised version, all comments from the Editor and Reviewers 1, 2, and 3 have been carefully addressed. Major modifications include:
- Expanded introduction, now clearly articulating the scientific rationale and the problem addressed;
- Strengthened Materials and Methods, with detailed operational definitions for dietary, physical activity, and behavioral interventions, reviewer workflow, and ethics statement;
- Comprehensive rewriting of the Discussion, making it more concise, interpretive, and focused on our own findings, including a new subsection, namely limitations;
- Completely reworded Conclusion, now concise, authorial, and directly aligned with the study results;
- Fully standardized references and in-text citations according to the style MDPI/Vancouver;
- Translation and standardization of Table 1 into English, and extensive language review by a native English speaker specializing in academic writing to ensure clarity, fluency, and consistency throughout the manuscript;
We firmly believe that the revised version now meets the journal's high scientific and editorial standards. We thank you and the reviewers once again for your thoughtful and valuable contributions.
Response to Reviewer 1
We sincerely thank Reviewer 1 for the careful and constructive evaluation of our manuscript. All comments have been fully addressed, resulting in substantial methodological and structural improvements. Below, we provide detailed point-by-point responses.
1. “As medicine and surgery play an important role in obesity treatment, please justify why non-invasive interventions are of particular interest for this review.”
Response: Thank you for this valuable comment. The Introduction has been expanded to include a clear scientific rationale for focusing on non-invasive, lifestyle-based interventions. We clarified that, although pharmacological and surgical treatments can be effective, they are often limited by accessibility, cost, and clinical eligibility. Therefore, non-invasive approaches centred on behavioural and environmental modification are especially relevant to workers, who represent a large, economically active, and at-risk population.
2. “In addition to the PICO framework, please provide definitions for dietary, physical activity, and behavioural interventions.”
Response: Addressed. Operational definitions for dietary interventions, physical activity, and behavioural modification were added in the Materials and Methods section, following WHO and ACSM frameworks. These definitions improve conceptual clarity and transparency of the inclusion criteria.
3. “Clarify how many reviewers were involved in each step and how disagreements were handled.”
Response: Implemented. The Selection and Extraction Process subsection now specifies that two independent reviewers conducted all stages of the review process, including search, screening, data extraction, and synthesis. Disagreements were resolved by consensus or, when necessary, by a third reviewer. This ensures methodological transparency and reproducibility.
4. “The search strategy seems narrow. Why use only PubMed?”
Response: We appreciate this important observation. A justification has been added to the Search Strategy subsection: PubMed was selected for its comprehensive biomedical coverage and indexing reliability. To reduce the risk of omission, we broadened the search with both MeSH terms and free-text keywords, verified spelling variants, and used Boolean operators to capture all relevant studies. This limitation is also acknowledged in the Limitations subsection of the Discussion.
5. “The use of the Newcastle–Ottawa Scale may not be appropriate for all study types. Consider complementary tools.”
Response: Implemented. To strengthen methodological rigour, the quality assessment was complemented using ROBINS-I for quasi-experimental studies and JBI Critical Appraisal Tools for mixed designs. These additions are described in the Methodological Quality Assessment subsection and mentioned in the Limitations section.
6. “Please ensure PRISMA compliance.”
Response: Done. The revised manuscript now explicitly states adherence to the PRISMA 2020 guidelines at the beginning of the Materials and Methods section. The PRISMA flow diagram was also updated and standardised in English, titled “Figure 1. Flow diagram of the study selection process (PRISMA 2020).”
7. “Include a Limitations subsection.”
Response: Fully implemented. A new Limitations subsection has been added at the end of the Discussion, addressing database restriction (PubMed only), heterogeneity of study designs, and the inability to conduct a quantitative meta-analysis.
8. “Moderate the conclusions to reflect the scope and limitations of the review.”
Response: Completed. The Conclusion was completely rewritten as a concise, authorial synthesis without external citations. It now summarises the main findings and proposes directions for future research in diverse socioeconomic and occupational contexts.
Reviewer 2 Report
Comments and Suggestions for AuthorsManuscript ID: obesities-3865916
Title: Lifestyle Interventions for the Treatment of Obesity in Workers: An Integrative Review
The concept of this article is fine and authors did many works with this research. The manuscript needs some revisions, because there are some aspects of the work that should be corrected and improved.
- In each page: " Obesities 2024, 5, FOR PEER REVIEW ", update to 2025
- The introduction must be improved with more relevant information about the core plot of the manuscript.
- The authors should be described the scientific rationale of the study (= what is the scientific problem?) in the Introduction section.
- The ethical approval number or code must be added to this study.
- In Table 1: The subjects in the first row are not English.
- The study lacks a sample size calculation.
- The Discussion section needs serious improvements. Authors have to focus on discussing their own findings and interpreting these results. Importantly, the discussion should be more focused, concise, and directly related to the study's findings.
- The conclusion should not include sentences from previous studies as it is your own conclusion, not for others.
- It doesn't make sense for the conclusion to be 32 lines long. The conclusion is longer than the Abstract. How is that?
- Insert the correct format style for journals in the references in the text and references list.
Author Response
Response to Reviewer 2
We sincerely thank Reviewer 2 for the careful review and constructive feedback. All comments have been addressed thoroughly, and the manuscript has been revised to improve clarity, focus, and methodological accuracy. Below are our detailed point-by-point responses.
1. “Improve the Introduction with more relevant information about the central theme of the manuscript.”
Response: Addressed. The Introduction has been expanded and rewritten to include a stronger theoretical and scientific rationale, clearly defining the problem addressed by the review. It now emphasises the relevance of lifestyle-based interventions in occupational contexts and the existing gap in synthesised evidence for this population.
2. “The authors should describe the scientific justification of the study (what is the scientific problem?) in the Introduction.”
Response: Implemented. The final paragraph of the Introduction now explicitly presents the research problem, highlighting that despite the high burden of obesity among workers, few studies have systematised evidence on lifestyle interventions in this population. This addition provides a clear justification and scientific rationale for the review.
3. “Add the ethics approval number or code.”
Response: Clarified. As this study is an integrative review using previously published data, ethical approval was not required. We have added the statement: “Ethical approval: Not applicable (review of previously published data; no identifiable human data)” in the Materials and Methods section.
4. “In Table 1, the first-row subjects are not in English.”
Response: Done. Table 1 has been fully translated and reformatted. Column headers now read: Reference | Population | Intervention | Comparison | Remarks. Terminology and structure were standardised for clarity and consistency.
5. “The study lacks a sample size calculation.”
Response: Clarified. A note was added at the end of the Materials and Methods section explaining that sample size calculation is not applicable to integrative reviews, as the sample derives from eligible studies identified through a structured search.
6. “The Discussion section needs serious improvement. It should focus on the authors’ findings and interpretation, be concise, and directly related to the study results.”
Response: Fully implemented as a major revision. The entire Discussion has been rewritten to focus on interpretation and synthesis of our own findings, removing redundant descriptions of external literature. It now emphasises key outcomes (dietary improvement, workplace physical activity, behavioural adherence), integrates implications for occupational health, and includes a new Limitations subsection, as requested. The revised section is approximately 25% shorter, clearer, and more aligned with the study objectives.
7. “The Conclusion should not include phrases from previous studies; shorten it.”
Response: Completed. The Conclusion has been completely rewritten as a concise, authorial synthesis (approximately 9 lines). It now highlights the study’s main contributions and proposes directions for future research, without citations from other studies.
8. “Insert the correct journal format for in-text citations and references.”
Response: Done. All in-text citations and the reference list have been reviewed and standardised according to MDPI/Vancouver formatting guidelines (author initials, journal abbreviations, year; volume(issue):pages; DOI or access data where applicable). Punctuation and spacing were corrected throughout the manuscript.
Reviewer 3 Report
Comments and Suggestions for AuthorsEven the manuscript is with high interest by readers the manuscript is poorly written.
What is more authors mixed Spanish and English
Only one point is nice - the methods described.
Author Response
Response to Reviewer 3
We thank Reviewer 3 for the time dedicated to evaluating our manuscript. However, we respectfully note that several of the reviewer’s comments appear to be based on a misunderstanding of the manuscript’s content and current version. We have nevertheless conducted a thorough revision to ensure that every section meets the journal’s scientific and language standards.
1. “The manuscript is poorly written.”
Response: We respectfully disagree with this general assessment. The manuscript was fully edited by a native English speaker with scientific writing experience, ensuring accuracy, consistency, and fluency. The revised version underwent a comprehensive language review, eliminating minor stylistic inconsistencies and improving overall readability. The editorial structure strictly follows the MDPI format (Introduction, Materials and Methods, Results, Discussion, Conclusions), and all sections were carefully revised for coherence and concision.
2. “The authors mixed Spanish and English.”
Response: We acknowledge that minor language inconsistencies may have appeared in the initial submission due to automatic formatting tools. All occurrences have now been corrected, and the text is written entirely in standard academic English. Every table, figure, and caption has been reviewed and harmonised linguistically. The editorial note “Obesidades 2024, 5, PARA REVISÃO POR PARES” has been updated to “Obesities 2025 – FOR PEER REVIEW,” resolving any residual bilingual elements.
3. “Only the Methods section is adequate.”
Response: While we appreciate that the Methods section was positively evaluated, we emphasise that the Discussion, Introduction, and Conclusion have now undergone substantial revision.
-
The Introduction has been expanded with a well-defined scientific rationale and problem statement.
-
The Discussion has been completely rewritten, focusing on the authors’ own findings, interpretation, and implications for occupational health, in full alignment with the reviewers’ and editor’s guidance.
-
A new Limitations subsection has been added for transparency.
-
The Conclusion has been shortened and rewritten as an original synthesis.
These changes ensure that the entire manuscript is coherent, scientifically rigorous, and consistent in structure and style.
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsDear Authors,
Thank you for the comprehensive revisions made in your manuscript. Its quality has been sufficiently improved. However, I have a few suggestions for minor corrections, which I will be sharing with you in my reviewer response 2. I hope you will find my comments useful.
Sincerely
Abstract
To align with the Conclusions section, I would suggest adding lifestyle to the sentence (line 32-34):
Lifestyle-based workplace interventions for obesity show limited long-term effectiveness in weight reduction but promote healthier lifestyle habits, cardiometabolic health, and more supportive work environments.
Introduction and Conclusions
For more consistency, please consider adding:
- In Line 44-45: This major cardiometabolic risk factor has a multifactorial origin and entails physical, psychological, and economic impacts for both individuals and society
- In Line 294-296: This integrative review demonstrated that workplace-based obesity treatment models combining dietary interventions, physical activity, and behavioural change produce modest effects on body weight but meaningful improvements in lifestyle habits and cardiometabolic health.
Table 1
Line 166: Please provide an English translation of the table heading.
Author Response
Dear Reviewer,
Thank you very much for your thoughtful re-evaluation and valuable suggestions. All your comments were fully addressed in the revised version of the manuscript.
In the Abstract, we added the term lifestyle to ensure alignment with the Conclusions section. In the Introduction, we incorporated the suggested sentence emphasizing the multifactorial origin and broad impacts of obesity. In the Conclusions, we included the sentence highlighting that workplace-based interventions combining diet, physical activity, and behavioral change produce modest effects on body weight but meaningful improvements in lifestyle habits and cardiometabolic health.
We also translated the Table 1 heading into English and reviewed all its column titles for linguistic consistency. Minor stylistic adjustments were made throughout the text to improve clarity and coherence.
All modifications are visible in the tracked-changes version of the manuscript.
Sincerely,
Reviewer 2 Report
Comments and Suggestions for AuthorsAccept
Author Response
Dear Reviewer,
Thank you for your observation regarding the language quality. We are pleased to inform you that the entire manuscript has undergone a comprehensive English revision by a native speaker with academic editing experience, ensuring clarity, precision, and fluency throughout the text.
Sincerely,
The Authors
Reviewer 3 Report
Comments and Suggestions for AuthorsSorry but the subject is old and the manuscript did not give new informations
Author Response
Dear Reviewer,
We regret that the study did not meet your expectations. It is unfortunate that, despite the relevance of the topic to current clinical and public health practice, it was perceived as providing no new information.
We would also like to note that in the first review round, no specific suggestions or methodological recommendations were provided that could have guided substantial improvement. Constructive and detailed feedback is always highly valued, as it contributes to the scientific quality of the manuscript and to the transparency of the peer-review process.
Nevertheless, we appreciate the time dedicated to reassessing our work.
Sincerely,
The Authors
