PONE-D-25-34933Exploring the prevalence of severe obesity in a large teaching hospitalPLOS ONE

Dear Dr. Jerry,

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This is a very interesting and methodologically sound research. Please address all reviewers’ comments before proceeding to final evaluation.==============================

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Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

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Reviewers' comments:

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Comments to the Author

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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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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Dear Authors,

I have read your manuscript and found it impressive. I do, however, have a few questions and suggestions that I hope could enhance the quality and impact of your upcoming manuscript:

1- The Lancet Commission on the Definition and Diagnosis of Clinical Obesity recommends defining and diagnosing clinical obesity based on the presence of "excess or dysfunctional adiposity that impairs health," irrespective of body mass index. I suggest incorporating this definition into both the Introduction and Discussion sections of your manuscript, as it may influence the accurate estimation of obesity prevalence in your study population.

2- An important subgroup worth considering is patients with cancer, particularly those with obesity-related cancers. Including this subgroup in your analysis could provide valuable insights and strengthen your findings. Would it be possible to add this population to your study cohort

Reviewer #2: Changes according to IFSO's accepted terminology

1. "Bariatric Surgery" → "Metabolic Bariatric Surgery (MBS)"

• Line 36

Original: Patients with a history or current treatment for bariatric surgery were excluded.

Suggested: Patients with a history or current treatment for Metabolic Bariatric Surgery (MBS) were excluded.

• Line 120

Original: Additionally, patients from the bariatric outpatient clinic were excluded

Suggested: Additionally, patients from the Metabolic Bariatric Surgery (MBS) outpatient clinic were excluded

• Line 321

Original: we excluded patients managed at the bariatric outpatient clinic

Suggested: we excluded patients managed at the Metabolic Bariatric Surgery (MBS) outpatient clinic

• Line 327

Original: The exclusion of bariatric and revisional cases helped define

Suggested: The exclusion of Metabolic Bariatric Surgery (MBS) and revisional cases helped define

• Line 415 (Reference)

Original: adult and adolescent bariatric surgery candidates.

Suggested: adult and adolescent Metabolic Bariatric Surgery (MBS) candidates.

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2. "Comorbidities" → "Obesity-associated diseases/disorders"

• Line 314

Original: Despite the consistency of this study's results with prior literature, there are several limitations that should be acknowledged.

(No change needed here — included for context)

• Line 321

Original: we had no access to post-admission measures of central adiposity, such as waist circumference or body composition, which could have provided a more accurate stratification.

(Also acceptable — contextually fine)

• Line 415

Original: The prevalence of co-morbidities in adult and adolescent bariatric surgery candidates.

Suggested: The prevalence of obesity-associated diseases in adult and adolescent Metabolic Bariatric Surgery (MBS) candidates.

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Optional: Add IFSO-aligned BMI Classification

While “severe obesity” (BMI ≥35 kg/m²) is used correctly, IFSO recommends using specific classes:

• BMI 35–<40: Obesity II

• BMI 40–<50: Obesity III

• BMI 50–<60: Obesity IV

• BMI ≥60: Obesity V

Overall , provides important data concerning BMI and hospital admittance and can be the start of further research

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Reviewer #1: Yes:  Mohammad Kermansaravi

Reviewer #2: No

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Exploring the prevalence of severe obesity in a large teaching hospital

PONE-D-25-34933R1

Dear Dr. Jerry,

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.

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Kind regards,

Athanasios G. Pantelis

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: