PONE-D-21-30163

Long-term changes in body image after bariatric surgery: an observational cohort study

PLOS ONE

Dear Dr. Gatta-Cherifi,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Anca Mihaela Pantea-Stoian, md, phd

Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear Authors,

The article is interesting and valuable. However, there are some improvements to make:

1. Line 56: The authors mention that bariatric surgery also significantly improves most obese patients' comorbidities. Could you please detail (for example, diabetes, metabolic syndrome, hypertension..)?

2. It would be interesting if you could make some correlations between several factors and the change in body image over time, such as sex, age, the onset of obesity, type of BS, comorbidities, weight loss.

3. Do you have separated the patients who achieved BMI <30? It could show different results between the groups. It is interesting to explain the results, for this cluster of patients .

4. Please explain and extend the discussion about the reasons for the dropouts after 18 months.

5. Refresh the whole manuscript, correct miswriting, and check the punctuation.

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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: Yes

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: No

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: Dear Authors,

The aim of following patients' body images for a longer period after bariatric surgery is a very important point considering it may help to build strategies to achieve better and prolonged results, even if not using the most appropriate tools. Just wondering if you had separated the patients who achieved BMI <30 it could show different results between the groups. Also, I wondered if wouldn't be interesting to refer to the reasons for the dropouts after 18 months.

I suggest you review the writing as there are a few miswriting and check the punctuation.

Reviewer #2: The paper is an original article regarding the body image perception and its variation in patients that underwent bariatric surgery. The topic is extremely interesting. The paper is written in a fluid English language and based on a solid statistical analysis. Some issues could be improved before publication:

1. Line 56: The authors mention that bariatric surgery also bring important improvement in comorbidities that most obese patients have. Could you please detail (for example: diabetes, metabolic syndrom, hypertension..)?

2. It would be interesting if you could make some correlations between several factors and the change in body image over time, such as sex, age, onset of obesity, type of BS, comorbidities, weight loss

********** 

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.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-21-30163R1Long-term changes in body image after bariatric surgery: an observational cohort studyPLOS ONE

Dear Dr. Gatta-Cherifi,

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.

Your manuscript has been seen by two additional reviewers and their comments are attached below. We would like to ask you to address the concerns of reviewer #3 and respond to the comments of reviewer #4, specifically:

• please discuss the limitation regarding the Figure Rating Scale
• please review current literature to ensure that the most recent literature on the topic has been included
• note that citing the reference requested by Reviewer 4 is not a requirement for publication

Could you please revise your manuscript to include their concerns?

Please submit your revised manuscript by Sep 25 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Thomas Tischer

Staff Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[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 #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

Reviewer #4: 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: Yes

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: No

Reviewer #4: 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 #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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 #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

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: The authors responded to the queries in the revised version. I have no further issues. I recommend publication.

Reviewer #3: This manuscript reports on data that is almost a decade old, for reasons that are unclear. Since that time, research in this area has grown to a size larger than suggested here. Much of the referenced literature is dated and many more recent empirical papers and reviews on this topic were missed. Further, the Figure Rating Scale is no longer viewed as an appropriate measure of body image dissatisfaction. It certainly not validated for those with clinically severe obesity. The results of the MBSRQ-AS replicate those from other studies. So, it's not clear what this small, dated study adds to the literature.

Reviewer #4: Long-term changes in body image after bariatric surgery: an observational cohort study.

Bariatric surgery and reconstructive procedures after weight loss are one of the most important and popular surgeries nowadays. On the other hand, the problem lies not only in the body structure and obesity. There is very an important, maybe the most important part how to prepare our patients’ mentally for the surgical journey. The surgery itself may give us a false belief that the patient is treated. But the psychiatric part may be as important as 80% of the treatment. It would be interesting to focus on the surgical outcome in comparison with the mental preparation before the surgery.

I find the study interesting. The manuscript is well organized, and statistically well prepared. Maybe the idea is not new, and the outcome is similar to the other studies, even the one presented by my team in 2020 The long-term effect of body contouring procedures on the quality of life in morbidly obese patients after bariatric surgery

doi.org/10.1371/journal.pone.0229138.

The strength of the study is long followed for up to 5 years. The response rate of the study is 66% which is more than needed to assess as a valid study. One of the most important parts of the manuscript is to show that after 5 years there is a decline in the body assessment, but it is still higher than before bariatric surgery. So we can say that the patient qualification process was proper.

There is my summary

1. The authors have responded properly to the reviewers

2. The study is valuable due to the long follow up

3. The response rate is 66% - enough to publish

4. Would be better to have a multicenter study, but thanks to long follow-up it should be considered valuable.

5. Please add the mentioned study

6. In the next studies I would recommend the assessment of the body reception and psychiatric evaluation of the patients.

I recommend this manuscript be accepted as an original article, please add the publication I mentioned.

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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

Reviewer #3: No

Reviewer #4: Yes: Marek A Paul

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[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.]

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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Long-term changes in body image after bariatric surgery: an observational cohort study

PONE-D-21-30163R2

Dear Dr. Gatta-Cherifi,

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

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Kind regards,

George Vousden

Staff Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: