Quality of Life in Patients with Obesity: The Role of Multidisciplinary Rehabilitation Medicine

Round 1

Reviewer 1 Report (New Reviewer)

Comments and Suggestions for Authors

The manuscript addresses an important theme, considering obesity as a global issue. While it presents interventions, it is recognized that it holds significance within a multidisciplinary treatment approach.

Here are some suggestions to enhance the manuscript:

1. Verify if the abstract adheres to the journal’s standards.
2. In the introduction, there is a reference to "GLP1R." This information seems unrelated to the study's focus and isn't elaborated upon. Consider emphasizing the study's objectives instead.
3. The Rehabilitation Program lacks specific details such as duration, frequency, and whether patients received treatment in a hospital or at home.
4. When discussing physical training, include details on training load, exercise intensity, volume, etc.
5. Information on the psychological intervention should include session duration and frequency.
6. In the results section, consider presenting separate data for men and women, as well as combined data.

Author Response

Please find attached the word file

Author Response File: Author Response.pdf

Reviewer 2 Report (New Reviewer)

Comments and Suggestions for Authors

1- The introduction could be more concise and more clarified by just avoiding repetition of statistics and instead focusing on the study's specific context and objectives.

2- Including more information about the sample size and potential biases in patient selection could be informative for the readers. We know that the sample size may influence the study’s generalizability and this fact should be more clarified.

3- The results section is very thorough and comprehensive, but maybe summarizing it more succinctly can enhance readability.

4- The limitations are well acknowledged, but a more detailed discussion on how further studies can address these issues is necessary. Specifically, the absence of a control group and the short follow up could be expanded upon.

 

 

Author Response

Please find attached the Word File

Author Response File: Author Response.pdf

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study examines the effect of a multidisciplinary intervention on quality of life in obese subjects with at least one comorbidity.

In my view, the methodology and analyses used in the article are not enough rigorous to produce findings useful to advance the scientific knowledge. The reasons are:

- The study design is not a randomised controlled trial. 

- The population is broad (authors should have been more specific regarding what comorbities patients have. For example, only patients with diabetes, only patients with osteoarthritis).

- Interventions are not clear. Authors mention that they prescribed individualised sessions of exercise but they do not report details. Using a fixed percentage of heart rate to estimate intensity is not an accurate way to prescribe intensity. Physiological thresholds using lactate values or ventilatory changes are more valid than heart rate measurements. In addition, a nutritional target based on percentage of macronutrients is not advancing the scientific knowledge about the effect of different diets on quality of life. Obese patients should change bad diets changing bad food patterns. Nutritionism paradigm is obsolete nowadays to improve public health nutrition.

- Statistical Analyses are not outstanding. Covariates used in the models (multiple regression) should be selected based on expert knowledge. Confounding is minimised according to explicit theoretical models of causal inference. 

- Intervention is short. Eight weeks of intervention may not have substantial impact on health outcomes. In the literature of quality of life and exercise, several months of intervention allow us to understand better the impact of interventions on quality of life. Obese patients need long term changes to improve population and individual health.

 

In sum, for all the reasons the study is not suitable to advance the scientific knowledge and does not merit publication.

Reviewer 2 Report

Comments and Suggestions for Authors

It is true that the authors have made modifications to the paper, but there remain some significant problems that limit the robustness of the study.

Problems:

Small sample size: The study involved only 124 patients, an insufficient number to draw generalisable conclusions on the entire obese population.

Lack of a control group: As there was no comparison group, it is impossible to establish with certainty whether the observed improvements are due to the intervention or to other factors.

Short-term follow-up: Two months is too short a period to evaluate the long-term effectiveness of the programme.

Subjective measures: Quality of life was assessed by self-report, a method easily influenced by bias.

Unclear intervention details: Detailed information on diet, exercise and personalisation of the plans is lacking.

Confounding factors not considered: It is unclear how external factors that might have influenced the results (medication, psychological support) were handled.

Incomplete assessment of physical activity: Only the 6-minute walk test was used, which provides limited information on behavioural changes.

Lack of cost analysis: The implementation of the programme requires resources. A cost-effectiveness evaluation would be useful to assess its practicability on a large scale.

In summary, despite the modifications made, the study has several methodological weaknesses that limit the strength of the conclusions.

Comments on the Quality of English Language

English is fine