Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with anorexia nervosa and bulimia nervosa in Germany and Switzerland

Kathrin Schopf; Silvia Schneider; Andrea Hans Meyer; Julia Lennertz; Nadine Humbel; Nadine-Messerli Bürgy; Andrea Wyssen; Esther Biedert; Bettina Isenschmid; Gabriella Milos; Malte Claussen; Stephan Trier; Katherina Whinyates; Dirk Adolph; Tobias Teismann; Jürgen Margraf; Hans-Jörg Assion; Bianca Überberg; Georg Juckel; Judith Müller; Benedikt Klauke; Simone Munsch

doi:10.1371/journal.pone.0280402

Peer Review History

Original SubmissionMay 16, 2022
2 Aug 2022 Decision Letter - César González-Blanch, Editor PONE-D-22-14198Implementation of eating disorder treatment in routine clinical care: A multi-center study examining short-term treatment outcomes among patients with anorexia nervosa and bulimia nervosa in Germany and SwitzerlandPLOS ONE Dear Dr. Schopf, 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. You will see from the accompanying comments that there was interest in your study, but the reviewers raised some important concerns too. I'm particularly concerned about the sample size issues and the data analysis strategy chosen, as suggested by one of the reviewers independent t-tests might not be the appropriate analyzes for comparing 3 groups on several variables. Please also specify the different types of treatment settings, whether in-patient, outpatient, or residential throughout the manuscript. Please submit your revised manuscript by Sep 16 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). 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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, César González-Blanch, PhD Academic Editor PLOS ONE 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 https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. 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Currently, your Funding Statement reads as follows: “This work was supported by the German Research Foundation (recipient: SSc, Grant SCHN 415/4-1, www.dfg.de) the Swiss National Science Foundation (recipient: SM, Grant 100013:149416, www.snf.ch) and the Swiss Anorexia Nervosa Foundation (recipient: SM, Grant 22-12, www.anorexia-nervosa.ch). None of the funders had a role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. [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: Partly Reviewer #2: Partly Reviewer #3: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: No Reviewer #3: 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 Reviewer #3: 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: Yes Reviewer #3: Yes ****** 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 basically a descriptive study which according to the investigators showed considerable symptomatic improvements among patients with AN and BN in routine clinical care. A highly-intensive, specialized residential treatment program was associated with large improvements within a short amount of time among women with AN. Inpatient and outpatient treatment were associated with almost comparable improvements among women with BN, but with different treatment dosages. Generally, results show that full recovery of EDs is typically not achieved within three months of treatment initiation and requires prolonged treatment duration, even after initial symptomatic improvements. Generally, results also show that treatment intensity and treatment outcomes are quite diverse, indicating the possibility for increasing effectiveness in the treatment of EDs in routine clinical care. As it is basically a descriptive study it appears that an inferential attempt at comparisons was really not the intent. However, the authors should explain the rationale for the sample size and its adequacy statistically for the findings, especially in the presentations of the Cohen’s d statistic. Reviewer #2: The study compares outcomes in different settings of routine clinical care for patients with EDs. One of the strengths of the study is that outcomes in all available settings of the German and Swiss health care system were included in one paper. Furthermore, authors recorded interviews and a part was coded by two raters which reflects high quality. Besides, I like that the authors assessed treatment components and treatment goals. One of the main limitations of the study is that sample size per setting and per diagnosis is very low. Introduction: • The authors might replace references 2-5 by newer papers. Methods: • Participants and procedure: “approximately three months later”: do the authors have detailed information on this timepoint (mean, SD, range after admission)? • Definition remission: I am wondering to which reference the authors refer to regarding e.g. the BMI=18 and EDE-Q<2.3 criteria? References 9, 37 and 38 seem to use other definitions? Furthermore, I am more familiar with a BMI=18.5 as remission criteria (and an EDE < 2.77). The authors should check if they used the most appropriate and most common remission criteria and might redo the remission analyses. • Please specify how many of the 10 treatment facilities were inpatient, residential and outpatient. • Statistical analyses: independent t-tests might not be the appropriate analyses comparing 3 groups on several variables. The authors might rather do MANOVAs with post-hoc-tests. Results: • Table 1: Is there any reason why n=114 is specified regarding age, but there is no information on “n” regarding the other variables • Table 1: Do the authors have more detailed information regarding comorbidity? • Table 2: The authors should specify ED severity and name the refence. • Table 2: MMD is not mentioned in the table, please clarify. Discussion: • The authors should include as a limitation that response rates of therapists was only 67%. • It seems that only 1 residential treatment center was included, so representativeness of this setting might be limited. The authors should mentioned this under limitations. • BMI of inpatients seems rather high (BMI=16.5 vs. BMI<15 being often one of the criteria for inpatient treatment). Please discuss. • From my point of view, the sample is not a strength of the study, but a limitation. References: • References 42 and 22 seem to be the same. Reviewer #3: This is an interesting and generally well-presented paper. A few aspects were unclear to me, and these are noted below. The title seems misleading in that it implies that effectiveness or efficacy the treatments will be examined, but in the abstract it's apparent that the study is more of a survey of existing treatments. In the abstract, the purpose of the study is not entirely clear to me. Is the study designed to compare treatments in different clinics? Is it designed to determine whether treatments are effective? In the introduction, the purpose of the paper needs to be stated explicitly. In the methods, more info about the purpose of the larger trial will be of benefit. A consort diagram for this study is required for transparency. In the results section, when making comparisons, it's important to always state the comparator. For example, what the end of page 10, the comparator is unclear. Throughout the paper, it could be helpful to make a more explicit definition of all the different types of treatment settings, whether in-patient, outpatient, or residential. I am not familiar with these terms, although I am familiar with the biology of eating disorders. ****** 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 Reviewer #3: Yes: Amanda Sainsbury-Salis ******** [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. 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Revision 1
27 Sep 2022 Author Response Reviewers' comments: Reviewer #1: This is basically a descriptive study which according to the investigators showed considerable symptomatic improvements among patients with AN and BN in routine clinical care. A highly-intensive, specialized residential treatment program was associated with large improvements within a short amount of time among women with AN. Inpatient and outpatient treatment were associated with almost comparable improvements among women with BN, but with different treatment dosages. Generally, results show that full recovery of EDs is typically not achieved within three months of treatment initiation and requires prolonged treatment duration, even after initial symptomatic improvements. Generally, results also show that treatment intensity and treatment outcomes are quite diverse, indicating the possibility for increasing effectiveness in the treatment of EDs in routine clinical care. As it is basically a descriptive study it appears that an inferential attempt at comparisons was really not the intent. However, the authors should explain the rationale for the sample size and its adequacy statistically for the findings, especially in the presentations of the Cohen’s d statistic. Response: It is correct that data of a randomized controlled clinical trial were subjected to secondary analyses for the present study. For the original clinical trial, an apriori power analysis (see study protocol, Munsch, 2014) was conducted. The power analysis referred to comparisons between clinical and control groups, but did not include comparisons within clinical subsamples. We agree with the reviewer that the sample sizes of subgroups are relatively small, which may limit generalizability of the present findings. In response, we have revised out methodological and statistical approach in order to avoid very low sample sizes and improve validity of findings. First, we have revised the comparison between treatment settings. In the revised manuscript, we only compare two settings (ambulatory and full-time treatment) instead of three settings (inpatient, outpatient, residential treatment). Furthermore, we added treatment outcomes for the total groups of patients with AN (n=59) and BN (n=57), as this more reliably reflects the average amount of change in patients (e.g., Table 5 and 6). In addition, we added regression analyses examining the relation between treatment intensity (number of psychotherapeutic sessions) and primary ED-related outcomes (weight gain and ED pathology) to better understand differences between full-time treatment and ambulatory treatment (p. 7, 12, 19). As the present study is one of the few studies evaluating symptomatic changes among patients with EDs in routine clinical care, we believe that this descriptive study contributes to this field of research. Reviewer #2: The study compares outcomes in different settings of routine clinical care for patients with EDs. One of the strengths of the study is that outcomes in all available settings of the German and Swiss health care system were included in one paper. Furthermore, authors recorded interviews and a part was coded by two raters which reflects high quality. Besides, I like that the authors assessed treatment components and treatment goals. One of the main limitations of the study is that sample size per setting and per diagnosis is very low. Response: We appreciate the reviewer’s positive appraisal of these study features and agree with his or her evaluation regarding the sample size. We refer to our response to Reviewer #1. Introduction: • The authors might replace references 2-5 by newer papers. Response: We like to thank the reviewer for this suggestion and have updated the references (p. 27). Methods: • Participants and procedure: “approximately three months later”: do the authors have detailed information on this timepoint (mean, SD, range after admission)? Response: The post-measurement was scheduled to take place three months after study entry. As with other data collections, delays may have occurred due to personal reasons of participants (e.g., rescheduling of appointments). However, this happened only in a minority of instances. In response to the reviewer’s question, we changed the wording from “approximately three months” into “three months” throughout the manuscript. • Definition remission: I am wondering to which reference the authors refer to regarding e.g. the BMI=18 and EDE-Q<2.3 criteria? References 9, 37 and 38 seem to use other definitions? Furthermore, I am more familiar with a BMI=18.5 as remission criteria (and an EDE < 2.77). The authors should check if they used the most appropriate and most common remission criteria and might redo the remission analyses. Response: As suggested by the reviewer, we have updated the remissions criteria and applied the more commonly used criteria of BMI ≥ 18.5 and EDE-Q ≤ 2.77 (cf. Schmidt et al., 2015; DeJong et al. 2020). The methods section and the results section were revised accordingly (p. 10-11 and 19-20). • Please specify how many of the 10 treatment facilities were inpatient, residential and outpatient. Response: We have added this information to the methods section (p. 8). Note: We also changed the number of cooperating treatment sites from ten to nine (as one of the cooperating sites did not treat ED patients). • Statistical analyses: independent t-tests might not be the appropriate analyses comparing 3 groups on several variables. The authors might rather do MANOVAs with post-hoc-tests. Response: We like to thank the reviewer for this suggestion. When comparing groups on several related continuous variables, we conducted a multivariate analysis instead of several t-tests, as suggested (p. 11-12). The strategy for analyses and the results were revised accordingly. (Please note that, in the revised version of the manuscript, only comparisons between two treatment settings were conducted, due to changes in the methodological approach, as explained above). Results: • Table 1: Is there any reason why n=114 is specified regarding age, but there is no information on “n” regarding the other variables Response: We apologize for the confusion. This is just an error in consistency. We have removed this information from Table 1. • Table 1: Do the authors have more detailed information regarding comorbidity? Response: Yes, comorbid diagnoses were assessed. We have added more information regarding comorbidity to the sample descriptives (page 12). • Table 2: The authors should specify ED severity and name the reference. Response: ED severity specifiers (i.e., mild, moderate, severe, extreme) have been determined in the diagnostic interviews based on DSM-5 criteria. We added this specification to the manuscript (p. 9). • Table 2: MMD is not mentioned in the table, please clarify. Response: We apologize for the error, which pertains to an earlier version of the manuscript. We removed this information from Table 2. Discussion: • The authors should include as a limitation that response rates of therapists was only 67%. Response: As suggested, we added this information to the discussion of the limitations (p. 25). • It seems that only 1 residential treatment center was included, so representativeness of this setting might be limited. The authors should mentioned this under limitations. Response: We agree with the reviewer. To improve validity of the findings, we have revised our methodological and statistical approach. In the revised version of the manuscript, the residential treatment center is now being subsumed into “full-time treatment”. • BMI of inpatients seems rather high (BMI=16.5 vs. BMI<15 being often one of the criteria for inpatient treatment). Please discuss. Response: We agree with the reviewer that this is noteworthy and added a brief discussion of the differences between patients receiving ambulatory treatment setting and full-time treatment (including BMI) to the manuscript (p. 22-23). (Please note that, in the revised manuscript, the average BMI of inpatients with AN is 16.7, due to changes in the statistical analysis). • From my point of view, the sample is not a strength of the study, but a limitation. Response: We agree with the reviewer. In response to the reviewers’ remarks, we have revised our methodological approach with the aim to avoid very low sample sizes and improve validity of findings. We also revised the discussion of the strengths and limitations (p. 24-25). References: • References 42 and 22 seem to be the same. Response: We like to thank the reviewer for this notification. This was corrected (p. 32). Reviewer #3: This is an interesting and generally well-presented paper. A few aspects were unclear to me, and these are noted below. The title seems misleading in that it implies that effectiveness or efficacy the treatments will be examined, but in the abstract it's apparent that the study is more of a survey of existing treatments. Response: We agree with the reviewer and have changed the study title to better describe the research design. The new title is “Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with anorexia nervosa and bulimia nervosa in Germany and Switzerland”. In the abstract, the purpose of the study is not entirely clear to me. Is the study designed to compare treatments in different clinics? Is it designed to determine whether treatments are effective? Response: In response to the reviewers question, we have clarified the purpose of the study in the abstract. In the introduction, the purpose of the paper needs to be stated explicitly. Response: The purpose of the study and the research questions were clarified in the introduction (p. 6-7). In the methods, more info about the purpose of the larger trial will be of benefit. Response: As requested, we have added more information about the original clinical trial in the methods section (p. 7). A consort diagram for this study is required for transparency. Response: The original consort diagram has been published in the main outcome paper of the randomized controlled trial (Munsch et al., 2021, Journal of Abnormal Psychology). We refer to this publication on page 7. As requested, we have also added a flow diagram (Fig 1), adapted for the present study. In the results section, when making comparisons, it's important to always state the comparator. For example, what the end of page 10, the comparator is unclear. Response: We apologize for being unclear. We have revised the results section (p. 12-13) in order to more clearly state the comparator. Throughout the paper, it could be helpful to make a more explicit definition of all the different types of treatment settings, whether in-patient, outpatient, or residential. I am not familiar with these terms, although I am familiar with the biology of eating disorders. Response: We have revised the description of treatment settings (p. 5) and now use the terms ambulatory treatment and full-time treatment throughout the manuscript. https://doi.org/10.1371/journal.pone.0280402.r002
7 Nov 2022 Decision Letter - César González-Blanch, Editor PONE-D-22-14198R1Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with Anorexia Nervosa and Bulimia Nervosa in Germany and SwitzerlandPLOS ONE Dear Dr. Schopf, 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 are almost there. But one of the reviewers suggest a minor revision to your manuscript. Therefore, you are invited to respond to the reviewer's comments and revise your manuscript. Please submit your revised manuscript by Dec 22 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, César González-Blanch, PhD Academic 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 #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 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 Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: 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 Reviewer #3: 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: Yes Reviewer #3: 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 #2: The authors addressed all my concerns very well. I have one minor comment regarding the revision: I think it is confusing that Table 1 and Table 2 contain partly the same and partly different variables. The authors might also consider combining the information into 1 Table and report the 4 subgroups and the 2 total samples in 1 Table regarding all different variables from Table 1 and 2 (as in Table 5 and 6) Reviewer #3: This revised paper is excellent, and all of my questions and concerns from previous Peer review has been addressed. ****** 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 Reviewer #3: Yes: Amanda Sainsbury Salis ******** [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. https://doi.org/10.1371/journal.pone.0280402.r003
Revision 2
20 Dec 2022 Author Response Reviewer #2: The authors addressed all my concerns very well. I have one minor comment regarding the revision:I think it is confusing that Table 1 and Table 2 contain partly the same and partly different variables. The authors might also consider combining the information into 1 Table and report the 4 subgroups and the 2 total samples in 1 Table regarding all different variables from Table 1 and 2 (as in Table 5 and 6) Response: As suggested, we have combined Table 1 and 2 into one Table. Reviewer #3: This revised paper is excellent, and all of my questions and concerns from previous Peer review has been addressed. Response: We like to thank both reviewers very much for their time! Attachments Attachment Submitted filename: response to reviewers.docx https://doi.org/10.1371/journal.pone.0280402.r004
28 Dec 2022 Decision Letter - César González-Blanch, Editor Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with Anorexia Nervosa and Bulimia Nervosa in Germany and Switzerland PONE-D-22-14198R2 Dear Dr. Schopf, 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. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- 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. Kind regards, César González-Blanch, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0280402.r005
Formally Accepted
6 Jan 2023 Acceptance Letter - César González-Blanch, Editor PONE-D-22-14198R2 Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with anorexia nervosa and bulimia nervosa in Germany and Switzerland Dear Dr. Schopf: I'm 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 let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. César González-Blanch Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0280402.r006

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