Sociodemographic Variables and Body Mass Index Associated with the Risk of Eating Disorders in Spanish University Students

Round 1

Reviewer 1 Report

I want to thank the authors and the Editorial Board for the opportunity to review the article submitted to the European Journal of Investigation in Health, Psychology and Education. The authors’ manuscript refers to a very important topic: eating disorders in young adults. Unfortunately, I do not believe it is worth publishing in EJIHPE.

Authors present results based on two groups of variables: (1) socio-demographic data, and (2) the risk of developing eating disorders. As it stands, the authors’ manuscript does not bring anything new to the field. What is more, the discussion section does not provide any practical implications of the presented results. The authors did not justify why they voided measuring other important data, which is related to the development of ED, such as mental health (e.g. depression, anxiety), quality of life, the levels of personal resources (e.g. social support, sense of coherence) etc. The presented results section seems like a part of a larger study, rather than a study on its own. Based on the above comment, I do not recommend the publication of the authors’ manuscript in EJIHPE.

Author Response

Reviewer 1: 

I want to thank the authors and the Editorial Board for the opportunity to review the article submitted to the European Journal of Investigation in Health, Psychology and Education. The authors’ manuscript refers to a very important topic: eating disorders in young adults. Unfortunately, I do not believe it is worth publishing in EJIHPE.

Authors present results based on two groups of variables: (1) socio-demographic data, and (2) the risk of developing eating disorders. As it stands, the authors’ manuscript does not bring anything new to the field. What is more, the discussion section does not provide any practical implications of the presented results. The authors did not justify why they voided measuring other important data, which is related to the development of ED, such as mental health (e.g. depression, anxiety), quality of life, the levels of personal resources (e.g. social support, sense of coherence) etc. The presented results section seems like a part of a larger study, rather than a study on its own. Based on the above comment, I do not recommend the publication of the authors’ manuscript in EJIHPE.

AUTHORS' RESPONSE: The authors would first like to thank Reviewer 1 for all the contributions he has made to the manuscript, which have helped us to improve it. We will now respond to all his requests. We have added BMI to the variables to be studied in relation to the risk of developing an eating disorder. We have modified and expanded the discussion section. In the limitations of the study, we point out that we are currently analyzing the relationship of ED development with anxiety and depression.

Reviewer 2 Report

Risk Factors Associated with Disordered Eating among Spanish University Students

General feedback

Overall, the theme discussed in the article is relevant and is within the scope of European Journal of Investigation in Health Psychology and Education.  The purpose of the paper is good. To determine whether, in Spanish university students, variables such as gender, age, course, and educational faculty are associated with a higher risk of suffering from eating disorders (ED) adds a lot of value to the field.

I leave my comments below, specifying each section of the manuscript.

 

Abstract:

Line 15:  Method is too generative. The authors could give more details about data analysis.

Line 17: Results did not include numeric information regarding the main findings.

Line 21: The conclusion is not directly related to the objective.

 

 

Introduction:

Lines 34-36:

Eating Disorders (ED) is the main subject of the manuscript. However, the authors do not present its clear definition.

 

Lines 37-40:

The authors mentioned “perceptions of their physical image”; “dissatisfaction with body weight” without properly defining the terms. They are not synonymous, although sometimes in the Introduction section, the authors tended to understand they could be used interchangeably.

Body image has 2 dimensions: perceptual and attitudinal (which also includes the behavioral, affective, and cognitive components). The authors must understand and let clear which dimension and component is going to be covered in the study.

Once BDI-3-RF include subscales related to body image, it is really important do define properly these terms in the introduction section.

 

-          Regarding the other variables included in the study (gender, age, course, and educational faculty) the authors did a god job in present their theoretical relationship with ED in university students.

-          Lines 109-112 - It would be important to present the research justification more clearly. Beyond just saying that: “Considering the above-mentioned aspects…”

2. Materials and Methods

Participants - Line 121-123: Please, add the reference for the sample size calculation.  

Table 1 - Frequency and percentage of students by academic year and educational 131 faculty.

During the introduction, the authors had given focus on the area of Health, such as Nutrition, Dietetics, Physical Education, Nursing and Medicine as most susceptible to ED. However, these areas were not included in the study sample. Is there any reason for this?

Lines 134-139 – BDI data.

The authors did not present data on the BMI classification in relation to the participants. How many students were underweight, normal weight, overweight and obese? This information is very important considering the influence of BMI on ED and BID.

Line 196 – The authors mentioned the test of the null hypothesis, but they did not elucidate this hypothesis.

Line 191 - Data analysis - Due to the influence of BMI on ED and BID, already demonstrated in the literature, the authors should considerer to include this variable as a covariable in the analysis.

Results

Table 4 is poorly designed. It is not possible to verify the information about physical exercise in both genders.

Tables 2, 3 and 5 – The authors should indicate the significant differences in the tables.

Once you indicate the significant differences on Table 5, the Table 6 is dispensable.

Please show the effect size of the difference between students under 20 years old to people over 26 years old.

By removing the table 6, you will have space to include a new table regarding “Differences as a Function of the Year of the Course”

Table 7 is poorly designed. It is not possible to verify the information about dependent variables in the different Educational Faculty.

 

Discussion:

Line 270-271: The first paragraph of the discussion, beyond of recapture the objective, should point out aspects of relevance to the investigation. The aspects that should be pointed out here, must be in line with my previous request about the study justification by the end of the introduction.

 

-          The main point of concern throughout the entire discussion is the fact that the authors did not consider the influence of BMI in the statistical analyses, nor did they mention this fact as a possible justification for their findings.

For example: Was the difference identified in terms of age really due to the critical age for the development of ED, OR the group that showed the highest risk symptoms were also the highest BMI? This questioning could be rethought for all investigated variables.

The international literature already has a consensus on the influence of BMI on aspects of body image and also on ED symptoms. The higher the BMI, the greater the negative body image tends to be, and consequently, the greater the symptoms of ED.

 

Line 363: Regarding the limitations of study, I highly recommend to review the limitations of the study. Was the only limitation the fact of using a self-administration questionnaire?

 

Authors contributions: remove the sentence of journal guides.

 

References: The authors use 16 references published in the last 3 years (2019-2022)

Author Response

Reviewer 2

Comments and Suggestions for Authors

Risk Factors Associated with Disordered Eating among Spanish University Students

General feedback

Overall, the theme discussed in the article is relevant and is within the scope of European Journal of Investigation in Health Psychology and Education.  The purpose of the paper is good. To determine whether, in Spanish university students, variables such as gender, age, course, and educational faculty are associated with a higher risk of suffering from eating disorders (ED) adds a lot of value to the field. I leave my comments below, specifying each section of the manuscript.

 

AUTHORS' RESPONSE: The authors would first like to thank Reviewer 2 for all the contributions he has made to the manuscript, which have helped us to improve it. We will now respond to all his requests.

Abstract:

Line 15:  Method is too generative. The authors could give more details about data analysis.

Line 17: Results did not include numeric information regarding the main findings.

Line 21: The conclusion is not directly related to the objective.

 

AUTHORS' RESPONSE: We have modified the ABSTRACT following your suggestions for improvement

Introduction:

Lines 34-36:

Eating Disorders (ED) is the main subject of the manuscript. However, the authors do not present its clear definition

AUTHORS' RESPONSE:  We have clarified the terms used in the introduction, in particular, we focus on body dissatisfaction.

Lines 37-40:

The authors mentioned “perceptions of their physical image”; “dissatisfaction with body weight” without properly defining the terms. They are not synonymous, although sometimes in the Introduction section, the authors tended to understand they could be used interchangeably.  

AUTHORS' RESPONSE: We have clarified the terms requested by the reviewer

 

Body image has 2 dimensions: perceptual and attitudinal (which also includes the behavioral, affective, and cognitive components). The authors must understand and let clear which dimension and component is going to be covered in the study.  

AUTHORS' RESPONSE: We have clarified the terms requested by the reviewer

 

 

Once BDI-3-RF include subscales related to body image, it is really important do define properly these terms in the introduction section.  

 AUTHORS' RESPONSE: We have clarified the terms requested by the reviewer

 

-          Regarding the other variables included in the study (gender, age, course, and educational faculty) the authors did a god job in present their theoretical relationship with ED in university students. -  

AUTHORS' RESPONSE: Thank you very much

 

-          Lines 109-112 - It would be important to present the research justification more clearly. Beyond just saying that: “Consiering the above-mentioned aspects…” -  

AUTHORS' RESPONSE: We have better justified the research

2. Materials and Methods

Participants - Line 121-123: Please, add the reference for the sample size calculation.  

AUTHORS' RESPONSE: We have added the reference for the sample size calculation

Table 1 - Frequency and percentage of students by academic year and educational 131 faculty.

During the introduction, the authors had given focus on the area of Health, such as Nutrition, Dietetics, Physical Education, Nursing and Medicine as most susceptible to ED. However, these areas were not included in the study sample. Is there any reason for this?  

AUTHORS' RESPONSE: We have clarified this aspect

Lines 134-139 – BDI data.

The authors did not present data on the BMI classification in relation to the participants. How many students were underweight, normal weight, overweight and obese? This information is very important considering the influence of BMI on ED and BID.  

AUTHORS' RESPONSE: We have added data on the BMI classification in relation to the participants

Line 196 – The authors mentioned the test of the null hypothesis, but they did not elucidate this hypothesis.  

AUTHORS' RESPONSE: We have corrected the typo

Line 191 - Data analysis - Due to the influence of BMI on ED and BID, already demonstrated in the literature, the authors should considerer to include this variable as a covariable in the analysis.  

AUTHORS' RESPONSE: New statistical analyses added including BMI

Results

Table 4 is poorly designed. It is not possible to verify the information about physical exercise in both genders.

Tables 2, 3 and 5 – The authors should indicate the significant differences in the tables.

Once you indicate the significant differences on Table 5, the Table 6 is dispensable.

Please show the effect size of the difference between students under 20 years old to people over 26 years old.

By removing the table 6, you will have space to include a new table regarding “Differences as a Function of the Year of the Course”

Table 7 is poorly designed. It is not possible to verify the information about dependent variables in the different Educational Faculty.

AUTHORS' RESPONSE: All tables indicated by the reviewer have been modified and new tables have been added to comply with the reviewer's suggestions for improvement.

Discussion:

Line 270-271: The first paragraph of the discussion, beyond of recapture the objective, should point out aspects of relevance to the investigation. The aspects that should be pointed out here, must be in line with my previous request about the study justification by the end of the introduction.

AUTHORS' RESPONSE: The first paragraph of the discussion has been modified

-          The main point of concern throughout the entire discussion is the fact that the authors did not consider the influence of BMI in the statistical analyses, nor did they mention this fact as a possible justification for their findings.

For example: Was the difference identified in terms of age really due to the critical age for the development of ED, OR the group that showed the highest risk symptoms were also the highest BMI? This questioning could be rethought for all investigated variables.

The international literature already has a consensus on the influence of BMI on aspects of body image and also on ED symptoms. The higher the BMI, the greater the negative body image tends to be, and consequently, the greater the symptoms of ED.

AUTHORS' RESPONSE: The results obtained with the new BMI variable have been introduced in the discussion, and the reviewer's doubts about this aspect are clarified.

Line 363: Regarding the limitations of study, I highly recommend to review the limitations of the study. Was the only limitation the fact of using a self-administration questionnaire?

AUTHORS' RESPONSE: The limitations of the study have been extended

Authors contributions: remove the sentence of journal guides.  

AUTHORS' RESPONSE: The typo has been corrected

References: The authors use 16 references published in the last 3 years (2019-2022

 

AUTHORS' RESPONSE: New references from the last three years have been included.

 

AUTHORS' RESPONSE: Once again, we thank you for your suggestions and the time you have taken to review our manuscript.

 

Round 2

Reviewer 1 Report

In the Review Report response authors write "we point out that we are currently analyzing the relationship of ED development with anxiety and depression".

In line 563 they write: "Likewise, as future research we will analyze the risk of suffering ED in university students in relation to other aspects of mental health, such as anxiety and depression. Aspects on which we are currently working".

The promise of a future study doesn't strenghten the presented results. What is more, authors response does not answer my initial review report concerns about lack of measurement of important variables. I stand as in my initial review report, which i bring back again below.

Authors present results based on two groups of variables: (1) socio-demographic data, and (2) the risk of developing eating disorders. As it stands, the authors’ manuscript does not bring anything new to the field. What is more, the discussion section does not provide any practical implications of the presented results. The authors did not justify why they voided measuring other important data, which is related to the development of ED, such as mental health (e.g. depression, anxiety), quality of life, the levels of personal resources (e.g. social support, sense of coherence) etc. The presented results section seems like a part of a larger study, rather than a study on its own. Based on the above comment, I do not recommend the publication of the authors’ manuscript in EJIHPE.

Author Response

AUTHORS' RESPONSE:

Dear Reviewer 1.

We wanted first of all to thank you for your words which we know are intended to contribute to improvements to the Manuscript.

We would also like to point out that the aim of this article has been exclusive to determine whether, in Spanish university students, variables such as gender, age, course, educational faculty, and BMI are associated with a higher risk of suffering from eating disorders (ED).

Indeed, we are currently working on analyzing in depth the relationship between disorders such as anxiety and depression with the risk of suffering an ED. In this sense, we would like to tell you that we have publications in which we have analyzed the relationship between suffering an ED and anxiety as well as other aspects. Below we point out these publications, which of course, have been pointed out in the manuscript under review:

1) Medina-Gómez, M.B.; Martínez-Martín, M.Á.; Escolar-Llamazares, M.C.; González-Alonso, Y.; Mercado-Val, E. Anxiety and Body Dissatisfaction in University Students. Acta Colomb. Psicol. 2019, 22, 13–21.

2) González-Alonso, M.Y.; Escolar-Llamazares, M.C.; Martín, M.Á.M.; Gómez, M.B.M.; Val, E.M. Comorbidity of Eating Disorders with Anxiety and Depression in University Students: Systematic Review. Rev. Argentina Clin. Psicol. 2019, 28, 375–384, doi:10.24205/03276716.2019.1149.

3) Escolar-LLamazares, M.C.; Martínez Martín, M.A.; González Alonso, M.Y.; Medina Gómez, M.B.; Mercado Val, E.; Lara Ortega, F. Risk Factors of Eating Disorders in University Students. Rev. Mex. Trastor. Aliment. 2017, 8, 105–112, doi:10.1016/j.rmta.2017.05.003.

4) Escolar Llamazares, M.C. TCA y Su Comorbilidad Con Los Trastornos Depresivos y de Ansiedad [ED and its Comorbidity with Depressive and Anxiety Disorders]. In Todo sobre los Trastornos de la Conducta Alimentaria. Una visión multidisciplinar desde la experiencia y la evidencia científica.; Martínez Martín, M.Á., Ed.; Altaria: Madrid, 2015; pp. 215–232 ISBN 978-84-944049-1-7.

5) Martínez Martín, M.A.; Bilbao León, M.C. Los Trastornos de La Conducta Alimentaria En El Contexto Universitario [Eating Disorders In The University Context]. In Todo sobre los Trastornos de la Conducta Alimentaria. Una visión multidisciplinar desde la experiencia y la evidencia científica; Martínez Martín, M.., Colaboradores, Eds.; Altaria: Tarragona, 2015; pp. 535–564.

Finally, we would like to ask you for the opportunity to publish this manuscript in the EJIHPE.

For us, the authors, it would be a step forward in our line of research that is so important to us and for which we are currently fighting.

In addition, as we have pointed out in the manuscript, we are currently developing sensitization groups on EDs in students at the University of Burgos, whose results we will communicate to the scientific community.

Reviewer 2 Report

Dear Editor-in-Chief,

I hope this message finds you well. I would like to inform you that the authors of the article entitled "Risk Factors Associated with Disordered Eating among Spanish University Students" have completed all the modifications requested in the text of the article and are ready to proceed with publication.

The authors carefully considered all the suggestions and criticisms made by the reviewers and made the necessary changes to improve the quality of the text. I believe these contributions have been valuable to the work and that the article is now ready to be published in the journal.

I would like to emphasize that the authors have shown great commitment and dedication to improving the text, and personally, I was very pleased to work with them in this process.

Thank you again for your continued support.

Best regards,

Author Response

AUTHORS' RESPONSE: Dear Reviewer 2. Thank you very much for your kind words.  It has also been a pleasure for the authors to work with you.  All the suggestions for improvement have been very valuable to improve the article and it has helped us to learn as researchers.

Thank you again.

Round 3

Reviewer 1 Report

In my initial and second review report I've suggested that the authors' manuscript should not be published due to its low novelty and very few measured variables. In their response, authors' bring up few arguments:
(1) That they published various different publications in the past.

Ad 1. Publishing various research in the past doesn't provide sufficient rationale to publish the mentioned manuscript and doesn't defend its low novelty (authors present results based on sociodemographic data, without any important covariants). If the presented study group is different from previous articles, all significant covariants should be included in order to verify their role in ED variance. 

(2) They ask "for the opportunity to publish this manuscript in the EJIHPE because , it would be a step forward in their line of research that is so important to us and for which we are currently fighting".

Ad 2. First, there is no justification behind publishing low quality research is such reputable journal as EJIHPE. Second, I believe that high quality research would jumpstart authors' scientific career more, rather than asking for publication (which is very unethical in my opinion). I believe that "asking" for publication without ability to defend own manuscript and its limitations would not be a good start. Rejection is an important part of the scientific process and personal growth as a researcher. This is the first time in my Reviewer's carrer where authors use that kind of argument in defense of their manuscript. I believe that such behavior underlines authors' lack of defensive arguments in their rationale. Pleading attitude should not take place in scientific discourse and all manuscripts should be published based on their scientific value, rather that authors' own personal goals and benefit.

Therefore, I stand as in my initial review.

Author Response

AUTHORS' RESPONSE:

Dear Reviewer 1. First of all, we would like to thank you, once again, for your words, which we know are intended to contribute to the scientific improvement of the manuscript. Consequently, we appreciate the effort you have made in reviewing the manuscript and we apologize if in our responses we have upset you or said anything inappropriate.

The interest of our publication has been exclusive to determine whether, in students of University of Burgos (Spain), variables such as gender, age, course, educational faculty, and BMI are associated with a higher risk of suffering from eating disorders (ED).

The results obtained in this research are currently helping us to offer, more targeted, eating disorder prevention programs to university students.

Thank you very much again