Socioeconomic inequalities in childhood and adolescent obesity in Australia: The role of behavioral and biological factors

Nirmal Gautam; Aquib Chowdhury; Mohammad Mafizur Rahman; Rasheda Khanam

doi:10.1371/journal.pone.0321861

Peer Review History

Original SubmissionAugust 30, 2024
30 Aug 2024 Author Response Attachments Attachment Submitted filename: Editor response.docx https://doi.org/10.1371/journal.pone.0321861.r001
23 Jan 2025 Decision Letter - Haris Khurram, Editor PONE-D-24-34935Socioeconomic Inequalities in Childhood and Adolescent Obesity in Australia: The role of behavioral and biological factorsPLOS ONE Dear Dr. Gautam, 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. Please submit your revised manuscript by Mar 09 2025 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. 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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: No ****** 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 ******** 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: Title: Socioeconomic Inequalities in Childhood and Adolescent Obesity in Australia: The role of behavioral and biological factors I have reviewed the manuscript thoroughly. It has good scientific processes. I want to congratulate the authors on their meticulous job. This is a well-conducted and written study. The authors used very clear methods, language and terminology. The concepts and ideas are nicely communicated. However, I suggest the following changes be made prior to publication. Abstract 1. L21: Replace it with “Obesity among children and adolescents.” 2. L21: Replace the term “interplay.” 3. L29: Start by adding, “This decomposition analysis study utilized data from...” to provide the reader with an idea of the type, function, or method employed in the study. 4. Add the total number of participants included from the Birth Cohort and Kindergarten Cohort of the LSAC. 5. Mention the original time lapses and duration of this longitudinal study. 6. L32: Add “and to identify the relative contributions.” 7. Include additional numerical values from the test results to enhance the results section. 8. Ensure consistent terminology throughout the abstract, such as “biological factors” and “parental body weight,” which are currently mixed up. Introduction 9. Highlight the originality of this research clearly, providing readers with an understanding of the new knowledge obtained from this study or clarifying whether it is an analysis of two published datasets. 10. L53: Add a reference. 11. L98: Replace the word “wealth.” 12. The transition from general global statistics to specific Australian data is abrupt. Include a clearer linkage and clarify why Australia was chosen as the focus area. 13. Although the section is comprehensive, it attempts to cover too much ground, making it less focused. Three pages are excessive. Details such as dietary examples seem extra; consider making it more concise. 14. Explain the BMI score classification by Cole et al. concisely, including the percentile used in this method. 15. L172: Provide a reference for literature. 16. Conclude with a stronger statement about the implications of this research. Study design 17. Concisely define the timeline for each wave of data collection for both cohorts, including start and end years for each wave, to ensure readers understand the temporal structure of the study. 18. Reference the reader to previous studies but also include sufficient details here. Explain the Birth Cohort (B) in the same way as you did the Kindergarten Cohort (K). 19. Explain why specific waves (e.g., waves 1–4 for the K cohort and waves 2–6 for the B cohort) were selected for the analysis. Were these choices based on data availability, age range, or other considerations? 20. Include a flow chart explaining the process. 21. Clarify whether the behavioral factors were a part of the LSAC. 22. L235: Specify whether permission was obtained for using the data or if it is publicly available and does not require prior permission. 23. L253: This section is nicely explained. 24. For exclusion criteria, mention if non-English studies were excluded. Results: 25. Modify Table 1 to start with control variable information, such as age in years, and include percentages by gender (apply this to other tables as well). 26. Nicely explained Table 2, its clear. Under the table note, explain abbreviations and the significance levels denoted by * and (apply this to other tables as well). Discussion: 27. While it is important to align findings with existing literature, highlight the new insights provided by this study that were not addressed before, as the discussion currently lacks clear rationale. 28. L473: The connection here is unclear. 29. Move the limitations section to the end of the discussion and present it as a separate section. 30. If there are recommendations for future research, include them. Good Luck Reviewer #2: Please, see the attached file for more details. The article makes a significant contribution to understanding the interplay between socioeconomic factors and childhood obesity. However, following are two minor observations need to be addressed before its acceptance for publications: 1. While behavioral factors are included, the study could further explore external environmental influences, such as urban design and access to recreational facilities, which might shape physical activity levels. 2. Despite the longitudinal design, some interpretations appear static, potentially overlooking temporal shifts in socioeconomic conditions. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). 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Revision 1
18 Feb 2025 Author Response 18th February 2025 Dr. Haris Khurram, Editor, PLOS ONE RE: Manuscript ID: PONE-D-24-34935 Dear Dr. Khurram, We sincerely appreciate the opportunity to revise and resubmit our manuscript titled "Socioeconomic Inequalities in Childhood and Adolescent Obesity in Australia: The role of behavioral and biological factors" (Manuscript ID: PONE-D-24-34935) for consideration in PLOS ONE. We extend our gratitude to the reviewers for their thoughtful and constructive feedback, which has significantly contributed to refining our study. We have carefully addressed all comments and made necessary revisions to improve the clarity, precision, and impact of our work. In response to Reviewers comments, we have implemented the following key revisions: 1. Abstract and Introduction: We have revised the abstract to enhance clarity, ensure consistency in terminology, and include additional numerical values from test results. In the introduction, we have explicitly highlighted the originality of our study, improved the transition from global statistics to Australian-specific data, and concisely stated the BMI classification method. 2. Study Design and Methodology: We have refined the explanation of the timeline for each wave of data collection, ensured consistency in describing the Birth and Kindergarten cohorts, and clarified the rationale behind selecting specific waves. Additionally, we have included a study participant flowchart to visually represent the selection process. 3. Results and Discussion: We have modified Table 1 to start with control variables, included percentage distributions for gender, and clarified significance levels in all tables. In the discussion, we have explicitly highlighted novel insights from our study and revised certain paragraphs for better coherence and clarity. 4. Limitations and Future Research: The limitations section has been moved to the end of the discussion, presented as a separate section, and expanded to include additional considerations. We have also included recommendations for future research, emphasizing the exploration of environmental influences on childhood obesity. We are thankful for the opportunity to revise and resubmit the paper. We hope that the revised version meets your publication standards. We look forward to your decision in due course. Yours faithfully, Nirmal Gautam Corresponding author University of Southern Queensland Toowoomba; Queensland; 4350; Australia Ph: 61 7 4631 1256; Fax: 61 7 4631 5597 Email: gnirmal655@gmail.com/nirmal.gautam@usq.edu.au Web: www.usq.edu.au Response to Referee #1 Referee’s comment Abstract Line 34: L21: Replace it with “Obesity among children and adolescents.”. Our Response Thank you for your suggestion. We have now revised it as suggested (Please see L. No 21 in the revised clean manuscript) Referee’s comment L21: Replace the term “interplay.”. Our Response Thank you for your suggestion. But we humbly disagree to replace the term “interplay”. The term "interplay" suggest a dynamic relationship between elements. So, we keep this as it is. Referee’s comment L29: Start by adding, “This decomposition analysis study utilized data from...” to provide the reader with an idea of the type, function, or method employed in the study. Our Response We appreciate the reviewer’s suggestion to revise the sentence as “This decomposition analysis study utilized data from...” to provide clarity regarding the study’s methodology. However, we respectfully disagree with this revision for the following reason:” The original wording maintains a logical flow by first introducing the data source and then specifying the analytical techniques used. The reviewer's suggestion could disrupt this clarity by shifting the focus prematurely to decomposition analysis, potentially making it less clear to readers unfamiliar with the method.” Referee’s comment Add the total number of participants included from the Birth Cohort and Kindergarten Cohort of the LSAC. Our Response Thank you for your suggestion. We have now revised it as suggested Referee’s comment Mention the original time lapses and duration of this longitudinal study. Our Response Thank you very much for your feedback. We have revised it in the revised manuscript (please see the Abstract: L. No. 31 in the revised clean manuscript). Referee’s comment L32: Add “and to identify the relative contributions.” Our Response Thank you for your suggestion. We have now revised it as suggested. Referee’s comment Include additional numerical values from the test results to enhance the results section. Our Response Thank you for your feedback. We have added numerical values from the test results to enhance the results section. (please see the Abstract section: L. No. 40 to 43 in the revised clean manuscript). Referee’s comment Ensure consistent terminology throughout the abstract, such as “biological factors” and “parental body weight,” which are currently mixed up. Our Response Thank you for your feedback. We have reviewed the abstract and ensured that biological factors” and “parental body weight,” is used consistently throughout. Introduction Referee’s comment on the Introduction: Highlight the originality of this research clearly, providing readers with an understanding of the new knowledge obtained from this study or clarifying whether it is an analysis of two published datasets. Our Response Thank you for your comments and for emphasizing the importance of clarifying the originality and contributions of our research. To address the request, we have revised the introduction parts as “This study uniquely integrates behavioral and biological factors with SES to analyze their combined impact on childhood obesity across different socioeconomic groups in Australia, providing new insights into the complex mechanisms underlying the development of obesity. By combining new empirical findings with analyses of the Birth (B) and Kindergarten (K) cohort data from the Longitudinal Study of Australian Children (LSAC), this research offers a comprehensive and novel perspective on the socioeconomic disparities in childhood obesity. While previous studies have examined the relationship between SES and childhood obesity, the simultaneous consideration of biological and behavioral factors within this context is less explored, particularly in the Australian setting [26-30].” (please see the Introduction section: Lo. No 101 to 109 in the clean revised manuscript). Referee’s comment L53: Add a reference. Our Response Thank you for your comment. We have now added the appropriate reference. Referee’s comment L98: Replace the word “wealth.”. Our Response Thank you for your suggestion. We have revised the term “wealth” to “extend of research” Referee’s comment The transition from general global statistics to specific Australian data is abrupt. Include a clearer linkage and clarify why Australia was chosen as the focus area. Our Response Thank you for the suggestion. We have revised the transition to provide a clearer linkage between the global statistics and the Australian context as follow; “Given the global burden of obesity and its strong socioeconomic determinants, it is crucial to examine these dynamics in specific national contexts to inform targeted interventions. Australia faces an uneven distribution of obesity, where SES is a stronger predictor of obesity than the country's overall economic level [20, 21]. Research by the Australian Institute of Health and Welfare (2020) indicates that 28% of children and adolescents (aged 2 to 17 years) from low-SES backgrounds are overweight or obese, compared to 21% of their high-SES counterparts, highlighting a disparity in the distribution of resources, opportunities, and goods and services between low- and high-SES households [22, 23]. This imbalance contributes to Australia's high burden of obesity, ranking fifth highest among OECD countries in 2017–2019 [22, 24, 25]” (please see the Introduction section: Lo. No 89 to 98 in the clean revised manuscript). Referee’s comment Although the section is comprehensive, it attempts to cover too much ground, making it less focused. Three pages are excessive. Details such as dietary examples seem extra; consider making it more concise. Our Response Thank you for your observation. We have now concise the entire introduction to make it clearer and consistent. Referee’s comment Explain the BMI score classification by Cole et al. concisely, including the percentile used in this method. Our Response Thank you for your feedback. We have now explained the BMI score classification by Cole et al. concisely, including the percentile used in this method. (please see in the method section 158 to 165 in the clean revised manuscript) “BMI classification in this study follows the age- and sex-specific thresholds defined by Cole et al. (2000, 2007). Cole et al. (2000, 2007) developed age- and sex-specific BMI cut-off points to classify children and adolescents into underweight, normal weight, overweight, and obesity categories. These thresholds are derived based on international growth reference data, aligning with adult BMI cut-offs (≥25 kg/m² for overweight and ≥30 kg/m² for obesity) at age 18. The method uses the 85th percentile to define overweight and the 95th percentile for obesity, ensuring a standardized approach across different populations.” Referee’s comment L172: Provide a reference for literature. Our Response Thank you for your feedback. We have provided a reference for literature. Referee’s comment Conclude with a stronger statement about the implications of this research. Our Response Thank you for your feedback. We have concluded with a stronger statement about the implications of this research (please see the Introduction section: Lo. No 121 to 126 in the clean revised manuscript). “This approach not only fills a significant gap in the existing literature but also provides actionable insights that could inform targeted interventions and policies aimed at reducing health disparities and achieving a broader impact on societal health equity. The findings from this study are pivotal, as they enhance the understanding of how interlinked factors contribute to obesity, paving the way for more effective public health strategies and interventions” Study design Referee’s comment Concisely define the timeline for each wave of data collection for both cohorts, including start and end years for each wave, to ensure readers understand the temporal structure of the study. Our Response Thank you for your suggestion. We have concisely defined the timeline for each wave of data collection for both cohorts, including start and end years for each wave as follow: “This study used the data from the B cohort and K cohort of the LSAC, which is an ongoing national representative survey commenced in 2003/04 and 1999/00, respectively, and conducted by the Australian Institute of Family Studies (AIFS), the Department of Social Service (DSS), and the Australian Bureau of Statistics (ABS). The LSAC employed a cross-sequential study design, utilizing a multistage cluster sampling method, and collected data biennially, primarily from the biological mothers (P1) in 95% of cases. If the biological mother was unavailable, data were gathered from fathers, grandparents, adoptive parents, or stepparents. Adolescents aged 12 and older provided their data directly to the LSAC. The data collection involved structured questionnaires for both parents and adolescents. In this secondary data analysis study, we examined the relationship between SES, parental BMI, and children's behavioral factors, as well as their distributional impact on childhood and adolescent obesity. Data were collected from P1 for children aged 2 to 12 years, corresponding to waves 2 to 6 for the B cohort and waves 1 to 4 for the K cohort. Additionally, data from adolescents aged 12-13 and 14-16 years were included during waves 5 and 6 for the K cohort. The analysis spans a 10-year follow-up period, encompassing five key data points. For the K cohort, the initial dataset at wave 1 comprised 4,982 participants during the years 1999/00. Follow-up continued through wave 6, resulting in a final sample of 3,537 participants in the years 2009/10. For the B cohort, the initial dataset at wave 2 included 4,605 participants in the years 2005/06, with follow-ups extending through wave 7, culminating in a final sample of 3,381 participants in the years 2015/16. The detailed LSAC methodology is available elsewhere [32]. ” Referee’s comment Reference the reader to previous studies but also include sufficient details here. Explain the Birth Cohort (B) in the same way as you did the Kindergarten Cohort (K). Thank you for your feedback. I have explained the Birth Cohort (B) in the same way as you the Kindergarten Cohort (K) as follow: “This study used the data from the B cohort and K cohort of the LSAC, which is an ongoing national representative survey commenced in 2003/04 and 1999/00, respectively, and conducted by the Australian Institute of Family Studies (AIFS), the Department of Social Service (DSS), and the Australian Bureau of Statistics (ABS). The LSAC employed a cross-sequential study design, utilizing a multistage cluster sampling method, and collected data biennially, primarily from the biological mothers (P1) in 95% of cases. If the biological mother was unavailable, data were gathered from fathers, grandparents, adoptive parents, or stepparents. Adolescents aged 12 and older provided their data directly to the LSAC. The data collection involved structured questionnaires for both parents and adolescents from B and K cohorts. In this secondary data analysis study, we examined the relationship between SES, parental BMI, and children's behavioral factors, as well as their distributional impact on childhood and adolescent obesity. Data were collected from P1 for children aged 2 to 12 years, corresponding to waves 2 to 6 for the B cohort and waves 1 to 4 for the K cohort. Additionally, data from adolescents aged 12-13 and 14-16 years were included in waves 5 and 6 for the K cohort. The analysis spans a 10-year follow-up period, encompassing five key data points. The selection of waves 2–7 for the B cohort and waves 1–6 for the K cohort was based on data availability for this study's objectives. For the K cohort, the initial dataset at wave 1 comprised 4,983 participants during the years 1999/00. Follow-up continued through wave 6, resulting in a final sample of 3,537 participants in the years 2009/10. For the B cohort, the initial dataset at wave 2 included 4,606 participants in the years 2005/06, with follow-ups extending through wave 7, culminating in a final sample of 3,381 participants in the years 2015/16 (Figure 1). The detailed LSAC methodology is available elsewhere [34]. ” Referee’s comment Explain why specific waves (e.g., waves 1–4 for the K cohort and waves 2–6 for the B cohort) were selected for the analysis. Were these choices based on data availability, age range, or other considerations? Our Response Thank you for the suggestion regarding the data used in this study. Yes, we have chosen the selective waves 2 to 7 for the B cohort and 1 to 6 waves for the K cohort. These choices are based on the availability of data. We have revised it in the revised manuscript (please see the Method section: Lo. No 144 to 146 in the clean revised manuscript). Referee’s comment Include a flow chart explaining the process. Our Response Thank you for your suggestions. We have included a study participants flow chart to explain the process. (please see Figure 1). Referee’s comment Clarify whether the behavioral factors were a part of the LSAC. Our Response Thank you for your comment. Yes, the behavioral factors examined in this study were obtained from the LSAC dataset. Referee’s comment L235: Specify whether permission was obtained for using the data or if it is publicly available and does not require prior permission. Our Response Thank you for your concern. We have updated the data availability in the revised manuscript as: “interested parties must comply with certain restrictions and sign confidentiality agreements. To Attachments Attachment Submitted filename: Editor_response_auresp_1.docx https://doi.org/10.1371/journal.pone.0321861.r003
12 Mar 2025 Decision Letter - Haris Khurram, Editor Socioeconomic Inequalities in Childhood and Adolescent Obesity in Australia: The role of behavioral and biological factors PONE-D-24-34935R1 Dear Dr. Gautam, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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Reviewer #1: Yes 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 #1: Yes 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 #1: Yes Reviewer #2: 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: All the comments have been thoroughly addressed. The authors have made significant improvements, and the revisions have enhanced the clarity and quality of the article. I am satisfied with its current form and recommend it for acceptance. Reviewer #2: The minor observation has been addressed and the article is fit for acceptance. Please the attached report. ****** 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: Yes: Syed Ghufran Hadier, Shanxi University, Taiyuan 030006, China Reviewer #2: Yes: Muhammad Aslam ******** Attachments Attachment Submitted filename: Evaluation_Report_PONE-D-24-34935R1.pdf https://doi.org/10.1371/journal.pone.0321861.r004
Formally Accepted
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