Weight-Normative versus Weight-Inclusive Narratives in Weight-Related Public Health Campaigns: Effects on Anti-Fat Attitudes, Stigma, Motivation, and Self-Efficacy

Round 1

Reviewer 1 Report

I appreciate the opportunity to review this interesting article on how to design obesity prevention campaigns, a very relevant topic today.
I think the article is well written (perhaps I would reduce, as far as possible, the length of the introduction and the results part) and I think it can be published.

Author Response

Please see detailed responses attached as a Word document. Thank you.

Author Response File: Author Response.docx

Reviewer 2 Report

In general, the paper entitled "Weight-normative versus weight-inclusive narratives in weight-related public health campaigns: Effects on anti-fat attitudes, stigma, motivation, and self-efficacy" assessed an important and interesting topic in the obesity field. The paper has the strength of conducting two studies in a row to examine the relationships between the studied variables across people with different weight status. Moreover, the study used standardized and validated instruments, of which capture accurate constructs examined in the present paper. The analytic strategies look reasonable and adequate to me. However, there are some issues that should be fixed before I recommend publication.

1. I believe that the Introduction should include some some recent meta-analyses discussing the relationship between weight stigma and psychological distress/mental health. This can provide strong rationale of examining the issue of anti-fat attitudes and stigma. Please see the following two meta-analyses.

Alimoradi Z, Golboni F, Griffiths MD, Broström A, Lin CY, Pakpour AH. Weight-related stigma and psychological distress: A systematic review and meta-analysis. Clin Nutr. 2020;39(7):2001-2013. doi:10.1016/j.clnu.2019.10.016

Emmer C, Bosnjak M, Mata J. The association between weight stigma and mental health: A meta-analysis. Obes Rev. 2020;21(1):e12935. doi:10.1111/obr.12935

2. In the main text, the authors mixed the writings for study 1 and study 2. This makes it hard to read. I would suggest the authors reformating the presentation structure. Specifically, after the Introduction, the authors can have a heading of Study 1; then, having Methods, Results, Discussion for Study 1. Afterward, using a heading of Study to have the same structure of Methods, Results, and Discussion. After reporting both studies, using a heading of General Discussion to discuss an overall findings from both studies. I believe that this type of structure will make readers easy to follow. Indeed, from my past experiences in a paper reporting multiple studies, they all use this type of presentation instead of mixing these multiple studies.

3. Following the previous comment, the presentation of hypotheses can be modified as follows:
The hypotheses for study 1 were (1) Weight-normative campaigns (personal responsibility, public health crisis) would be associated with stronger anti-fat attitudes than weight-inclusive campaigns (HAES, fat acceptance); (2) Weight-normative campaigns would be rated as more stigmatising than weight-inclusive campaigns; (3) The HAES campaign would be rated as more motivating than all other campaigns; (4) The fat acceptance campaign would be rated as less motivating than all other campaigns.
The hypotheses of study 2 repeated the last three hypotheses in study 1 with the following additional hypotheses: (1) The HAES campaign would be associated with higher self-efficacy than all other campaigns; (2) The fat acceptance campaign would be associated with lower self-efficacy than all other campaigns.

4. I would like to see a subsection of data analysis in the Methods section.

5. Please report the internal consistency for each instrument used in the present study. That is, the statement "All scales showed adequate reliability (Cronbach’s alpha >0.75)" is too vague. I would suggest reporting the internal consistency information in the Measures. For example, 2.2.3. Campaign Stigmatisation. Participants answered seven questions [14] about the extent to which...higher scores indicating higher stigma. "Cronbach's alpha = XXX for the Campaign Stigmatization."

6. Please change the title "2.2. Materials" into "2.2. Materials and Measures"

7. The authors have removed the data with substantial missing values. Then, what did the authors do for the data with missing but not substantial? I suppose that they have imputed the data. Am I right? If yes, how did the authors impute the data?

8. The authors did the MANCOVA, and what covariates were included in the MANCOVA model? I wonder, why the authors did the MANCOVA and then ANOVA instead of ANCOVA?

9. Also, a question regarding the MANCOVA is whether the authors have adjusted the alpha level for significance level? In the default of SPSS, it does not adjust the alpha level.

10. The Conclusions section is too long for a reader to get the take-home message. Please shortened it into one paragraph within 150 words.

Author Response

Please see detailed responses attached as a Word document. Thank you.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The authors have substantially improved the work. I am satisfied with the present revision and have no more comments.