Dear Dr. Essat,

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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: N/A

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: A very Noble topic for Review

� The manuscript acknowledges the predominance of studies from high-income countries. By including more studies from low- and middle-income countries would improve the generalizability of the findings. India and China may have the maximum children and adolescents with obesity. However, the review papers that were included in the analysis have minimal representation from these countries.

Reviewer #2: 1. Scientific Review and Research Ethics

• Strengths:

• The research appears ethically sound, with no overt ethical issues in participant recruitment or data handling.

• The objectives and background are well motivated and framed within the context of public health needs.

• Weaknesses:

• The methodology section lacks sufficient detail to ensure full reproducibility. For example, information about the data collection process, survey tools, or any instruments used is limited.

• Statistical methods are not comprehensively described—clarify which tests were used, why, and include confidence intervals or effect sizes.

2. Data Availability and Transparency

• Weaknesses:

• There is no clear data availability statement, which is a core requirement of PLOS ONE.

• The manuscript does not mention whether datasets are publicly accessible or under restricted access.

3. Manuscript Structure and Clarity

• Strengths:

• The structure follows a standard IMRAD format (Introduction, Methods, Results, and Discussion).

• The abstract provides a useful summary, though it could be tightened for clarity.

• Weaknesses:

• There are grammatical issues and awkward phrasing in several sections (e.g., Introduction and Results).

• Transitions between paragraphs are sometimes abrupt, reducing narrative coherence.

4. Discussion and Conclusion

• Strengths:

• Conclusions are consistent with the reported findings.

• The discussion links findings back to the literature.

• Weaknesses:

• Some conclusions may overstate the findings given the study’s limitations (e.g., generalizability or potential biases).

• Limitations are acknowledged but not deeply discussed.

5. Figures, Tables, and Supplementary Material

• Strengths:

• Tables summarize data well and are mostly easy to interpret.

• Weaknesses:

• Tables lack clear titles and captions in some cases.

• No figures or supplementary files were referenced

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Reviewer #1: No

Reviewer #2: Yes: Rahma K. Abdelseed

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Attachments

Attachment

Submitted filename: PONE-D-24-58575_reviewer.RG.pdf

Attachment

Submitted filename: RG.Observations of the research artcle on Obesity.pdf

Dear Dr. Essat,

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.

• 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'.
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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,

AKM Alamgir, PhD

Academic Editor

PLOS ONE

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If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

**********

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

Reviewer #3: Partly

**********

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

Reviewer #3: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #3: Yes

**********

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

Reviewer #3: Yes

**********

Reviewer #3:  I agree with earlier reviewers that this study addresses an important topic, and the results are valuable for informing the refinement and redesign of lifestyle interventions for children and adolescents with obesity. My suggestions and concerns are mainly related to the study framing and rationale, integration of the study aims and results into the broader literature, and discussion of how the results could be applied.

1. I would recommend that the introduction provide an argument for why it is important to understand the values and preferences of patients, and their respective ‘communities’ (families), in relation to interventions and treatment. This argument can draw on literature from community-engaged research and translational science principles, and the evidence base documenting how program/treatment adoption and efficacy can be improved by ensuring interventions align with patient and community priorities. I would also recommend this be highlighted in the discussion as motivation for why interventionists should use the results from this study.

2. Line 98-99: This sentence is a little confusing: “This paper includes the findings

from two of these reviews, examining the evidence on dietary and physical activity interventions”. What are the “two reviews”? Are they separate reviews on (i) diet interventions for children and adolescents, and (ii) physical activity interventions for children and adolescents? Please clarify.

3. Related to the item above, please clarify in the introduction, methods, and results if the goal of the review was to review interventions that targeted (i) diet only, OR (ii) physical activity only, OR (iii) diet and physical activity jointly (but not other health behaviors).

4. Line 100-101: Please clarify whose ‘values and preferences’ have been excluded (children, parents, both?), as well as clarify what these values and preference are of (e.g., values related to the treatment for obesity in children and adolescents)?

Methods

5. Table 1: There are several aspects of this table that I found unclear or confusing:

-Please clarify what “Setting” refers to. E.g., is the setting in which the intervention is delivered?

-Please clarify why the focal ‘Setting’ for children is “Home” (but not childcare or school), and why the focal ‘Setting’ for adolescents is “School” (but not home). And why is the “Setting” for parents/caregivers only “Clinical settings”?

-Under “Phenomenon of Interest”: use punctuation to make it clear there are two ‘phenomenon’ listed here (Diet intervention; Physical activity intervention)

-I am not clear how to interpret the correspondence of the rows under the “Time/Timing” and “Findings columns: is Time = “Initiation” only applicable to the “Children with Obesity” row; and “Continuation” only applicable to the “Adolescents with obesity row”. I have the same confusion interpreting the rows under “Findings”.

-Line 24, replace “Plus” with “+” so it is clear you are referencing this symbol in “PROGRESS+”

6. Line 137: Revise “for individuals and groups with obesity” to “for individuals with obesity, either delivered in an individual or group setting”. Similarly, could the diet interventions (lines 137-139) be delivered in individual or group formats?

7. Lines 142-143: I do not understand what this sentence means – can you revise for clarity? “Reviews were excluded if the health effects of the interventions could not be attributed distinctly to diet or physical activity or explored diet or physical activity for obesity prevention.” E.g., reviews were only included if the outcomes being measured (e.g., weight loss) were attributed to an intervention component focused on dietary change, or physical activity change, which presumably was a randomized controlled trial testing effects of specific components? It’s unclear how this applies to qualitative research. I also do not understand the point being made in the second part of the sentence, about prevention.

8. Data Extraction (lines 178-189). Could you provide more detail about the method for extracting themes of qualitative analysis results that were summarized in the reviews? E.g., were all themes or topics in the reviews transferred verbatim to a qualitative data management tool, or did any synthesis or transformation of the text about these themes occur at this data extraction stage?

9. Line 195: Is QES an acronym that stands for something? If so, please define it here.

10. Line 238: What does “0/6” years mean, when referring to a child’s age?

11. Lines 241: In the sentence “one review [20] that drew upon evidence exclusively from that region” please state what region this is referring to.

12. Table 3: Under the column “Number of Qualitative studies” please define what the numbers reported represent (i.e., what is the first number, and what is the second bracketed number?).

13. Table 5: Representing the 3 categories as colors (e.g., low = green, orange = medium, red = high) could provide an easier visual interpretation of the patterns of ‘risk to rigor’ across studies and across evaluation features.

14. Table 6: I’d suggest revising the header “The role of support” as “The role of social support”, so it is clear this supporting is coming from interpersonal relationships (and to use this label throughout the manuscript).

15. Figure 2: Why are the arrows between “interventions” and each of the elicited ‘factors that influence engagement in interventions’ bidirectional? The bidirectional arrows imply the factors influence the intervention, and that the intervention influences the factors – is that the intended meaning?

16. Lines 383-396: With regards to the findings on health worker support, can you clarify in this section if the health workers being referred to are predominantly (or only) people who are delivering the intervention, or if the scope of the referent group for health workers is broader and might include health care providers that are not directly providing or delivering the intervention?

17. Line 468: This sentence states “Parents preferred to enrol their children in programmes that focused on lifestyle..”. Please clarify what they preferred this over (i.e., they preferred enrolling their kids in programs focused on lifestyle changes, over what other options/what other programs that have a different focus)?

18. Results: Why are quotes from parents and children so rarely included in the results, given they were included in the data extraction protocol? Their inclusion in lines 516-518 helps to integrate the patient/caregiver voice about their perspectives into the summary of the results. I would recommend including more of these quotes to illustrate key themes.

19. Lines 528-529: The argument in the first few lines of this section is not clear. There are statements that children and caregivers prefer ‘knowledge’, ‘practical instruction’, and ‘evidence-based knowledge’, but they do not prefer ‘theory’. How does ‘evidence based knowledge’ differ to ‘theory’ when provided in the context of the interventions?

20. The discussion rarely integrates the study findings with the broader literature, apart from one paragraph (lines 593-613). I’d suggest that the first few paragraphs not just restate the findings, but interpret them in light of existing evidence and theory, and discuss how they could guide changes to intervention strategies. For example, in relation to the preferences for social support, refer to the extensive literature showing that family-based interventions are more effective than interventions that focus only on the child, and that social support is a known moderator of intervention outcomes; then, provide some examples of how interventions can be design to address this need (e.g., prioritize whole family interventions, include interventions with components to build social support among family and peers). The section “Implications for practice” provides questions that interventionists should ask themselves, but I think it would be useful to additionally provide examples of intervention strategies/protocols/components that actually address specific needs and preferences. E.g. child preferences for autonomy and choice could be addressed by the integration of motivational interviewing in the intervention delivery.

21. Lines 707-709: I think there is an opportunity here to highlight that pharmacological therapies, such as GLPs, can be effective for weight loss and reduced caloric intake, but may not be effective in addressing other health goals: e.g., increasing some healthy dietary behaviors (e.g., consumption of more nutrient dense foods or healthy eating habits, or increased physical activity). Arguably their delivery in adolescent populations should be complemented with lifestyle behavior change interventions, particularly to achieve sustainable improvements in child health outcomes. And so, the results of this study could be very valuable in informing those complimentary lifestyle intervention designs.

**********

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Reviewer #3: Yes: Kayla de la Haye

**********

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Dear Dr. Essat,

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 Dec 24 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.

• 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'.
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• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

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,

AKM Alamgir, PhD

Academic Editor

PLOS ONE

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If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #4: All comments have been addressed

**********

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

Reviewer #4: Yes

**********

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

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #4: Yes

**********

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

Reviewer #4: Yes

**********

Reviewer #4: The research article is a good synthesis of existing researches and reviews on managing obesity in children and adolescents, the preferences of these young people and their families regarding interventions focused on managing diet and physical activities. This review can help in shaping interventions according to the preferences of the people who are affected and are to be catered for. This review is supported by evidences are from lived experiences of people who have been directly affected, it has to be given a high standing and urgency in getting published or disseminated as it can help many.

The review is very comprehensive and informative with regard to the topic at hand. The data extracted from other reviews have been presented in a very clear and concise manner yet maintaining the integrity and completeness. The language used to report is very simple and clear making it accessible to all type of readers.

I congratulate the authors in completing a very important study which will add value to existing knowledge and help young people living with obesity.

I do have few suggestions which are minor:

General observation: The search methods and eligibility criteria described is very nice and comprehensive. However, I could not find any guiding research questions in the introduction, objectives or purpose to help in finding relevant reviews and articles and guide the whole process of the research.

76 Is it possible to specify the geographical location? Whether it is globally or in America or Europe? Similarly, regarding the geographic scope of this review, I understand it includes reviews and studies across continents. Is this review aiming to inform WHO regarding the preferences and values of young people and their caregiver’s globally? Although it does mention it cannot be generalized for every setting as the studies included are mostly from high income countries in the limitation. Hence, is it possible to give a geographic scope to the review?

142 Comma (,) after the word inclusion

143 Instead of “Mixed methods reviews were included”, which although correct is a little awkward, is it possible to change it to” Reviews that used mixed methods approach were included”.

316 The sentence structure is a little awkward to read. Maybe rephrase “such as to prevent health sequelae “to “such as preventing health sequelae”.

rephrase “to be” to “being”

rephrase “to gain” to “gaining”

35 Add the word “their” in front of the word “families”

Add the word “other” between the words “many commitments”

354 Change the word “few” to a comparison word such as “fewer” or rephrase the sentence to a comparison sentence.

382 The starting sentence is a little unclear. What do you mean by “such activities”? “The intervention activities such as physical exercises? Or diet management?

393 The information” This could create a sense of self-blaming.” Needs to be continued or explained as the following sentence does not explain it or connect with it.

411 Delete the word “the” in front of the word “home”

512 “On offer” sounds more casual. Can we change it to “available”

521 Is it possible to change “rued” to “complained” or another similar word. “Rued” sounds a little dramatic.

540 “On offer” if we can change it to another appropriate word

578 The title “The amount and nature….” This section does not specify anything about the amount of advice given. In my opinion it is more about the quality or nature of advice on types of intervention.

581 Delete the letter “e” between the words “provide” and “them,

598 Maintain the consistency and add “adolescents “to the topic as well?

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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 #4: Yes: Pema Yangzom

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Exploring the values and preferences of children and adolescents with obesity and their parents/caregivers concerning diet or physical activity interventions for weight management: Mega-ethnography of qualitative syntheses

PONE-D-24-58575R3

Dear Dr. Essat,

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,

AKM Alamgir, PhD

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

**********

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

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

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Reviewer #1: The submitted manuscript has been reviewed and found it satisfactory.

The author has incorporated all the suggestions

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Reviewer #1: Yes: Rakesh kumar gupta

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