Reviewer’ s report
Title: #Ihaveembraced: A pilot cross-sectional naturalistic evaluation of the documentary
film Embrace and its potential associations with body image in adult women
Version: 2Date: 25 Jun 2019
Reviewer: Viren Swami
Reviewer's report:
This is my second review of this manuscript. In my original comments, I was - unlike two other
reviewers - much more critical of the submission and (I hope) clearly identified my concerns. Theauthor(s) have now submitted a revised version of my manuscript, which deals with some - but notall - of my concerns. Most pressingly, I am afraid that given the cross-sectional design of the studythe author(s) are unable to deal with my central concern: that they are likely important confoundsthat in the data and, as such, the conclusions the author(s) are trying to draw cannot be supported.In response, the author(s) write that this study was unfunded (which is neither here nor there) andthat it was preliminary. I don't see how this gets around the central point that the conclusionscannot be supported without additional data. Let me try and unpack this issue in more detail. Theauthor(s) argue that women who had seen Embrace had more positive body image than those whohad not. As I have said before, it is quite possible - and in fact highly likely given the nature of thefilm - that any differences preceded the film. That is, women who had more positive body imageand/or less negative body image were more likely to seek out and watch the film. The author(s)suggest, in response, that their qualitative data support an interpretation that the film was the causeof any between-group differences, but to repeat this point: that conclusion cannot be supported inthe absence of additional data. Framing the study as preliminary does not get around that central
point. Another, related point: even assuming that there were no between-group differences prior to
watching the film, it is still possible that it was not the film per se that resulted in anyimprovements to body image, but rather a whole repertoire of behaviours that may or may nothave included watching the film. I am minded again to suggest that the present data are toopreliminary to warrant publication. Why not use this as a basis of conducting a follow-upexperimental study, which is reported concurrently? Surely that would make for better use of thepresent data and would also allay my concerns. Until such time that additional data is available, itis (in my view) wholly unjustified to claim that it was viewing Embrace that resulted - or even wasassociated - with improved body image. There are other, equally plausible explanations for thepresent findings; merely mentioning those alternative explanations when discussing limitations ofthe study design is, in my view, unjustified. Likewise, simply reframing the study as "preliminary"without in fact dealing effectively with the central problem is misleading. (Note also that talkingabout "associations" still gives the impression that there were in fact associations; in the absence ofadditional data, such a conclusion is unwarranted.) I don't want to belabour this point, but it is anessential one about the interpretation of data and what sorts of conclusions we can and cannotdraw based on cross-sectional data. I would perhaps be more forgiving in this current review hadthe author(s) been more forthcoming about some of my other concerns. To summarise:1.To claimimplicitly or explicitly that Embrace might provide the core of an intervention for promoting
healthier body image is, at this time, unwarranted. It is quite possible that it could - at some point
in the future - be developed as such, but right now the author(s) simply have not got the data to
support such a claim. Hence, my argument earlier that reflections about other interventions isunwarranted. One might also make a simple argument: given other interventions *do* exist, whatare scholars supposed to conclude based on this study? That it has potential? But so do many otherpotential interventions. I just don't see what value there is in making an implicit claim thatEmbrace could provide the core for a future intervention in the absence of stronger data supportingsuch a claim. 2.The evaluation of positive and negative body image in the Introduction iswelcome. But this needs to be more strongly tied to theory. Why should we expect that watchingEmbrace will be associated with changes in both positive *and* negative body image? What is
theoretical underpinning of this claim?3.The author(s) side-stepped my question about whether the
measures they included were suitable for an international audience. Merely indicating that allparticipants responded in English does not get around the fact that the measures they included maynot demonstrate measurement invariance across national contexts, even if completed in English.One way to resolve this would be to remove all participants not from predominantly English-speaking countries. 4.It turns out the author(s) have another study based on the same dataset. Itwould be useful to know what that study is and whether there is any overlap with the current study.5.The author(s) declined to report omega in place of alpha because it is "widely used" in the field.That fact is irrelevant I'm afraid. There are good reasons to think that alpha is deficient (see Dunnet al., 2014, British Journal of Psychology). This seems like such a simple change to make and Ido not understand the author(s)' reticence to make the change. 6.I see that another reviewer askedthe authors to control for when the film was seen. This makes conceptual sense: one would expecta dose-response effect, i.e., the more recently the film was seen, the stronger the effect. If theauthors have the data, they should run the additional tests. 7.The use of qualitative data to supportthe conclusions of the quantitative data is problematic. There is no real attempt at propertriangulation here. Is it also possible that respondents were primed to think about the film inpositive terms when responding to the qualitative questions? Note also that the nature of the open-ended questions mean that inferring triangulation should be avoided.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
NoAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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