Prevalence and associated risk factors of general and abdominal obesity in rural and urban women in Bangladesh

Farjana Islam; Rahanuma Raihanu Kathak; Abu Hasan Sumon; Noyan Hossain Molla

doi:10.1371/journal.pone.0233754

Peer Review History

Original SubmissionDecember 4, 2019
13 Mar 2020 Decision Letter - Benn Sartorius, Editor PONE-D-19-33594 Prevalence and associated risk factors of general and abdominal obesity in rural and urban women in Bangladesh PLOS ONE Dear Mrs. Islam, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by Apr 27 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Benn Sartorius, PhD Academic Editor PLOS ONE Additional Editor Comments (if provided): Please include a completed STROBE checklist in the revised manuscript as a supplementary file. A checklist relevant to the study design can be found at: https://www.strobe-statement.org/index.php?id=available-checklists Journal Requirements: When submitting your revision, we need you to address these additional requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.plosone.org/attachments/PLOSOne_formatting_sample_main_body.pdf and http://www.plosone.org/attachments/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In your Methods section, please provide additional information about the participant recruitment method and the demographic details of your participants. Please ensure you have provided sufficient details to replicate the analyses such as: a) the recruitment date range (month and year), b) a description of any inclusion/exclusion criteria that were applied to participant recruitment, c) a table of relevant demographic details, d) a statement as to whether your sample can be considered representative of a larger population (and a description of the methods used to calculate sample size), e) a description of how participants were recruited, and f) descriptions of where participants were recruited and where the research took place. 3. Our internal editors have looked over your manuscript and determined that it is within the scope of our Determinants, Consequences and Management of Obesity Call for Papers. This collection of papers is headed by a team of Guest Editors for PLOS ONE:Rachel Nugent and Pratibha V. Nerurkar. Additional information can be found on our announcement page: https://collections.plos.org/s/obesity-one. If you would like your manuscript to be considered for this collection, please let us know in your cover letter and we will ensure that your paper is treated as if you were responding to this call. If you would prefer to remove your manuscript from collection consideration, please specify this in the cover letter. 4. Please amend your list of authors on the manuscript to ensure that each author is linked to an affiliation. Authors’ affiliations should reflect the institution where the work was done (if authors moved subsequently, you can also list the new affiliation stating “current affiliation:….” as necessary). [Note: HTML markup is below. Please do not edit.] 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 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: Yes Reviewer #2: Yes ****** 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: No ****** 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 manuscript provided information on central and overall adiposity among a small group of Bangladeshi women by geographic region. Overall, this paper is somewhat underdeveloped. Further information is needed to justify urban-rural analysis and data presented by 4 regions. Further more information is needed to adequately evaluate the results. Abstract: “Physical activity, socioeconomic status and education levels were associated with the increased prevalence of general and abdominal obesity.” Need to specify showed increased prevalence, for example physical activity or inactivity, lower or higher SES, lower or higher educ. Line 16, page 3: “the epidemiological” should be “an epidemiological” not ‘the’ Line 8, page 4: ” The Bangladesh’s population is of this country is projected to increase from 147 million in 2007 to 218 million in 2050. This is super old data using 2007. There is more recent population data. Methods: Please describe the enrollment process. How were these women selected, etc. Please provide a rationale for the selection of these 4 regions How was the data found to be able to know medical history (line 1, page 5) since there seemed to be a difference between “self reported or medical history” Page 6, line 6. Why are you including males in this definition since men are not part of your study. Important variables need to be defined. Particularly physical activity, smoking status, food habits, and socio-economic,—how was this determined. Only 2 variables were adequately defined: the measurements, educ. How was urban and rural status determined? How were the dependent variables defined in the model? Why is overweight considered important as most of the literature seems to indicate that the concern with overall adiposity is related to obese status and not so much for overweight. Overall the statistics section was significantly underdeveloped. Page 6, line 14. “Differences for the baseline data in WC and BMI groups were analyzed by independent sample t-test and ANOVA, respectively.” What is the baseline data? This suggest a longitudinal data collection design? Confusing. There needs to be some background on the value of assessing both since most of the issues with health conditions are more strongly related to abdominal adiposity. Why both? What does analyzing both add to the literature. There needs to be some indication of how the model was constructed. It is abit concerning that there are 5 age groups in the model (but table 1 does not show these age groups). As Sylhet has 22 urban people in 5 age groups, then even with equal numbers in each group that would mean there are 4 (or fewer in some groups. This is VERY small numbers to consider reasonable for a finding. Much of the discussion really focused on obesity yet it seems that the analyses used overweight too as a risky weight since in the results mean BMI was used. Table 2: the values indicate 2 places with no-one in that region classified as obese. This really begs the question as to whether the overall finding are really a reflection on Bangladesh prevalence. I struggle with understanding the value of 1) urban vs rural and 2) by region, especially given the small number of participants. Reviewer #2: This article addresses an important public health issue not just in Bangladesh but globally. With many LMIC populations undergoing epidemiological transitions, it is crucial to understand contextual differences in obesity levels in order to tailor interventions appropriately. The comparison between rural and urban is therefore a key addition to the body of knowledge. The statistical analyses are technically sound and appropriate conclusions have been drawn from the data. However, the overall language and grammar of the manuscript needs a major review for clarity, if possible working with a copy-editor. The methods section in my view also needs further clarification. MAJOR REVISIONS 1. I recommend that the authors work with a copy-editor in reviewing language and grammar of the entire manuscript. Because the paper not only compares rural and urban but also the different regions, the language needs to be clear and precise to get the right story across. The discussion section will also benefit immensely from language review in order to bring forward the true value of this study. Examples of unclear areas: page 2 lines 19/20 "An increasing trend of abdominal obesity 19 was found among the participants with increasing age except for the Chattragram region, 20 {whereas}, the prevalence of general obesity was comparatively higher at middle age to 60 years 21 participants." Also page 7, line 9; page 8 line 6-7. 2. Methods: a) More detail can be added to the description of the setting eg How were the divisions selected? Out of a total of how many? This helps the reader to see generalisability of the study. What is the population size of these regions? Do they each have the same proportion of rural to urban area? b) How was the sample size arrived at? The Sylhet region has a noticeably smaller sample size compared to the others - why was this? A discussion of potential implications may be necessary too. c) Physical activity categories: it might be useful to show the classes of jobs or occupation that were used to arrive at the physical activity groups and whether this follows any other connvetion or tool used in quantifying physical activity. This is especially important because there is a sizeable proportion of housewives - how does this occupation the classification of physical activity. MINOR REVISIONS Results: It brings better clarity if the reference category is mentioned when reporting regression results, and to indicate the direction of the association, especially in the abstract. ****** 6. 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 [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Review Manuscript Number PONE.docx https://doi.org/10.1371/journal.pone.0233754.r001
Revision 1
4 Apr 2020 Author Response Date: 04 April 2020 Prof. Benn Sartorius Academic Editor, PLOS ONE Manuscript ID: PONE-D-19-33594 Dear Editor, We appreciate the feedback from the editor and reviewers and their helpful suggestions for further improving our manuscript. We have carefully considered all the valuable comments and made revisions accordingly. We have revised the entire manuscript text to avoid grammatical errors. Text changes are marked in colour in the attached revised manuscript. We also formatted the revised manuscript according to the journal style. We feel that we satisfactorily responded to all the issues raised and are looking forward to your reconsideration of our manuscript. We thank the referees for evaluating the manuscript and for the helpful suggestions which contributed substantially to improve the quality of our manuscript. In the following, we briefly cite the comments made by the referees and state how we responded to them. We would be happy to include our manuscript to of special collection “Consequences and Management of Obesity” With best regards, Farjana Islam Department of Biochemistry and Molecular Biology Shahjalal University of Science and Technology, Sylhet, Bangladesh E-mail: farjanaislam308@gmail.com Response to Additional Editor Comments (if provided): Please include a completed STROBE checklist in the revised manuscript as a supplementary file. Response: According to the suggestion STROBE checklist has been included in the manuscript as a supplementary file. Journal Requirements: Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.plosone.org/attachments/PLOSOne_formatting_sample_main_body.pdf and http://www.plosone.org/attachments/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: We have formatted the revised manuscript and named the files according to the journal style. 2. In your Methods section, please provide additional information about the participant recruitment method and the demographic details of your participants. Please ensure you have provided sufficient details to replicate the analyses such as: a) the recruitment date range (month and year), b) a description of any inclusion/exclusion criteria that were applied to participant recruitment, c) a table of relevant demographic details, d) a statement as to whether your sample can be considered representative of a larger population (and a description of the methods used to calculate sample size), e) a description of how participants were recruited, and f) descriptions of where participants were recruited and where the research took place. Response: According to the suggestion, we have included details in the method section (page 4-5). 3. Our internal editors have looked over your manuscript and determined that it is within the scope of our Determinants, Consequences and Management of Obesity Call for Papers. This collection of papers is headed by a team of Guest Editors for PLOS ONE:Rachel Nugent and Pratibha V. Nerurkar. Additional information can be found on our announcement page: https://collections.plos.org/s/obesity-one. If you would like your manuscript to be considered for this collection, please let us know in your cover letter and we will ensure that your paper is treated as if you were responding to this call. If you would prefer to remove your manuscript from collection consideration, please specify this in the cover letter. Response: Thanks for the suggestion. We would be happy to include our manuscript to of special collection “Consequences and Management of Obesity” 4. Please amend your list of authors on the manuscript to ensure that each author is linked to an affiliation. Authors’ affiliations should reflect the institution where the work was done (if authors moved subsequently, you can also list the new affiliation stating “current affiliation:….” as necessary). Response: All authors names and the affiliated institute name have been checked to avoid errors. List of changes made in response to the reviewers Responses to Reviewer #1 Reviewer #1: This manuscript provided information on central and overall adiposity among a small group of Bangladeshi women by geographic region. Overall, this paper is somewhat underdeveloped. Further information is needed to justify urban-rural analysis and data presented by 4 regions. Further more information is needed to adequately evaluate the results. Response: Thanks for the comments. We have considered all comments during the revision and further improvement of the manuscript. Abstract: “Physical activity, socioeconomic status and education levels were associated with the increased prevalence of general and abdominal obesity.” Need to specify showed increased prevalence, for example physical activity or inactivity, lower or higher SES, lower or higher educ. Response: Thanks for the suggestion. The sentences in the abstract section have been corrected. Regarding food habits, we asked participants about their daily and weekly habits but a significant number of the participants did not provide detail information on their food habits. Therefore, we could not include individual dietary habits in detail. But we assume that food habits may be another determinant of obesity in Bangladeshi women (page 10, line 2). Line 16, page 3: “the epidemiological” should be “an epidemiological” not ‘the’ Response: The word has been corrected based on suggestion. Line 8, page 4: ” The Bangladesh’s population is of this country is projected to increase from Response: The sentence has been corrected. 147 million in 2007 to 218 million in 2050. This is super old data using 2007. There is more recent population data. Response: Thanks for the suggestion. The current population size in Bangladesh is 164 million and projected to increase 192 million by 2050. The information has been updated in the text (page 4, lines 11-12). Methods: Please describe the enrollment process. How were these women selected, etc. Please provide a rationale for the selection of these 4 regions Response: The selected four regions were the main administrative regions in Bangladesh which were located in the central (Dhaka, the capital city), Northwest (Rajshahi), South (Chittagong) and East (Sylhet) of Bangladesh. Details on participants enrolled have been included in the method section (page 5, lines 5-15). How was the data found to be able to know medical history (line 1, page 5) since there seemed to be a difference between “self reported or medical history” Response: Thanks for the remark and we agree with that. As exclusion criteria, we excluded the participants who had known cardiac, renal, liver and malignant diseases during data collection. We asked the participants whether they have diagnosed as positive by the physician for any of these diseases. To avoid the confusion we have now edited the sentence (page 5 lines 13-15). Page 6, line 6. Why are you including males in this definition since men are not part of your study. Response: We included the definition for both genders which would be helpful to understand the differences of the specific variable level between male and female subjects. Important variables need to be defined. Particularly physical activity, smoking status, food habits, and socio-economic,—how was this determined. Only 2 variables were adequately defined: the measurements, educ. Response: Response: According to the suggestion, physical activity, smoking status, food habits and socio-economic status have been defined in the method section (page 6 line 23, page 7 lines 1-3). How was urban and rural status determined? Response: In our study, the city areas were considered the urban areas where people are mainly involved with a different types of works and jobs. On the other hand, the areas outside/far from the city were considered as rural areas where a major percentage of people are involved with the agricultural works. How were the dependent variables defined in the model? Response: In the regression model, general and abdominal obesity (yes) was considered as the dependent variable and socio-demographic variables as the independent variable (details in the statistics section, page 7). Why is overweight considered important as most of the literature seems to indicate that the concern with overall adiposity is related to obese status and not so much for overweight. Response: We agree that obesity is the major concern for public health other than overweight. However, participants with overweight have a future trend to develop obesity in their life. Therefore, besides obesity, it might be important to present the percentage overweight among the participants. However, considering the suggestion, we have edited the text and given the emphasis on obesity other than overweight throughout the manuscript. Overall the statistics section was significantly underdeveloped. Response: We have checked and revised the statistical section to avoid any missing information (page 7). Page 6, line 14. “Differences for the baseline data in WC and BMI groups were analyzed by independent sample t-test and ANOVA, respectively.” What is the baseline data? This suggest a longitudinal data collection design? Confusing. Response: Thanks for marking the errors. It was our mistake in wording the term. It would be socio-demographic characteristics/data instead of baseline data. It has been corrected in the statistics section (page 7). There needs to be some background on the value of assessing both since most of the issues with health conditions are more strongly related to abdominal adiposity. Why both? What does analyzing both add to the literature. Response: In some studies, measures of abdominal obesity such as WC indicated as the best parameter correlated with cardiovascular diseases and metabolic dysfunctions. While some other studies have not found sufficient evidence that the measure of abdominal obesity is superior to BMI in predicting the risk of cardiovascular disorders (Tailor et al, Am J Clin Nutr. 2010, 91: 547-556. 10.3945/ajcn.2009.28757; Liu et al. BMC Public Health. 2011, 11: 35-10.1186/1471-2458-11-, Qiao et al. Eur J Clin Nutr. 2010, 64: 30-34. 10.1038/ejcn.2009.93. and some other studies. Moreover, some studies indicated the association of both general and abdominal obesity with cardiovascular diseases and metabolic dysfunctions. Considering the previous reports, we have analyzed both general and abdominal obesity in our participants. Some background has been added in the introduction section (page 4, lines 1-4). There needs to be some indication of how the model was constructed. It is a bit concerning that there are 5 age groups in the model (but table 1 does not show these age groups). As Sylhet has 22 urban people in 5 age groups, then even with equal numbers in each group that would mean there are 4 (or fewer in some groups. This is VERY small numbers to consider reasonable for a finding. Response: In regression analysis, the model was constructed for all participants enrolled from the four regions not for the individual region. According to the age range, we divided participants into five groups to see which age groups are more associated with the prevalence of obesity. In such analysis, we observed that the middle age groups were significantly associated with the prevalence of obesity. We also checked the analysis even excluding the small number of participants (n=22) from the urban area of the Sylhet region, but the results remained significant. Much of the discussion really focused on obesity yet it seems that the analyses used overweight too as a risky weight since in the results mean BMI was used. Response: According to the comments we have revised the text in the discussion section and given the emphasis on obesity other than overweight. Table 2: the values indicate 2 places with no-one in that region classified as obese. This really begs the question as to whether the overall finding are really a reflection on Bangladesh prevalence. I struggle with understanding the value of 1) urban vs rural and 2) by region, especially given the small number of participants. Response: Thanks for the comments. As a limitation of the study, we already mentioned in the text that the present study has been conducted in four regions of Bangladesh with a small number of participants; therefore, we recommend a further study including all regions of Bangladesh to explore the exact scenario of obesity prevalence in adult women in Bangladesh (page 12 lines 21-23). In the present study, we could not collect large data due to limited funding. However, in our next study, we planned to collect data on both genders including young adults from all eight regions of Bangladesh to estimate the prevalence of hypertension, diabetes and obesity and their associated risk factors. Reviewer #2: This article addresses an important public health issue not just in Bangladesh but globally. With many LMIC populations undergoing epidemiological transitions, it is crucial to understand contextual differences in obesity levels in order to tailor interventions appropriately. The comparison between rural and urban is therefore a key addition to the body of knowledge. Response: Thank you for appreciating comments about our study. The statistical analyses are technically sound and appropriate conclusions have been drawn from the data. However, the overall language and grammar of the manuscript needs a major review for clarity, if possible working with a copy-editor. The methods section in my view also needs further clarification. Response: We appreciate the positive comments on the statistics and conclusion section. We thank you for the valuable suggestions on language and grammar checking of the manuscript. During the revision of the manuscript, we have taken help from a colleague of the English Department and a senior colleague who is experienced in scientific writing from our institute. MAJOR REVISIONS 1. I recommend that the authors work with a copy-editor in reviewing language and grammar of the entire manuscript. Because the paper not only compares rural and urban but also the different regions, the language needs to be clear and precise to get the right story across. The discussion section will also benefit immensely from language review in order to bring forward the true value of this study. Response: According to the suggestion, we have taken help from a colleague of the English Department and a senior colleague who is experienced in scientific writing from our institute. With their help we have revised the entire manuscript to avoid language and grammatical errors. Examples of unclear areas: page 2 lines 19/20 "An increasing trend of abdominal obesity 19 was found among the participants with increasing age except for the Chattragram region, 20 {whereas}, the prevalence of general obesity was comparatively higher at middle age to 60 years 21 participants." Response: The sentence has been revised and made simple to clear the meaning (page 2 lines 18-19). Also page 7, line 9; page 8 line 6-7. Response: The sentences have been revised (page 8 lines 3-4). In page 8, the sentences have been revised and shortened to clear the meaning (page 8 lines 20-22). 2. Methods: a) More detail can be added to the description of the setting eg How were the divisions selected? Out of a total of how many? This helps the reader to see generalisability of the study. What is the population size of these regions? Do they each have the same proportion of rural to urban area? Response: In Bangladesh, there are eight administrative divisional regions. The selected four regions were the larger and major administrative regions in Bangladesh which were located in the central (Dhaka: capital city), Northwest (Rajshahi), South (Chittagong) and East (Sylhet) of Bangladesh (information has been added in the method section, page 5). The population size was about 5 million in Chittagram, 6 million in Dhaka, 1.7 million in Rajshahi and 1.9 million in Sylhet region. Dhaka is the capital city in Bangladesh, so a major portion of this region is an urban area. In other regions, the proportion of rural areas is also high but the difference is not big. Now a day’s, urban areas in Bangladesh are increasing due to rapid urbanization and industrialization. But still now, a major portion (about 60%) of the population lives in rural areas in Bangladesh. b) How was the sample size arrived at? The Sylhet region has a noticeably smaller sample size compared to the others - why was this? A discussion of potential implications may be necessary too. Response: Details about the participant’s enrollment process have been included in the method section (page 5). However, we also believe that the sample size is relatively small and large data should be collected from all regions of Bangladesh to explore the exact prevalence throughout the country. Regarding sample size, we have included it as one of the limitations of our study (page 12 line 19-21). We also requested a large number of subjects to participate from the Sylhet region, unfortunately a major portion of them was not agreed to participate and not willing to disclose their personal information Moreover, many of the participants did not provide complete information in the questionnaire form. So we did not include them due to missing information. We have included some text in the discussion section (page 12 line 19-21). c) Physical activity categories: it might be useful to show the classes of jobs or occupation that were used to arrive at the physical activity groups and whether this follows any other connvetion or tool used in quantifying physical activity. This is especially important because there is a sizeable proportion of housewives - how does this occupation the classification of physical activity. Response: Thanks for the suggestion. Now physical activities have been defined with examples (page 6 line 23 and page 7 lines 1-2). MINOR REVISIONS Results: It brings better clarity if the reference category is mentioned when reporting regression results, and to indicate the direction of the association, especially in the abstract. Response: According to suggestion the reference category has been added in the abstract section (page 2 lines 20-22). Attachments Attachment Submitted filename: Response to reviewer comments.docx https://doi.org/10.1371/journal.pone.0233754.r002
4 May 2020 Decision Letter - Benn Sartorius, Editor PONE-D-19-33594R1 Prevalence and associated risk factors of general and abdominal obesity in rural and urban women in Bangladesh PLOS ONE Dear Mrs. Islam, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by Jun 18 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Benn Sartorius, PhD Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: (No Response) ******** 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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes ****** 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 #2: Yes ****** 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 #2: No ****** 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 #2: The manuscript is now methodologically sound and sufficient discussion has been given regards study weaknesses and further research. However I feel the grammar and language still need further revision to present these finding s in the clearest possible way. Below are more examples that may need to be revised: • Page 4 line 1-8; line 16-18 • Page 5 line 6: should be “aged above 18” Line 9-11 • Page 7 line 14-15 • Page 8 line 12: should be “higher prevalence” • Page 10 line 4-5: “ documented” not documents…”higher than that reported”… Line 8: “than that reported” Line 9-11: “the prevalence of general obesity was found to have increased almost 3 fold…” • Page 11 lines 1-3 Line 16-17 • Page 12 line: should be “a significant portion of the participants did not agree to participate in the study” ****** 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 #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0233754.r003
Revision 2
6 May 2020 Author Response Date: 06 May 2020 Prof. Benn Sartorius Academic Editor, PLOS ONE Manuscript ID: PONE-D-19-33594R1 Dear Editor, We acknowledge and appreciate the editor and reviewers suggestions for further improving our manuscript. We have carefully considered all the valuable comments and made revisions accordingly. We have revised the entire manuscript text once again to avoid language and grammatical errors. Text changes are marked in colour in the attached revised manuscript. We feel that we satisfactorily responded to all the issues raised and are looking forward to your reconsideration of our manuscript. With best regards, Farjana Islam Department of Biochemistry and Molecular Biology Shahjalal University of Science and Technology, Sylhet, Bangladesh E-mail: farjanaislam308@gmail.com List of changes made in response to the reviewers Responses to Reviewer #2 Reviewer #2: The manuscript is now methodologically sound and sufficient discussion has been given regards study weaknesses and further research. However I feel the grammar and language still need further revision to present these finding s in the clearest possible way. Below are more examples that may need to be revised: Response: We appreciate the valuable comments and suggestions. According to the suggestion we have revised the manuscript text to avoid the language and grammatical errors. • Page 4 line 1-8; line 16-18 Response: The text has been revised (page 4 line 1-9 and line 15-16) • Page 5 line 6: should be “aged above 18” Line 9-11 Response: The word has been corrected according to suggestion. Moreover, lines 9-11 have been revised to clear the meaning (page 5 line 9-11) • Page 7 line 14-15 Response: The sentences have been revised (page 7 line 13-14). • Page 8 line 12: should be “higher prevalence” Response: Thanks for marking the error. This has now been corrected. • Page 10 line 4-5: “ documented” not documents…”higher than that reported”… Line 8: “than that reported” Line 9-11: “the prevalence of general obesity was found to have increased almost 3 fold…” Response: The words have been corrected according to the suggestion (Page 10 line 3-9) • Page 11 lines 1-3 Line 16-17 Response: The sentences have been revised. (page 11 line 1-2 and line 13-16). • Page 12 line: should be “a significant portion of the participants did not agree to participate in the study” Response: The sentence has been edited based on suggestion. Attachments Attachment Submitted filename: Response to reviewer comments.docx https://doi.org/10.1371/journal.pone.0233754.r004
13 May 2020 Decision Letter - Benn Sartorius, Editor Prevalence and associated risk factors of general and abdominal obesity in rural and urban women in Bangladesh PONE-D-19-33594R2 Dear Dr. Islam, 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. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Benn Sartorius, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0233754.r005
Formally Accepted
20 May 2020 Acceptance Letter - Benn Sartorius, Editor PONE-D-19-33594R2 Prevalence and associated risk factors of general and abdominal obesity in rural and urban women in Bangladesh Dear Dr. Islam: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Benn Sartorius Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0233754.r006

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