PONE-D-19-29357

Spatial index relating urban environment to health lifestyle and obesity risk in men and women from different age groups

PLOS ONE

Dear PhD Pessôa Filho,

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Additional Editor Comments (if provided):

Overall a very interesting study. An overall and simple explanation of the statistical approach would be helpful to many readers.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an interesting paper as it seeks to develop a quantification tool to assess environmental factors that may contribute to activity levels and health lifestyle. This was a concept explored by the Australian group Leslie E et al., Health and Place 2007 but has never really been developed. The tool used four main indicators i.e. population density, road connectivity, area of green spaces and land incline in the calculation of the spatial index.

Relevant ethical approval appears to have been obtained for the study.

It is not clear how recruitment to the study was decided however to some degree it appears a biased population was obtained, as the study only sampled those who were outdoors using park or outdoor spaces. The study results may have been more powerful if this was compared with a control group of people approached within office spaces or homes within those areas. Alternatively comparing this population against a similar cohort from Goiania to verify results.

The paper is well written and statistical methods appear robust.

Further description is required regarding how the actual auxological/anthropometric measurements were taken (e.g. number of observers at any one time) and how standardisation was preserved to prevent significant inter or intraobserver error. Some increased clarity on this needs to be included.

Increasing BMI in the male group seems to correlate better with abdominal circumference than in the female group. This may have confounded the significance in result obtained in the two gender groups. A better measure may have been to not just look at BMI but using a portable bioimpedance scale to measure percentage fat versus muscle mass.

Although brief assessment of health risks was made in the study population such as smoking, dietary control and alcohol consumption, it is a shame that brief assessment of actual metabolic comorbidities such as heart disease and diabetes was not done and included in the analyses.

The discussion did effectively identify some of the limitations of the study, particularly to address the possible effect that the limited level of higher-intensity cardiovascular activity (running) was in the group and may have been contributory to the lack of statistical significance in the results.

When looking at this study along with other systematic reviews on effects of urban environments on health outcomes, it is clear that more confounders needs to be included in the measures such as actual equipment available for activity, indoor exercise spaces particularly in urban areas and population demographic that may be affected by ethnicity and other genetic factors.

Nevertheless, this paper is original in its approach and will almost certainly act as a study that will generate further research in the area.

Reviewer #2: Very interesting paper. Having an urban environment that promotes exercise is important and encourages exercise. However I was not surprised that there was no effect on BMI given the little impact that exercise plays in weight loss and changes in BMI. Especially when the main mode of activity is walking and given how little calories it burns when compared to other more intense exercise. Many studes show eating habits and genetic predispostion play a much larger role in weight loss and changes in BMI.

It would have been nice to look at body compostion as well to see if the higher BMI's were becasue of excess body fat or higher muscle mass in the more active population.

I found the statistical analysis very confusing but the paper was overall pretty easy to read and understand.

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Reviewer #1: Yes: Mars Skae

Reviewer #2: No

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Spatial index relating urban environment to health lifestyle and obesity risk in men and women from different age groups

PONE-D-19-29357R1

Dear Dr. Pessôa Filho,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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Robert Siegel

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors are to be commended for addressing all the reviewer concerns and incorporating all the requested changes.

The manuscript is ready for publication.

Reviewers' comments: