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PLOS ONE

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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?

Reviewer #1: Yes

Reviewer #2: Partly

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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

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Thank you for the opportunity to read this manuscript! I think it will be a good value add to the literature. I have a few questions/comments for consideration:

-In line 94, you state the objective is to assess prevalence among adolescents aged 9-17, but then state in the methods it is just students from 3 grades. In the introduction, I think you could spend a couple more sentences on why the grade 7-9 adolescent population was the population of interest.

-You state HOW height and weight were measured, but I would add the metrics used (cm, kgs, etc.)

-In lines 142-145, you discuss the calculation of BMI. I think the article would be strengthened if you added citations that supported the percentile cut offs you used to determine overweight and obese classifications.

-In the Data Collection section, there was a bit of unnecessary repetition of details already discussed in the Sampling section above it.

-I (strongly) encourage you to add a table to your data collection sections that discusses how each variable was measured and cite the original measurement scales if possible. Please see Table 1 in the following study for an example.

Patil, C. L., Norr, K. F., Kapito, E., Liu, L. C., Mei, X., Chodzaza, E., ... & Chirwa, E. (2025). Group antenatal care positively transforms the care experience: Results of an effectiveness trial in Malawi. PLoS One, 20(6), e0317171.

-Line 251 is incomplete with an error message

-I think there needs to be a little more discussion in how you combined variables to create the variables in Table 6. For example, what made up the categories "does not eat" vs "eats at school"?

-I am curious, for the multivariate analysis, did you consider any type of model selection (forward, backward, stepwise)? I am thinking that some of these variables might be masking the effects of others. If you were to use backward selection, for example, and drop TV time, I am curious if the significance of screen time would change? That being said, did you run a correlation analysis to rule out multicollinearity? If you did not do this, I recommend it. If you did do this, add a sentence about it!

-In lines 290-291, you say that the BMI was calculated according to CDC standards. I would add a citation here.

-In line 296 you cite a (Rahimi et al., 2025) study. This is not in the references section. How is this paper similar and different to yours? I would discuss it a bit more.

-Are all the studies cited between lines 299-310 on school children that are of similar age to the ones in your study? If not, it may be a stretch to include them. This paragraph should end with discussion of how the prevalence found in your study compares to these other studies - is it lower, higher, about the same?

-In line 360-361, you discuss the use of CDC percentiles, but there has been a lot of literature lately discussing how the CDC percentiles are actually not that acurate for non-white populations. I think it is fine that you are using these percentiles, but am not convinced it is a strength.

Reviewer #2: Question: Is the manuscript technically sound and do the results fit the conclusions?

Response: Partly

Reason: The design and analysis are appropriate, and the results support the stated conclusions. However, the conclusions are written too broadly, as the study included only male adolescents and was cross-sectional, which limits generalizability and prevents causal inference.

Question: Has the statistical analysis been performed appropriately?

Response: Yes

Reason: The authors applied univariate, bivariate (Chi-square), and multivariate regression analyses, which are suitable for a cross-sectional study. The analyses were reported correctly, though interpretation should remain associational, not causal.

Question: Have the authors made the underlying data fully available?

Response: No

Reason: The Data Availability Statement notes that data are available “upon request to the corresponding author,” which does not comply with PLOS ONE’s requirement for unrestricted access via a public repository or supplementary files.

Question: Is the manuscript written in an intelligent way with standard English?

Response:Yes

Reason: The manuscript is generally clear and uses standard English, but contains grammatical errors, repetitive phrasing, and formatting problems (e.g., “Error! Reference source not found”), which need editing to meet journal standards.

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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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Attachments

Attachment

Submitted filename: Comments_PONE_D_25_33318.docx

The prevalence of overweight and obesity and the assessment of associated risk factors among school-aged adolescents in Kandahar City, Afghanistan

PONE-D-25-33318R1

Dear Dr. Rahimi

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,

Zehra Batu

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Thank you for revising this manuscript! Many of the comments were addressed, but there were a few things I noticed during my second read that warrant some small edits:

-in-text citation style varies (comma between references in line 92 and no comma between references in line 108)

-Lines 163-173 should be moved from the sampling to the data collection section, they are not necessary when discussing population sampling. You can then remove line 198.

-Your paragraph on strengths (lines 491-495) could be strengthened! The first sentence has a typo. Beyond that, I would discuss how the sample population is representative of the population of Kandahar. The phrase "proportionate to the population" is not accurate here - this is usually used when stratified sampling is done across population subgroups. Perhaps you meant to discuss the sample size provided adequate statistical power? Additionally, explain to the reader why/how using the three analytical approaches strengthened the analysis and findings.

Thanks again for the opportunity to review and great job with this research!

Reviewer #2: I have reviewed the revised version of the manuscript titled “The prevalence of overweight and obesity and the assessment of associated risk factors among school-aged adolescents in Kandahar City, Afghanistan.”

The authors have made considerable efforts to address the earlier reviewer comments. The revised manuscript is now clearer, better structured, and more focused. The limitation of including only male adolescents is now clearly stated throughout the Abstract, Methods, Discussion, and Limitations sections. The justification for using CDC BMI percentiles has been appropriately provided as per the ethics committee’s guidance. The explanation of the screen-time threshold is now clearer. Formatting errors have been corrected, tables simplified, and the Discussion section refined to emphasize key findings and regional context.

Overall, the manuscript has improved in clarity, presentation, and methodological transparency. The revisions address the major concerns raised previously. Only minor editorial or language polishing may be required before publication.

I found no concerns regarding dual publication, research ethics, or publication ethics in this revision.

Recommendation: Accept after minor editorial review.

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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: Yes:  Rebecca Nabulya

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Attachments

Attachment

Submitted filename: Reviewer Re-Review Report.docx