Assessing the Risk of Normal Weight Obesity in Korean Women across Generations: A Study on Body Composition and Physical Fitness
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThis is a good paper which will provide new idea on obesity may be relevant for management purposes. Need to clarify following areas.
1. Classification of age groups which not tally with conventional way. Need the reference or justification for this new classification. However, considering the physiological and hormonal changes during the different stages in life, better to classify as follows. 19-40 as early adulthood; 40-65 as middle age and 65 and 65 and above Elderly. Need to classify and do the reanalysis. Authors should use World Health Organisation Classification. This will help in comparison with other countries.
2. A quite a large proportion in this cohort is underweight, which affect the muscle power, tone and strength. This group cannot be excluded in the analysis. It may be a good finding to see the sarcopenia is more common among underweight or obese. Need to include underweight category in the analysis.
3. Discussion and conclusion should be aligned to above two areas.
Author Response
Thank you for your comments.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsSuggestions for improvement
Materials and Methods Section
- Further clarification of the criteria for selecting the body fat percentage threshold for NWO could be beneficial. The rationale for adopting a 30% body fat percentage, as suggested by Oliveros et al., may necessitate additional context, particularly regarding its relevance to the unique demographics of Korean women, taking into account potential variations in body composition resulting from racial and regional factors.
- A more detailed explanation of the statistical techniques used for the data analysis would be advantageous. While mention of Kruskal-Wallis and logistic regression was made, a thorough justification for the choice of these specific tests and their suitability for the data type would enhance the clarity of the document.
Results Section strengths: The demographic analysis and stratification of data by obesity level in the presentation provided a comprehensive and detailed perspective on the prevalence and distribution of NWO among the participants. A thorough comparative analysis of body composition, blood pressure, and physical fitness across different groups (normal, NWO, and obese) effectively delineates the specific health risks associated with NWO.
Areas for improvement
- The interpretation of the results could be enhanced by discussing the potential biological or environmental factors contributing to the observed differences in physical fitness and body composition among the groups. Although the study offers significant insights into NWO, discussion of the implications of these findings for public health policy and preventive measures is somewhat limited. Elaborating on how these results could influence future healthcare strategies for women with NWO in Korea would be beneficial.
- This section would also benefit from a discussion of the limitations of the findings, such as potential biases introduced by self-reported data or the limitations of bioelectrical impedance analysis in accurately measuring body composition in various body types.
- Overall, the study appears to be well-conducted with robust data analysis methods. However, further strengthening of the manuscript could be achieved by providing more information on methodological choices and expanding the discussion around the implications of the findings.
- Including a comparative analysis to contrast these findings with global data on NWO would provide a more holistic approach and thus make the paper relevant to all.
-Longitudinal study: Another study design useful in providing a more precise explanation of the development of NWO and health implications over time might be a longitudinal study design. Follow-up of NWO and health risks should involve a longitudinal study.
-Broader demographics: Generalization might have been enhanced if a more extensive group of participants were used to include a broader demographic population, thereby shedding more light on the impact of NWO among different populations.
Comments for author File: Comments.pdf
Author Response
Thank you for your comments.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsGeneral Comments
Thank you for your research regarding the subject of Normal Weight Obesity. Your work highlights the importance of implementing interventions to address body composition and physical fitness issued in individuals with NWO. Please consider my comments bellow.
Specific Comments
Line 22. Please consider using person-first language when referring to body mass index and obesity emphasizing the humanity of people over their medical condition (eg groups with obesity instead of obese groups).
Line 22, 23: please replace the phrase “normal group” with the phrase “group with normal body mass index”
Line 24: please consider “exhibited lower levels compared to the group with normal body mass index”
Line 27: please correct “obese individuals” to “individuals with obesity” according to principles of person-first language.
Line 107: please add that values are expressed as means (SD). Please consider adding number (n) of individuals to all study groups.
Line 213: Please explain the statistically significant results as displayed in Figure 2.
Lines 214, 236, 237, 256: tables 3, 5, 6 and 7 are not explained in the text. Please place the tables after the paragraph of its first citation including table 4 (is sited in line 243).
Author Response
Thank you for your comments.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsNone of the comments were adopted. However, It should be included in the paper. Especialy age standard, Otherwise Readers will be confused. Low sample of underweight and missing data should be mentioned.
Author Response
Thank you for high quality comments.
Author Response File: Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsYour study on the prevalence and implications of Normal Weight Obesity (NWO) among Korean women across generations is both timely and significant. It provides valuable insights into a relatively under-explored area, with potential implications for public health policies and preventive measures. The research design is robust, and the findings are clearly presented. The following are some specific suggestions to further enhance the quality of your manuscript:
Specific Comments:
Abstract: Consider revising the sentence: "While there are reports of a high prevalence of cardiovascular and metabolic diseases in NWO, there has been a lack of analysis regarding physical fitness." to "Although there are reports of a high prevalence of cardiovascular and metabolic diseases in NWO, analyses regarding physical fitness have been lacking." for better clarity.
Introduction: The introduction provides a strong background, but the sentence "Consequently, the importance of addressing obesity and preventing various diseases is emphasized." could be revised to "Consequently, addressing obesity and preventing related diseases is of paramount importance." to improve readability.
Materials and Methods: The methods are well described; however, they consider simplifying the technical descriptions for broader audience comprehension. For example, revise "Height was determined utilizing a stadiometer (Seca Corporation, Columbia, MD, USA) with a precision of 0.1 cm, and weight and body composition were examined using bioelectrical impedance analysis (Inbody 720, Bio space, Seoul, Korea) with a precision of 0.1 kg." to "Height was measured using a stadiometer (Seca Corporation, Columbia, MD, USA) with a precision of 0.1 cm, while weight and body composition were assessed using bioelectrical impedance analysis (Inbody 720, Biospace, Seoul, Korea) with a precision of 0.1 kg." Results: All tables and figures were clearly labeled and referenced in the text. For example, when referring to Figure 1, we specify the key findings illustrated in the figure.
Discussion: Although the discussion is thorough, we explicitly link our findings to broader public health implications. For instance, it highlights how this study can inform specific interventions or policies aimed at addressing NWO in different age groups.
Ethical considerations/data availability: It is recommended that more information be provided regarding the accessibility of the data. Making the dataset publicly available would enhance transparency and facilitate further research.
Conflicts of interest: The authors declare that the conflict of interest statement is thorough and unambiguous. Although no conflicts exist, a clear declaration strengthens the credibility of the study.
Conclusion: Your conclusions successfully summarize the key findings and their implications. Consider incorporating a brief statement on potential future research directions or practical applications of your findings to provide a forward-looking perspective.
Final Suggestions:
-Enhancing the language can significantly improve the clarity of the manuscript. Maintain consistency in terminology and minimize the use of overly technical jargon, where possible.
-Ensure that all references are current and pertinent to the study. We confirm that all in-text citations correspond to the reference list and adhere to the journal guidelines for formatting.
Your work on NWO among Korean women is a substantial contribution to this field. It represents an essential step towards better comprehending and addressing this health concern.
Comments on the Quality of English LanguageWhile the overall quality of English is good, there are minor areas where clarity can be improved. Consider professional language editing to enhance readability and ensure that the manuscript meets high linguistic standards.
Author Response
Thank you for high quality comments.
Author Response File: Author Response.pdf
