Reviewer ’s report  
 
Title: Weight management barriers and facilitators after breast cancer in Australian women: a  
national survey  
 
Version: 0 Date: 25 Apr 2020  
 
Reviewer's report:  
 
Reviewer comment  
Weight gain after breast cancer diagnosis had been described. Numerous studies have reported 
multiple reasons to explain the weight gain. The authors used an online survey to describe 
current practice among Australian women with breast cancer. The topic is important; however, I 
need more information to understand: (1) study sample - who your study population is, (2) how 
the authors designed survey questions to understa nd barrier for weight management, and (3) 
what are the associations between your barriers and weight change. I included my comments 
below.  
  
Major comments:  
1. Numerous studies have used data from large cohort studies to understand factors 
associated with weight gain after breast cancer diagnosis. What does your study add to the 
current literature? The introduction needs to be very specific to clarify what your p aper adds to 
and improves current understanding.   
2. It is important to know who your study sample is such as numbers of people you 
contacted, and responded. "The survey was emailed on December 5th, 2017 and a reminder 
email was sent to 1835 members on Ja nuary 15th, 2018 (Appendix 1). Also, the authors 
mentioned additional recruitments from online communities to avoid sampling bias. What was 
your break down in your recruitment and differences in characteristics by methods of 
recruitment? If you are not pla nning to include details about the recruitment, I recommend 
placing a reference (i.e., previous publications that used this dataset).  
Line 87: "In an attempt to reduce sampling bias, we also recruited women from online 
communities (women's health organiza tion social media pages, online breast cancer support 
groups in Australia) and through word of mouth."  
3. The authors explored barriers and facilitators for weight changes after breast cancer 
diagnosis. As described in introduction, previous studies have i ndicated that weight gain after 
diagnosis of breast cancer multifactorial. Did the authors use theoretical frameworks or 
conceptual models to guide how you structured your study questionnaire?  
4. Reviewing your result tables, your participants are with rel atively good social 
economic status (education, employment rate, relationship status), good lifestyle behaviors (diet, 
exercise, alcohol, smoking), few comorbid medical conditions and high self -rated health. I would 
like to know more about your study sampl e including age, menopausal state, BMI, cancer 
treatment and stage at the time of survey, because these factors had been reported to affect 
weight status but also barriers to exercise or healthy diet.  
5. Were there associations between subjective weight c hanges after diagnosis and 
examined variables? It will help to find out which factors accounted more for weight loss, gain 
or maintenance after diagnosis.   
 
Minor comments  
1. Physical activity is listed as PA or physical activity throughout the manuscrip t. Please 
be consistent.  
2. All figures need figure number sand legends.   
3. Line 67: "Australian expects to diagnose more than 25,000 new cases of BC annually 
by 2040." Please rewrite this sentence.  
4. Line 99: "In this manuscript we report on how women  were managing their weight, and 
the perceived barriers and facilitators." Please clarify perceived barriers and facilitators for what. 
Also, how you came up with these questionnaires.   
5. From the authors, sample size, and the recruitment method, I belie ve this is an analysis 
using the same dataset of previously published paper in BMC cancer 2020. If that is the case, 
please place the reference of your original paper so that we will have more information on the 
study. I would recommend a brief summary on your study samples in your methods and results 
even if you place your previous paper as a reference.  
6. Were any of study questions/scales related to weight after diagnosis validated or used 
in other studies?  
7. There are many validated physical activity  questionnaires to assess MET. Please clarify 
how you assessed physical activity level. I was not able to use reference 11 to find out which 
measurements and methods were used.  
Line 119: "Physical activity levels were calculated according to the number of  20-minute 
sessions of less vigorous exercise or more vigorous exercise a week, given a weighting and 
described in terms of MET (metabolic cost) minutes where MET minutes less than 80 were 
coded as no physical activity, 80 to 400 as low, 400 to 560 as mode rate and more than 560 as 
high. A value of 4 METs was given to moderate physical activity and 7.5 to vigorous physical 
activity (11)."  
8. Line 150 -153.  Pre -cancer self reported weight is described as "kg." Previous studies 
have shown worse outcomes in wom en who gained weight who had pre -cancer BMI &lt;25. 
Please include pre -diagnosis BMI.  
9. Line 295 -296: Please clarify the following sentence.  "Our findings also suggest a gap 
in translation of the evidence on exercise as a treatment for postcancer fatigue ." 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an add itional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any w ay gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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