Assessment of Eating Attitudes and Body Image Among 17–20-Year-Olds Engaged in Regular Sports Activity
, Martyna Kłoda 2, Wiktoria Staśkiewicz-Bartecka 3 and Joanna Woźniak-Holecka 1Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsAfter careful consideration, I fell that the manuscript entitled “Assessment of Eating Attitudes and Body Image Among 17–20-Year-Olds Engaged in Regular Sports Activity” has merit, but is not suitable for publication in its current form. My criticisms are mainly directed at the statistical analyses:
1. Participants section:
1.1. The sample size calculation is not correct, as it is not related to the tests conducted in the study. In fact, the calculation should be based on a hypothesis test comparing two groups, specifying the significance level, clinically significant difference (effect size), and statistical power. Additionally, the minimum required sample size resulting from the calculation should be presented.
1.2. Line 120: What does “response rate of 95%” mean? Please clarify this in the text.
1.3. It is not clear what the study population is. Are the 17–20-year-old athletes from a specific country, city, program, etc.? Better describe the target population and explain why this sample is representative of that population.
2. Statistical analysis section:
Some statistical tests performed were not described in this section and should be included:
2.1. The linear regression analysis (presented in Tables 6 and 7) should be described in this section, including explanations of R and R² and their interpretations.
2.2. Cramér’s V effect size is appropriate only for categorical variables (which were analyzed using the chi-squared test). For the Student’s t-test, Cohen’s d should be used, and for the Mann-Whitney test, Cliff’s delta is more appropriate. Additionally, the interpretation of the effect size values (thresholds) should be provided. Include this information in this section and update the values in Tables 2, 3, and 4 accordingly.
3. Results section:
3.1. Improve the resolution of Figure 1.
3.2. In all tables, specify which test was used to generate the reported p-values (Student’s t, Mann-Whitney, or Chi-squared).
3.3. Table 3: The footnote is incorrect, as no means or standard deviations are presented.
3.4. Tables 2–4: Typo — “Cramera” should be corrected.
3.5. Table 5: There is no “*” symbol included.
3.6. Lines 294–299: Clarify what “beta” refers to (it is recommended to use this term in the table instead of “Estimate”).
3.7. All chi-squared tests involving more than three categories must be followed by a post-hoc analysis to identify where the differences lie. For example, in lines 253–255, the authors state: “The analysis revealed that participants in the risk group were significantly more likely to be underweight compared with those in the non-risk group (p < 0.001)...” But how can such a statement be made without a post-hoc analysis? Is this “greater likelihood” in comparison to all other groups (normal weight, overweight, and obesity)?
Author Response
We sincerely thank the reviewer for the thorough and constructive comments. We have carefully revised the manuscript to address each point. Our responses are detailed below:
Comment 1
The sample size calculation is not correct, as it is not related to the tests conducted in the study. In fact, the calculation should be based on a hypothesis test comparing two groups, specifying the significance level, clinically significant difference (effect size), and statistical power. Additionally, the minimum required sample size resulting from the calculation should be presented.
Response: We appreciate the reviewer’s observation. The sample size calculation has been revised to reflect the requirements of hypothesis testing comparing two groups. The calculation now specifies the significance level (α = 0.05), clinically significant difference (effect size, Cohen’s d = 0.5), and statistical power (90%). The resulting minimum required sample size is reported in the Methods section.
Comment 2
Line 120: What does “response rate of 95%” mean? Please clarify this in the text.
Response: Thank you for the comment. The term "response rate" refers to the proportion of participants who completed the questionnaire among those invited to participate. The description of the sample selection process has been modified in the revised version of the manuscript.
Comment 3
It is not clear what the study population is. Are the 17–20-year-old athletes from a specific country, city, program, etc.? Better describe the target population and explain why this sample is representative of that population.
Response: Thank you for the comment. We have supplemented section 2.2 Participants with a detailed description of the target population and the sample selection process. The online questionnaire was sent to people aged 17–20 who regularly participate in sports, attend secondary schools and sports clubs in the Silesian Province (Poland). The sample was purposively selected – it included individuals who had been actively participating in training sessions at least three times a week for at least six months.
Comment 4
The linear regression analysis (presented in Tables 6 and 7) should be described in this section, including explanations of R and R² and their interpretations.
Response: Thank you for the comment. The Statistical Analysis section has been updated to include a detailed description of the linear regression models. This includes explanations of R, R², and their interpretation, as well as specification of dependent and independent variables.
Comment 5
Cramér’s V effect size is appropriate only for categorical variables (which were analyzed using the chi-squared test). For the Student’s t-test, Cohen’s d should be used, and for the Mann-Whitney test, Cliff’s delta is more appropriate. Additionally, the interpretation of the effect size values (thresholds) should be provided. Include this information in this section and update the values in Tables 2, 3, and 4 accordingly.
Response: Thank you for the comment. Corrections have been made throughout the manuscript.
Comment 6
Improve the resolution of Figure 1.
Response: Thank you for the comment. The resolution of Figure 1 has been improved for better clarity.
Comment 7
In all tables, specify which test was used to generate the reported p-values (Student’s t, Mann-Whitney, or Chi-squared).
Response: Thank you for the comment. Descriptions have been modified. Tables specify which statistical test was used to generate the reported p-values (Student's t-test, Mann-Whitney test, or chi-square test).
Comment 8
Table 3: The footnote is incorrect, as no means or standard deviations are presented.
Response: Thank you for the comment. The footnote in Table 3 has been corrected to accurately reflect the content of the table.
Comment 9
Tables 2–4: Typo — “Cramera” should be corrected.
Response: Thank you for this comment. The issue has been corrected in the revised manuscript.
Comment 10
Table 5: There is no “*” symbol included.
Response: Thank you for this comment. The issue has been corrected in the revised manuscript.
Comment 11
Lines 294–299: Clarify what “beta” refers to (it is recommended to use this term in the table instead of “Estimate”).
Response: Thank you for the comment. The term “Estimate” has been replaced with “β (Beta)” in the regression tables to improve clarity.
Comment 12
All chi-squared tests involving more than three categories must be followed by a post-hoc analysis to identify where the differences lie. For example, in lines 253–255, the authors state: “The analysis revealed that participants in the risk group were significantly more likely to be underweight compared with those in the non-risk group (p < 0.001)...” But how can such a statement be made without a post-hoc analysis? Is this “greater likelihood” in comparison to all other groups (normal weight, overweight, and obesity)?
Response: Thank you for the comment. All chi-squared tests with more than three categories now include appropriate post-hoc analyses (e.g., pairwise comparisons with Bonferroni correction).
Revised the manuscript to meet expectations.
Thank you for your help. Your guidance is invaluable.
Kind regards,
Authors
Reviewer 2 Report
Comments and Suggestions for Authorsreview of “Assessment of Eating Attitudes and Body Image Among 17–20 Year-Olds Engaged in Regular Sports Activity”
-Line 24: Please, report the actual number of individuals, along with the prevalence of 32.9%.
-Abstract, results: Please show more numbers in your results. Show the actual effects between the associations, along with CI95% and p-values.
-Methods: please, follow STROBE guidelines for reporting the paper
-Methods, participants: please, report the result of the sample size calculation. What was the sample size that was aimed? also, the estimated proportion of 0.5 was for which outcome? and what were the premises that based this estimated proportion for such an outcome?
- paragraph from line 120 to 129 is a result of the paper, as per the STROBE guidelines. It should also come with a figure.
- Why are authors using “V cramera” in the tables? Isn't it “Cramer’s”?
- As per Table 3, BMI was associated with EAT-26 (as expected). Hence, it would be important to adjust all findings from Table 2 for BMI. That is, the association between the type of sport and the EAT-26 should be adjusted for BMI (and age, in my opinion). Also, it would be important to adjust for sex as well, even if the authors are showing the results stratified by sex.
- As a whole, it would be important to adjust all analyses for BMI and age
Author Response
We sincerely thank the reviewer for the detailed and constructive comments. Each point has been carefully considered, and the manuscript has been revised accordingly. Our responses are detailed below:
Comment 1
Line 24: Please, report the actual number of individuals, along with the prevalence of 32.9%.
Response: Thank you for your comment. We have added the actual number of individuals corresponding to the reported prevalence: 141 out of 428 participants (32.9%).
Comment 2
Abstract, results: Please show more numbers in your results. Show the actual effects between the associations, along with CI95% and p-values.
Response: Thank you for your comment. The Results section of the Abstract has been updated to include numerical results, effect sizes, 95% confidence intervals, and p-values to provide a clearer and more precise presentation of the findings.
Comment 3
Methods: please, follow STROBE guidelines for reporting the paper.
Response: Thank you for your comment. The Methods section has been revised to align with STROBE guidelines, including detailed descriptions of participants, variables, and statistical analyses.
Comment 4
Methods, participants: please, report the result of the sample size calculation. What was the sample size that was aimed? also, the estimated proportion of 0.5 was for which outcome? and what were the premises that based this estimated proportion for such an outcome?
Response: Thank you for your comment. We have now reported the sample size calculation. The proportion of 0.5 was chosen as a conservative estimate to ensure adequate power, given that exact prevalence was unknown.
Comment 5
Paragraph from line 120 to 129 is a result of the paper, as per the STROBE guidelines. It should also come with a figure.
Response: Thank you for your comment. A figure illustrating the distribution of participants by risk and sex has been added, in accordance with STROBE guidelines.
Comment 6
Why are authors using “V cramera” in the tables? Isn't it “Cramer’s”?
Response: Thank you for your comment. All references to “V cramera” in the tables have been corrected to “Cramer’s ”, following standard terminology.
Comment 7
As per Table 3, BMI was associated with EAT-26 (as expected). Hence, it would be important to adjust all findings from Table 2 for BMI. That is, the association between the type of sport and the EAT-26 should be adjusted for BMI (and age, in my opinion). Also, it would be important to adjust for sex as well, even if the authors are showing the results stratified by sex.As a whole, it would be important to adjust all analyses for BMI and age
Response: Thank you for your comment. All relevant analyses have now been adjusted for BMI, age, and sex. Specifically: Associations between type of sport and EAT-26 scores are adjusted for BMI, age, and sex.
We believe that these revisions address all the reviewer’s comments and significantly enhance the clarity, rigor, and transparency of the manuscript.
Thank you for your help. Your guidance is invaluable.
Kind regards,
Authors
Reviewer 3 Report
Comments and Suggestions for AuthorsThis is an interesting article which intent to call for action to prevent eating disorders among youngsters. Its aim (If I understood correctly) was to define predictors for eating disorders among young athletes. To have better understanding of the study design and learn more about the target population and some of the variables, there is a need to present more details:
In the Materials and Methods chapter, the reader should have much more information about:
- What was the sampling frame? To which target population was the online questionnaire distributed?
- It is mentioned (2.2 participants) that: "The study employed a defined sampling procedure". What does it mean? What was the sampling procedure?
- The sample size calculation was clear, but there is a need to mention what was the required size of the calculated sample size.
- On lines 120-121 it is written: "A total of 450 respondents participated in the study corresponding to a response rate of 95%." This is a strange statement as we don't know anything about the sampling frame and the size of the sample who was approached with the questionnaire.
- On line 134 it is mentioned that the questionnaire included data on the respondents’ level of physical activity. As this is one of the main variables which define the study population, it deserves more details. How does it refer to "Regular Sports Activity" that is mentioned in the title of this article. What is the meaning of "level" in this case.
- On line 186 there is a new variable "type of sport" that was not mentioned in the methodology. How does this variable refer to the variable of "level of activity"?
- In the result chapter there are new variables which were not mentioned in the methodology ("The extent to which physical activity helps to cope with stress", " Pressure from the coach regarding body image"). They should have been defined among other variables in the methodology.
In the results:
I have realized that the main dependent variable is the EAT-26 test. This variable was presented either by its 3 subscales, or as a total score or as a dichotomy divided between risk and no risk for eating disorders. As this EAT-26 test is presented as a reliable and valid test, I may assume a high internal correlation between its three components. This fact rules out the rational for presenting table 6. I would suggest putting in the linear regression with the EAT-26 as a continues dependent variable all those independent variables which were associated with it either as a continues variable or as a dichotomy (sex, physical activity, Body Estimate Scale, BMI). Another option which could better represent the aim of the study is a logistic regression with its dichotomy (risk-no risk) variable as the dependent one.
In addition, as there were differences between male and female, I suggest introducing, to any multivariate analysis, an interaction term between sex and one or more independent variables.
Minor comments:
- The title of table 2 does not represent what is the data in the table cells. It does not present relationships but distributions of the participants in each group (total, male, female with and without risk) in each one of the variables tested.
- Tables 3 & 4 present distributions – this should be stated in the title "summary of results" does not indicate what is in the table. Furthermore, I suggest combining tables 3 and 4.
- Table 5 present means and SD – this should be clearly stated in the title.
- In a regression analysis it is important to add, as footnote, which category of a categorical variable is the reference. This is missing here.
Author Response
We sincerely thank you for your valuable and constructive comments, which have helped us improve the clarity and quality of our manuscript. Please find below our detailed responses to each point:
Comment 1
What was the sampling frame? To which target population was the online questionnaire distributed? It is mentioned (2.2 participants) that: "The study employed a defined sampling procedure". What does it mean? What was the sampling procedure?
Response: We have supplemented section 2.2 Participants with a detailed description of the target population and the sample selection process. The online questionnaire was sent to people aged 17–20 who regularly participate in sports, attend secondary schools and sports clubs in the Silesian Province (Poland). The sample was purposively selected – it included individuals who had been actively participating in training sessions at least three times a week for at least six months.
Comment 2
The sample size calculation was clear, but there is a need to mention what was the required size of the calculated sample size.
Response: Thank you for your comment. Indeed, this section needed clarification. The entry has been added to section 2.2 Participants.
Comment 3
On lines 120-121 it is written: "A total of 450 respondents participated in the study corresponding to a response rate of 95%." This is a strange statement as we don't know anything about the sampling frame and the size of the sample who was approached with the questionnaire.
Response: Thank you for your comment. The section of the manuscript concerning group selection has been clarified.
Comment 4
On line 134 it is mentioned that the questionnaire included data on the respondents’ level of physical activity. As this is one of the main variables which define the study population, it deserves more details. How does it refer to "Regular Sports Activity" that is mentioned in the title of this article. What is the meaning of "level" in this case.
Response: Physical activity levels were assessed based on the number of training sessions per week and their average duration. Regular physical activity was defined as participation in at least three training sessions per week (≥150 minutes in total). This variable was both an inclusion criterion for the study and an element of the description of the study population.
Comment 5
On line 186 there is a new variable "type of sport" that was not mentioned in the methodology. How does this variable refer to the variable of "level of activity"?
Response: Thank you for your valuable comment. The variable ‘type of sport’ referred to the discipline practised by the participant. It was not a measure of the intensity of physical activity, but a factor differentiating the sporting environment and the associated aesthetic norms. The description of this variable has been supplemented accordingly in the methodology section.
Comment 6
In the result chapter there are new variables which were not mentioned in the methodology ("The extent to which physical activity helps to cope with stress", " Pressure from the coach regarding body image"). They should have been defined among other variables in the methodology.
Response: Thank you for your comment. The variables were indeed included in the questionnaire, but were not explicitly described in the ‘Methodology’ section. In the revised version of the manuscript, both variables have been defined and described among other measures.
Comment 7
I have realized that the main dependent variable is the EAT-26 test. This variable was presented either by its 3 subscales, or as a total score or as a dichotomy divided between risk and no risk for eating disorders. As this EAT-26 test is presented as a reliable and valid test, I may assume a high internal correlation between its three components. This fact rules out the rational for presenting table 6. I would suggest putting in the linear regression with the EAT-26 as a continues dependent variable all those independent variables which were associated with it either as a continues variable or as a dichotomy (sex, physical activity, Body Estimate Scale, BMI). Another option which could better represent the aim of the study is a logistic regression with its dichotomy (risk-no risk) variable as the dependent one.
Response: We thank the reviewer for the insightful suggestion regarding the analytical strategy. Following the recommendation, Table 6 has been revised to present a logistic regression model using sex (male vs. female) as the dependent variable and including BMI, age, and the dichotomous EAT-26 variable (risk vs. no risk) as predictors.These adjustments improve the clarity and interpretability of the results, ensuring consistency with the main aims of the study.
Comment 8
In addition, as there were differences between male and female, I suggest introducing, to any multivariate analysis, an interaction term between sex and one or more independent variables.
Response: Thank you for your comment. Multivariate analyses include BMI and age as covariates to improve the accuracy and validity of the findings.
Comment 9
The title of table 2 does not represent what is the data in the table cells. It does not present relationships but distributions of the participants in each group (total, male, female with and without risk) in each one of the variables tested.
Response: We thank the reviewer for this helpful comment. We agree that the original title of Table 2 did not accurately reflect the nature of the data presented. The table shows the distribution of participants across groups (the entire sample, men and women, each divided into "risk" and "no risk" categories according to the EAT-26 questionnaire) for all study variables, not the relationships between them. The table caption has been modified.
Comment 10
Tables 3 & 4 present distributions – this should be stated in the title "summary of results" does not indicate what is in the table. Furthermore, I suggest combining tables 3 and 4.
Response: Thank you for your comment. The results from Tables 3 and 4 have been combined and presented in the revised manuscript in Table 3. The table caption has been modified.
Comment 11
Table 5 present means and SD – this should be clearly stated in the title.
Response: Thank you for your suggestions. The table caption has been modified.
Comment 12
In a regression analysis it is important to add, as footnote, which category of a categorical variable is the reference. This is missing here.
Response: We thank the reviewer for this important observation. We agree that specifying the reference category for categorical variables is essential for accurate interpretation of regression coefficients. In the revised manuscript, all regression tables now include a footnote indicating the reference category for each categorical variable.
Revised the manuscript to meet expectations.
Thank you for your help. Your guidance is invaluable.
Kind regards,
Authors
Reviewer 4 Report
Comments and Suggestions for AuthorsThank you for the opportunity to review this manuscript.
The authors didn't define "physical activity" in this phrase "Exclusion criteria included diagnosed mental or neurological disorders potentially affecting response reliability, age outside the 17–20 range, and absence of physical activity.". Regarding physical activity, the article does not specify whether the athletes included are amateur or professional. I suggest the authors to discuss the differences between amateurs and professionals.
Author Response
Thank you for your careful reading of our manuscript and for your valuable comments. Detailed responses and changes are presented below.
Comments 1
The authors didn't define "physical activity" in this phrase "Exclusion criteria included diagnosed mental or neurological disorders potentially affecting response reliability, age outside the 17–20 range, and absence of physical activity".
Response: Thank you for bringing this to our attention. The wording in Section 2.2 (Participants) has been revised to provide a precise definition of ‘physical activity’.
The following sentence has been added:
“Individuals who actively participated in at least three training sessions per week (≥150 minutes in total) for a minimum of six months…”
This clarification explicitly links the definition to the accepted criteria for regularity and duration of activity, with inactivity (below this threshold) serving as a criterion for exclusion.
Comments 2
Regarding physical activity, the article does not specify whether the athletes included are amateur or professional. I suggest the authors to discuss the differences between amateurs and professionals.
Response:
We agree with this comment. Section 2.2 (Participants) has been revised to clarify that all participants were amateur athletes who regularly engaged in training and competitions at a recreational or school level.
Revised the manuxcript to meet expectations.
Thank you for your help. Your guidance is invaluable.
Kind regards,
Authors
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsI feel that the authors have satisfactorily made the requested corrections and I have only two minor additional comments:
-
In the Abstract, in some instances, a comma was used instead of a period for decimal numbers;
-
A new analysis was added in this revised version of the manuscript (Table 3), and the test performed (ANCOVA) should be described in the Statistical Analysis section.
Author Response
Thank you so much for taking the time to evaluate our work. We have tried to incorporate all your valuable suggestions. If we could improve our work in any way, please let us know.
Comment 1
I feel that the authors have satisfactorily made the requested corrections and I have only two minor additional comments:
In the Abstract, in some instances, a comma was used instead of a period for decimal numbers;
Corrected as suggested.
A new analysis was added in this revised version of the manuscript (Table 3), and the test performed (ANCOVA) should be described in the Statistical Analysis section..
Added: „Analysis of covariance (ANCOVA) was performed to assess differences in EAT-26 scores between groups of participants engaging in different types of physical activity, controlling for demographic and anthropometric variables. Age, gender, and BMI were included as covariates, and the model also included the interaction effect between type of physical activity and gender.”
Kind regards,
Authors.
Reviewer 2 Report
Comments and Suggestions for AuthorsI appreciate the authors response to my comments.
Author Response
Thank you so much for taking the time to evaluate our work.
Reviewer 3 Report
Comments and Suggestions for Authors
I appreciate the authors' efforts to refer to my comments and for adding information.
Now it is clear who the target population was, and the titles of the tables are clearly written. There is also additional information which was added by additional analysis. This was very important. However, I still have comments (sorry for ignoring some comments on the first version).
- In the methods, adding information, not always correct the previous version.
In the first version of the article, it was clear that the sampling size calculation referred to a prevalence study with an assumption of proportion of 0.5. This was clear. In the revised version it is mentioned: "…. yielding a required minimum of 170 participants (85 in each group)." It is not clear to which groups they refer to here. This statement should be deleted as it reflects a different type of study and not the original (prevalence – cross-sectional study). If the main aim of the study was to compare the risk factors of men and women, this should have been mentioned in the aims of the study.
In the results:
- I apologize that I had not noticed the following inaccuracies in my first review.
- In relation to the results in table 2 – the text does not align with the data in the table, for example:
- In the text (lines 233-6) it is mentioned: "When broken down by gender, a significant relationship between the type of activity and risk was found in women (p = 0.002; V = 0.299), while in men the relationship did not reach statistical significance (p = 0.382)." In the table data shows the opposite – the authors exchanged men with women.
- Referring to the extent to which physical activity helps to cope with stress, data which appear in the men's column are mentioned in the text as they were the total population's data. It also appears that for the total population data, they use the data for those with no risk, without mentioning that.
- Referring to feeling pressure from coach – the text refers only to differences between those at risk and without risk within the total population and in each sex, while the main result is missing. The table indicate very high percentage of both men and women in the risk groups who feel pressure from coach. Among men even the group with no risk show high percentage.
- Referring to the rest of the items in the table, results appear in the text as referring to the total population while it appears in the table as reflecting only those with no risk.
- The 'Body Esteem Scale' was described in the method's section as having different subscales for male and female (lines 157-159): "For male participants, the subscales included physical attractiveness, body strength, and physical condition, whereas for female participants, the subscales encompassed sexual attractiveness, weight control, and physical condition." It is not clear how these definitions were converted into one which is presented in table 3 for the total population (male and female) with the subscale of: Physical Attractiveness (male), Weight Control (female) and Physical Condition (male & female).
- In relation to the results in table 2 – the text does not align with the data in the table, for example:
- In response to my comment on the 1st version referring to table 6, the author's response was not appropriate. They stated that they have been revised table 6 to present a logistic regression model using sex (male vs. female) as the dependent variable and including BMI, age, and the dichotomous EAT-26 variable (risk vs. no risk) as predictors. This idea (sex as dependent variable) is a big mistake. However, in the revised text they didn't change neither the text nor the content of table 6 (which appear in the revised version as table 5). It is mentioned (lines 319-320) that: "All three subscales analyzed had a significant effect on the EAT-26 score (p < 0.01)". I repeat here my previous comment: " As this EAT-26 test is presented as a reliable and valid test, I may assume a high internal correlation between its three components. This fact rules out the rational for presenting table 6. I would suggest putting in the linear regression with the EAT-26 as a continues dependent variable all those independent variables which were associated with it either as a continues variable or as a dichotomy (sex, physical activity, Body Estimate Scale, BMI)." It seems that table 6 in the article represents adopting only part of my suggestion.
- One of the main objectives of this study was to assess the prevalence of eating disorders within the study population. The overall figure appears in the abstract and in the discussion, but not in the results chapter, where it is expected to be.
- One of the indicators for risk was ignored in this article (I mentioned it in 2.1.3), though it appears very clearly in table I refer here to having pressure from oneself coach regarding the assessment of their physique. I noticed that 82% of those at risk answered "yes" while only 67% of the no-risk group answered "yes". This should have been farther tested, and it could be one of the conclusions and recommendations of this article – coachers should change their behavior while being aware of this result. This should be added.
Author Response
We sincerely thank the Reviewer for the careful re-evaluation of our revised manuscript and for the constructive feedback that helped us further improve the clarity, methodological accuracy, and coherence of our paper. We have carefully addressed each of the new and previously overlooked comments. Below, we provide a detailed, point-by-point response, with corresponding changes implemented in the manuscript.
Reviewer’s comment 1:
In the first version of the article, it was clear that the sampling size calculation referred to a prevalence study with an assumption of proportion of 0.5. This was clear. In the revised version it is mentioned: "…. yielding a required minimum of 170 participants (85 in each group)." It is not clear to which groups they refer to here. This statement should be deleted as it reflects a different type of study and not the original (prevalence – cross-sectional study). If the main aim of the study was to compare the risk factors of men and women, this should have been mentioned in the aims of the study.
Response:
We thank the Reviewer for the valuable observation. The modification of the sample size calculation was introduced in response to another reviewer’s previous comment, who suggested aligning the calculation with a two-group comparison framework. However, we fully acknowledge that the original and primary design of our study was cross-sectional and prevalence-based, aiming to estimate the proportion of young athletes at risk of eating disorders.
To clarify this and maintain methodological consistency, we have revised the section on sample size estimation to reflect the correct prevalence study approach (assuming p = 0.5, 95% confidence level, and 5% margin of error). The final sample of 428 participants exceeds the minimum required number, ensuring adequate precision of estimates.
We have also clarified in the Introduction that gender-based comparisons were secondary objectives, intended to explore potential differences rather than to define the main analytical framework of the study.
Accordingly, the sentence referring to “85 participants in each group” has been removed, and the methodological section has been updated to ensure full coherence with the cross-sectional study design.
Reviewer’s comment 2:
In relation to the results in Table 2 – the text does not align with the data in the table, for example: [...]
Response:
- We thank the reviewer for carefully noting this error. After reviewing the description, we found that the level of statistical significance between men and women in relation to the type of activity and the risk of eating disorders had been mistakenly reversed. The text has been corrected to accurately reflect the data presented in Table 2, ensuring full consistency between the results and their description
- Coping with stress. We have corrected the sentences describing the relationship between physical activity and coping with stress to clearly distinguish between data for the total sample and for specific subgroups (men, women, and risk categories). The revised text indicates which data refer to the total population and which to each subgroup.
- Pressure from coaches. We agree with the Reviewer that the previous description did not fully capture the main finding. The text has been revised to emphasize that a very high proportion of both men and women in the at-risk groups reported experiencing pressure from coaches regarding body image.
- Clarification of subgroup descriptions. Throughout the section, we have ensured that each numerical result is now clearly labeled as referring to the total sample, men, women, at-risk, or no-risk groups, as indicated in Table 2.
Reviewer’s comment 3:
The 'Body Esteem Scale' was described in the method's section as having different subscales for male and female (lines 157-159): "For male participants, the subscales included physical attractiveness, body strength, and physical condition, whereas for female participants, the subscales encompassed sexual attractiveness, weight control, and physical condition." It is not clear how these definitions were converted into one which is presented in table 3 for the total population (male and female) with the subscale of: Physical Attractiveness (male), Weight Control (female) and Physical Condition (male & female).
Response:
We agree this required clarification. We have added an explanatory sentence in the Methods section (2.3.1) describing how the subscales were harmonized for comparative analysis.
Reviewer’s comment 4:
In response to my comment on the 1st version referring to table 6, the author's response was not appropriate. They stated that they have been revised table 6 to present a logistic regression model using sex (male vs. female) as the dependent variable and including BMI, age, and the dichotomous EAT-26 variable (risk vs. no risk) as predictors. This idea (sex as dependent variable) is a big mistake. However, in the revised text they didn't change neither the text nor the content of table 6 (which appear in the revised version as table 5). It is mentioned (lines 319-320) that: "All three subscales analyzed had a significant effect on the EAT-26 score (p < 0.01)". I repeat here my previous comment: " As this EAT-26 test is presented as a reliable and valid test, I may assume a high internal correlation between its three components. This fact rules out the rational for presenting table 6. I would suggest putting in the linear regression with the EAT-26 as a continues dependent variable all those independent variables which were associated with it either as a continues variable or as a dichotomy (sex, physical activity, Body Estimate Scale, BMI)." It seems that table 6 in the article represents adopting only part of my suggestion.
Response:
Thank you very much for this valuable methodological observation. We agree that defining sex as a dependent variable was conceptually incorrect. In the revised version, we have removed this reference and clarified that the linear regression model used the total EAT-26 score as the dependent variable.
We have retained a single regression model (previously Table 6, now Table 5) in which the EAT-26 total score is predicted by relevant independent variables — including sex, physical activity, Body Esteem Scale subscales, and BMI — in accordance with your original recommendation.
Additionally, we have revised the explanation in the Results section to clearly describe the model structure and analytical intent.
We hope that we have now correctly understood your comment and implemented the expected changes to clarify the methodological approach and align the analysis with your recommendations.
Reviewer’s comment 5:
One of the main objectives of this study was to assess the prevalence of eating disorders within the study population. The overall figure appears in the abstract and in the discussion, but not in the results chapter, where it is expected to be.
Response:
We agree and have added the missing statement in the Results section.
Reviewer’s comment 6:
One of the indicators for risk was ignored in this article (I mentioned it in 2.1.3), though it appears very clearly in table I refer here to having pressure from oneself coach regarding the assessment of their physique. I noticed that 82% of those at risk answered "yes" while only 67% of the no-risk group answered "yes". This should have been farther tested, and it could be one of the conclusions and recommendations of this article – coachers should change their behavior while being aware of this result. This should be added.
Response:
We fully agree and have emphasized this result in both the Discussion and Conclusions sections.
Added text (Discussion):
“A particularly noteworthy finding was the high prevalence of perceived pressure from coaches regarding body image—reported by over 80% of at-risk respondents. This confirms that coach-related expectations constitute a significant psychosocial factor that may contribute to disordered eating behaviors among young athletes.”
Added text (Conclusions):
“Given that over 80% of at-risk athletes reported experiencing body-related pressure from coaches, it is essential to incorporate education and preventive interventions for coaches, aimed at promoting body-positive communication and awareness of their potential impact on athletes’ mental health.”
We thank the Reviewer once again for their valuable input. These revisions have substantially improved the methodological precision and interpretative clarity of our manuscript.
Please do not hesitate to contact us if there are any additional aspects we could further clarify or improve to enhance the quality of the paper. We remain at your full disposal for any further adjustments.
Thank you for your help. Your guidance is invaluable.
Kind regards,
Authors
