PONE-D-19-34507

Psychological Risk Indicators of Disordered Eating in Athletes

PLOS ONE

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Valentina

Valentina Cardi

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

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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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

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: Thank you for inviting me to review this manuscript, examining psychological risk factors of disordered eating in athletes. The project tested a theoretical model proposed by Petrie and Greenleaf in a large, multi-sport and mixed gender sample using structural equation modelling. It also tested the utility of a newly formed model including the addition of social media as a risk factor. The newly revised model was then tested to see if it is equivalent across groups including gender, age, sport type and competition level.

The study found a poor fit for the original theoretical model, which improved slightly with the addition of social media. The newly revised model had a better fit for males than females, young athletes and those at a non-elite level.

Strengths of this manuscript include its large sample size, mixed gender sample, the clarity in writing and the importance of the research topic. Limitations include the use of research scales which have not been validated by past research and its cross-sectional design meaning that causation cannot be inferred (as noted by the authors).

My recommendation is to accept this manuscript for publication following minor amendments, as follows:

1) Can the authors provide more details on the studies that previously undertook structural testing of the model? For example, I think it would be helpful for the reader to know which pathways required adjustment in the study by Anderson et al. Further, in De Sousa Fortes and colleagues study, what sports did the male Brazilian athletes compete in? I think this information would help the reader to further understand the background to the present study, to then aid their interpretation of this study’s findings.

2) What led the authors to suspect that there were duplicates in the completion of the survey? Was this based on email addresses or IP addresses?

3) Further information on the demographic details would be useful. For the age range, 27+, what was the maximum age recruited in the study? What was the mean BMI for the study? I also think it is important to include the total N for each of the different sports that the athletes took part in so that future research could replicate this study.

4) In the limitations it should also be mentioned that due to human error one of the questions from the restrained eating measure was omitted. Which item was omitted from the scale? Please include this information in the manuscript.

5) There are a few minor typos in the article that require editing, otherwise the article is very well written. Please amend: line 57: ‘disordered eating in’; line 235 there is a % sign missing; line 226, please remove either 1,017 or N=1017 as repetition is not needed; line 357 ‘due to a lack of fit’; line 186 a full stop is missing; line 92 please spell out the acronym NCAA in full.

6) The discussion section of the article would benefit from elaboration. For instance, drawing on psychological theory why did the model fit better for certain groups and how could the findings be taken into account when considering the prevention and treatment of disordered eating in athletes?

Reviewer #2: This study entitled “Psychological Risk Indicators of Disordered Eating in Athletes” aimed at assessing the applicability of the theoretical etiological model proposed by Petrie and Greenleaf (2007; 2012) in a large sample of athletes. Overall, the study addresses a gap in the current literature and I believe that it offers an interesting contribution, but would be strengthened by addressing the following concerns.

Introduction:

General feedback: The authors need to spend more time/space explaining why is important to investigate disordered eating and eating disorders in athletes. Although I am familiar with the literature, the authors assume a lot of knowledge about this topic from the reader. I suggest explaining why this topic is important before describe the Petrie and Greenleaf (2007; 2012) model.

1) Page 3, line 57: The sentence starting with "Participation in competitive sports has the potential to increase the risk of eating disorders and disordered eating in" do not make sense. Perhaps the authors mean: in athletes?

2) Page 3, lines 63-64: Please explain briefly the dual-pathway model.

3) Page 3, line 73: Authors should clearly state that they are going to explain all the eight factors/mediators included in the model.

4) Pages 3 and 4, lines 78-83: Why the number of years of sport participation and whether an athlete is currently competing or in his/her off-season are elements that may relate to the development of disordered eating? Other variables might have been chosen. Indeed, later (lines 90-101) authors introduced the number of hours spent training per week as a relevant factor of spot pressure. Please clarify because it is misleading.

5) Page 4, lines 84-85: Please provide examples of lean sports. Again, authors assume a lot of knowledge about this topic from the reader.

6) Page 4, line 86: Please include the bracket after the number 15.

7) Page 4, line 92: Do not use the acronym (NCAA) the first time you mentioned a word.

8) Page 5, line 113: I think authors should include also the coach as a source of societal pressure (along with teammates).

9) Page 6, lines 140-142: Authors should explain deeply the debate pertaining to which type(s) of athletes experience the most body dissatisfaction and whether they experience more dissatisfaction than the general population.

10) Page 6, lines 146-148: The sentence "Research has found that negative affect in athletes, especially constructs such as fear and guilt, influenced bulimic behaviour when tested in conjunction with increased body dissatisfaction, dietary intent, and dietary intent and that certain elements of negative affect " do not make sense. Please clarify.

11) Page 8, line 186: Please include a full stop after the word analysis.

Methods & Results:

General feedback: The authors should have assessed for the presence of psychological disorders and, specifically, for EDs (and eventually removed participants with EDs) or, at least, include the lack of assessment for psychological disorder within the Limitation section.

Indeed, the range of BMI (Table 1) was comprised between 14.1 and 32.4; both a BMI of 14.1 and 32.4 may be indicative of an ED/disordered eating. Therefore, the etiological model was tested in a sample of athletes where the prevalence of EDs and disordered eating was uncertain. Authors should include this information in the limitation section.

Furthermore, authors should include internal consistency reliabilities for the current study instead of from others' investigations (see Measures section).

1) Page 9, lines 217-219: Why 10 hours of training should be an index of significant involvement in sport activity (instead of a lower/higher number of hours)?

2) Page 9, lines 227-229: It could be useful for readers the inclusion of % for each sport included in the study.

3) Page 10, lines 253-245: It is not clear to me why authors operationalized sport pressure with participation in an individual/team sport. They did not include any reference pertaining to this topic in the introduction.

4) Page 12, line 299: Include a full stop after the question mark.

Discussion:

General feedback: The discussion largely repeats the findings of the analyses, which is helpful to the reader. However, the authors do not give enough attention to theoretical explanations of the findings (i.e. page 21, lines 466-467: please provide explanations for the invariance of the model across lean and non-lean sports). In general, the authors need to spend less time re-stating their results and more time discussing them. Why are the important? What is the next step?

Furthermore, authors should discuss the clinical implications of the current study. Why your results pertaining to the Petrie and Greenleaf (2007; 2012) model are important in terms of clinical implications?

1) Page 20, line 440: Please include a full stop.

2) Page 20, line 444: Authors should rephrase the discussion in accordance with the results they found. They should refer only to binge eating and bulimia symptoms instead of talking about disordered eating in general. See also page 21, line 488.

3) Page 21: Authors should include in the future directions section the inclusion of athletes younger than 18 yeas old, given that this population was overlook by authors but represents an high-risk population for the development of EDs.

Figures:

Please include the number and the legend for each figure.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Review.docx

Psychological Risk Indicators of Disordered Eating in Athletes

PONE-D-19-34507R1

Dear Mrs Stoyel

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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With kind regards,

Valentina Cardi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Both reviewers found your revisions satisfactory and have approved publication of the manuscript.

Reviewers' comments:

Reviewer's Responses to Questions

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Yes

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

Reviewer #1: (No Response)

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

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6. 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: (No Response)

Reviewer #2: This is a revised version of a manuscript that I previously reviewed. The authors have adequately addressed my prior concerns.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No