Eating Disorders (EDs) and the COVID-19 Pandemic: A Pilot Study on the Impact of Phase II of the Lockdown

Round 1

Reviewer 1 Report

This brief report investigates eating pathology in a small sample of young women during the COVID-19 pandemic in Italy. I believe this study, with major revisions, could provide benefit to the literature on how recent stressors in the world are impacting eating disorders. However, several important aspects of the paper must be addressed prior to publication.

Major edits are recommended in the following areas:

1. Introduction- It would be helpful to provide a clearer description of what "lockdown" means and the implications of that in Italy. Given the background described on COVID-19 and its impact on others, could the authors provide a few sentences on what the lockdown entailed and when it occurred?
2. Method- The study method is unclear. The method section states that participants were referred by their doctors for meeting criteria for a DSM-5 eating disorder. Are these only adults, or adolescents too? Over what period of time was data collected? Then, the description states that psychologists interviewed participants, but then the scales used all seem to be self-report questionnaires. Were there additional questions asked during the interviews? How did you know when onset of symptoms began? Is there more information on the demographics of the sample that authors can provide, as well? Please provide more information in these areas.
3. For results and discussions- authors state that symptoms onset during the lockdown phase. How do we know that reported symptoms onset during this time? Were they asked in the interviews? Are these findings simply a result of the individuals interviewed having a diagnosis of AN-r or AN-bp and that's why they are reporting symptoms?

Overall, given the small sample size and study design, the findings seem hard to generalize to clinical implications whether it's for treatment or prevention. The authors also don't speak to what this study adds to the literature or how this may be helpful clinically. It would be important for the authors to outline this in the discussion, even if the findings are very preliminary. It simply appears they are reporting on clinical symptoms of a small sample versus highlighting how in particular the pandemic lockdown may have worsened symptoms. 

Author Response

 

1. Introduction- It would be helpful to provide a clearer description of what "lockdown" means and the implications of that in Italy. Given the background described on COVID-19 and its impact on others, could the authors provide a few sentences on what the lockdown entailed and when it occurred?

Authors: Thanks to the reviewer for the suggestions. In the introduction paragraph we have included references with more details to the lockdown phase that affected the context (see lines 72 to 95).

2. Method- The study method is unclear. The method section states that participants were referred by their doctors for meeting criteria for a DSM-5 eating disorder. Are these only adults, or adolescents too? Over what period of time was data collected? Then, the description states that psychologists interviewed participants, but then the scales used all seem to be self-report questionnaires. Were there additional questions asked during the interviews? How did you know when onset of symptoms began? Is there more information on the demographics of the sample that authors can provide, as well? Please provide more information in these areas.

Authors: In the Methods paragraph, information relating to the data collection and diagnosis period has been entered. Furthermore, the procedure for the recruitment of patients already under treatment and the method of administering the test protocol were detailed. Additional missing demographic information was placed in the "Conclusions" paragraph as a limitation.

3. For results and discussions- authors state that symptoms onset during the lockdown phase. How do we know that reported symptoms onset during this time? Were they asked in the interviews? Are these findings simply a result of the individuals interviewed having a diagnosis of AN-r or AN-bp and that's why they are reporting symptoms?

Authors: In the "Results" and "discussions" paragraphs we have inserted the item "J" of the EDI-3 questionnaire, an open-ended question in which the patients are asked at what age they experienced feeding problems and for the most part the answer coincided. when they requested a visit to the EDs Unit, thus detecting the period of onset of symptoms.

4. Overall, given the small sample size and study design, the findings seem hard to generalize to clinical implications whether it's for treatment or prevention. The authors also don't speak to what this study adds to the literature or how this may be helpful clinically. It would be important for the authors to outline this in the discussion, even if the findings are very preliminary. It simply appears they are reporting on clinical symptoms of a small sample versus highlighting how in particular the pandemic lockdown may have worsened symptoms.

Authors: In the paragraph Conclusions we have deepened the purpose of our preliminary research, deepening how relevant it can be for clinical and prevention purposes.

Author Response File: Author Response.doc

Reviewer 2 Report

The study is a pilot one that describes an important topic, which is eating disorder during the pandemic. The follow changes are needed:

 

Title: add the term pilot study on the title

1. Abstract: should be re-written in a better structure to follow the following order: background, aim, methods, results and conclusion but with out any headings, all not to exceed 200 words.

 

2. Methods:

• Any data is available about weight, height, BMI, body fat etc. If yes, please include, if not this should be included as major limitation of the study to add in the Discussion section.

 

• Do all the questionnaires used are validated in Italian language? If yes, please add the references. If no, this should be added in the limitation.

 

3. Discussion

            This section is poor and need to re-structured as follows:

• Main finding of the study and comparison with previous published literature
• Clinical Implication of the findings
• Strength and limitations, especially the absence of anthropometric variable such as i.e. body fat and mention its importance. Please check: https://pubmed.ncbi.nlm.nih.gov/27230963/

 

4. In general the manuscript needs an extensive English proofreading.

Author Response

 

Authors: Thank you for appreciating our research purpose and for your valuable suggestions.

The follow changes are needed:

Title: add the term pilot study on the title

Authors: “A pilot study” was inserted in the title

1. Abstract: should be re-written in a better structure to follow the following order: background, aim, methods, results and conclusion but with out any headings, all not to exceed 200 words.

Authors: We revised the abstact according to the suggested structure and limited the number of words.

2. Methods:

• Any data is available about weight, height, BMI, body fat etc. If yes, please include, if not this should be included as major limitation of the study to add in the Discussion section.

Authors: We have inserted table 1 in which the requested data have been entered.

• Do all the questionnaires used are validated in Italian language? If yes, please add the references. If no, this should be added in the limitation.

Authors: We have inserted the references of the Italian validations of the tests used. The validation and standardization study was reported for the DS-R scale.

3. Discussion

This section is poor and need to re-structured as follows:

• Main finding of the study and comparison with previous published literature
• Clinical Implication of the findings
• Strength and limitations, especially the absence of anthropometric variable such as i.e. body fat and mention its importance. Please check: https://pubmed.ncbi.nlm.nih.gov/27230963/

Authors: We have expanded the Discussion and Conclusions paragraph as indicated

4. In general the manuscript needs an extensive English proofreading.

Authors: Both the previous version and the current revised version have been subjected to linguistic revision carried out by the English Editing Service (MDPI).

 

 

Author Response File: Author Response.doc

Round 2

Reviewer 2 Report

The manuscript can be accepted in the current form.