The Impact of the COVID-19 Pandemic on Childhood Obesity and Lifestyle—A Report from Italy

Round 1

Reviewer 1 Report

The work I was to review concerns the impact of the COVID-19 lock-down in 2020 on BMI in children.

The manuscript is very weak in terms of text editing. Only the introduction has been properly edited, the remaining chapters need to be improved. All tables are unnecessarily large and unsightly. The references chapter has been poorly prepared (the wrong element of the bibliometric description is shown in bold) and important bibliometric data are missing in many places. Items 15 and 16 are unnecessary self-citations that can be easily removed from the manuscript without loss of context. Sources: 2 and 3 are completely impossible to find (incorrect bibliometric notation).

There is no data on the consent of the bioethics commission, there is no data on the form of compliance with the provisions of the RODO and others required in this type of research on children. 

The: discussion chapter needs to be completely improved. The participants number is limited, as is the number of variables observed. The individual values ​​of this project should be emphasized: what makes it different from other, numerous studies on this subject. Another element that has been overlooked is the fact that childhood obesity is increasing not only as a result of a COVID-19 lock-down, but is a phenomenon that has been observed before. Please indicate how this process looked like before and what is the change caused by the lock-down.

Conclusions cannot include source literature! It is a summary of the obtained results and the authors' conclusions after conducting a critical discussion of the available literature with application conclusions for practitioners dealing with the topic in the clinic. This is missing here.

Author Response

Thanks for your suggestions

please find attached our answer to your valuable comments

Author Response File: Author Response.pdf

Reviewer 2 Report

I read it with great interest, but I have raised several concerns.

#1. Please describe IRB and IRB number. This is very important.

#2. The chi-squared test was used to compare percentages. Nonparametric related- 124 samples test was used to compare BMI during the three monitored years -> Please cite the statistical guideline such as DOI: https://doi.org/10.54724/lc.2022.e1

#3. Please re-perform the statistics through SPSS version 26.0 (recent version).

#4. Kim MJ, Lee KH, Lee JS, Kim N, Song JY, Shin YH, Yang JM, Lee SW, Hwang J, Rhee SY, Yon DK, Shin JI, Choi YJ. Trends in body mass index changes among Korean adolescents between 2005-2020, including the COVID-19 pandemic period: a national representative survey of one million adolescents. Eur Rev Med Pharmacol Sci. 2022 Jun;26(11):4082-4091. doi: 10.26355/eurrev_202206_28978. PMID: 35731079.

Please see this paper. This is large-scale study. Please discuss about this paper.

#5. In limitation section, this is too short. Please describe in detail.

Author Response

Thanks for your suggestions

please find attached our answer to your valuable comments

Author Response File: Author Response.pdf

Reviewer 3 Report

The authors (AA) aim to changes in children’s weights, nutritional habits and physical activity during the first wave of COVID-19 pandemic in Italy. This is an article useful to increase our knowledge of the issue. Addressing all the issues below reported could make this manuscript eligible for the publication.

The title should be improved deleting COVID-19 disease (not considered) and reporting not only childhood obesity but also lifestyles.

Abstract:

Lines 16-17 and 18-21: AA should better explain the selected population (who are, age, where etc.).

Lines 22-25: AA should report results about sweet consumption and physical activity.

Introduction:

Lines 42-43: AA should add references such as:

 

⁻          Zhu, X.; Haegele, J.A.; Tang, Y.; Wu, X. Prevalence and Demographic Correlates of Overweight, Physical Activity, and Screen Time Among School-Aged Children in Urban China: The Shanghai Study. Asia-Pacific journal of public health 2018, 30, 353 118-127, doi:10.1177/1010539518754538.

⁻          Paduano S, Borsari L, Salvia C, Arletti S, Tripodi A, Pinca J, Borella P. Risk Factors for Overweight and Obesity in Children Attending the First Year of Primary Schools in Modena, Italy. J Community Health. 2020 Apr;45(2):301-309. doi: 10.1007/s10900-019-00741-7.

⁻          Kumar, S.; Kelly, A.S. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clinic proceedings 2017, 92, 251-265, doi:10.1016/j.mayocp.2016.09.017.

⁻          Paduano S., Greco A., Borsari L., Salvia C., Tancredi S., Pinca J., Midili S., Tripodi A., Borella P., Marchesi I. Physical and Sedentary Activities and Childhood Overweight/Obesity: A Cross-Sectional Study among First-Year Children of Primary Schools in Modena, Italy. Int J Environ Res Public Health. 2021 Mar; 18(6): 3221. doi: 10.3390/ijerph18063221.

 

 

Lines 63-66: in which population?

 

Materials and Methods:

 

Lines 69-75: Why was this population selected? Is there a risk of selection bias, did AA evaluate this aspect? how was the "convenience sample" defined? What selection criteria (age, affiliation etc.) were used?

 

Did AA consider the possible association with socio-demographic characteristics of families?

 

Lines 98-100: Check reference.

 

Lines 122-123: Are continuous variables normally distributed?

 

Lines 124-125: Why did the authors use nonparametric tests?

 

Results:

 

Lines 150-154: AA should report these data in the table 2.

 

Discussion:

 

Lines 188-191: In the light of the data presented these statements are a little bit speculative. Is there any supporting literature?

 

Table 3: This is useful to better understand the results of each study, but I suggest tha AA report this as supplementary materials. This table in not exhaustive of the existing literature.

 

Lines 225-232: AA should add the limitation about the selected population.  AA should underline that they cannot generalize their results for this. Moreover, AA should evaluete the possible association not only with parents BMI but also with socio-demographic characteristics of family.

 

Conclusion:

 

AA should improve their conclusion considering not only nutrition habits but also physical activity. Moreover, I suggest that AA delete the link between physical activity and COVID-19 infection (this is not linked with their results).

 

Author Response

Thanks for your suggestions

please find attached our answer to your valuable comments

Author Response File: Author Response.pdf

Reviewer 4 Report

With interest, I read the manuscript entitled "Childhood obesity and COVID-19 disease: an Italian report from the first wave of the pandemic"

First of all, I have to notice the inadequate title. Although you are processing and comparing 2019, 2020, and 2021, you mention the first wave in the title. Design the entire study for pre-pandemic (pre-COVID) and pandemic (COVID) times.

Please write the abstract by the instructions for the authors. No separation required.

In addition to specific indicators of the proportion of obese children, please also touch on the trends of recent decades in the introduction -> https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Compare Italian trends with global ones.

In materials and methods, it is not necessary to emphasize that the study was conducted according to STROBE guidelines.

When you talk about employers' children, it would also be useful to write down which provinces of Italy the children came to the program from, given that we know that not all provinces experienced the waves of the pandemic with the same intensity.

Please check the LINK to the questionnaire as it is not working. Also, suppl. materials cannot be opened.

You used non-parametric statistics to compare BMI. Please explain. Which test exactly did you use? Have you done a distribution test?

Authors should use trend analysis or compare "weight rates", "BMI rates" etc. in the same month of previous year with rates during COVID to obtain results that match the study objective.

Also, in table 2 , the Percentage Change should also be shown in addition to the above data. Please add it so readers can follow the data more logically.

Throughout the entire study, it would be logical to use the phrase before and during the COVID-19 pandemic, and not before and after the first wave of the pandemic.

Also, it would be useful if the authors calculated the correlation between anthropometric indicators and answers in the questionnaire before and during the pandemic (for indicators for which it is possible to calculate).

Please put table 3 in suppl. materials.

What other confounders could you list as a limitation of the study?

Please remove the reference from the conclusion, because it is not customary for the conclusion to contain references, but only the conclusions of one's own study.

Please write references in accordance with the instructions for authors. Proofreading of the English language is required.

Author Response

Thanks for your suggestions

please find attached our answer to your valuable comments

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The title: “Childhood obesity and lifestyle and COVID-19 disease: an Italian report” contains to many AND. Remove the firs one.

Line 22: missed dot.

Line 63: missed space

Line 71-72: wrong text edition

Line 75-146: the text was not justified

Line 75 (and many other places in the manuscript): no indentation at the beginning of the paragraph

Line 105: (Osservatorio sulle Eccedenze, sui 105 Recuperi e sugli Sprechi Alimentari) use italics when non-English names are used

p-value: use italics for p

Table 1 and 2: they are still unnecessarily large and unsightly. The legend under table 1 does not have to contain such large line spacing. Write all explanations on one line in a smaller font.

Line 217: Moreover, in a recent report [33] Kim et al. reported – the style of this sentence is incorrect.

Discussion: there is still no indication of the trend of increasing BMI in children in the years before the pandemic.

Conclusions: The cover letter said that the conclusions were corrected. Unfortunately, I do not agree with that. As it stands, the conclusions are still too vague and do not relate to the precise data obtained in this study. They do not emphasize the uniqueness of this research, as I indicated in previous comments, and do not provide direct application conclusions, i.e. there is no information or guidance for practitioners who deal with the problem of childhood obesity.

Author Response

Thanks for your precious suggestions.

We changed the title.

We corrected the mistakes all over the manuscript.

We tried to improved style of both tables: however, we will further improve them as soon as the editor will get in touch with us, trying to finalize the paper. We think to do better with that version, in MDPI manuscripts editing process.

We modified the conclusion, following your suggestions.

Reviewer 2 Report

This is an excellent paper.

Author Response

Thanks!

Reviewer 3 Report

The authors (AA) have carefully addressed the reviewers' comments. Overall the changes made have improved the manuscript, but there are some points to better clarify.

The title should be improved deleting COVID-19 disease.

Abstract:

AA should better explain the selected population (who are, age, where etc.).

Author Response

Thanks for your precious suggestions.

We changed the title.

We improved method section of the abstract: children were selected among Ferrari car company employeers' children. Sex and age are presented in result section of the abstract

Reviewer 4 Report

I suggest the following title; “The impact of the COVID-19 pandemic on childhood obesity and lifestyle - a report from the Emilia Romagna region"

Please, between years, show the results in percentage changes as well.

Given that you have the data, why not show in this manuscript the correlation between anthropometric indicators and questionnaire responses before and during the pandemic (for indicators that can be calculated)?

Author Response

Thanks for your precious suggestions.

We changed the Title.

We addedd a Figure 1 with changes in BMI classess percentages between 2019, 2020 and 2021: I hope that this is good for you, since it better clarifys graphically these differences

Unfortunately we could not analyze the correlation between indicators and questionnaire responses in only 5 days since the researcher who own these data is momentanely out of office: it would have been difficult to us and we were afraid to do a bad work. However, we addedd this interesting aspect to the "future direction paragraph" of the discussion

Hope that this could be enough for you to go ahead further in the reviewing process