Title: Eating Behaviors, Attitudes, and Beliefs that Contribute to Overweight and Obesity
among Women in Lilongwe City, Malawi: A Qualitative Study
Version: 1 Date: 15 Mar 2022
Reviewer's report:
Overall Comments:
• Authors of this study investigated the eating behaviors, beliefs and attitudes of Malawian
women of different body habitus. The authors provided a well-written manuscript on an
important topic. A major suggestion will be to highlight how participants felt about their weight
gain, as I was left confused of whether participants felt this was a beneficial thing (as they dieted
but discussed that weight gain was expected and somewhat good.) I am also curious whether
there were any differences in beliefs between those with and without normal weight. I also
recommend using person-first language throughout the manuscript.
ABSTRACT
• Clearly written abstract.
• Line 22: Person-first language is encouraged. Therefore, rather than stating that women are
overweight or obese, it is recommended that we use “women with BMI in overweight/obesity
categories”.
• Line 27: Recommend revising “13 normal weight and 14 overweight/obese women” to “13 in
normal weight range, 14 in overweight/obesity ranges.”
• Please provide a sentence about data saturation in the methods.
• In the results, please include percentages and/or the number of participants who responded
(e.g., sentences where “majority” or “most” are used)
• Recommend checking for person-first language throughout the manuscript.
• For the results section, recommend ensuring that the paragraph is in past tense.
INTRODUCTION:
Major Comments:
• Recommend authors make a stronger case for examining why Malawi specifically. In the
previous paragraph, the authors state that in Sub-Saharan Africa (which includes Malawi, I
believe) that individuals in low-income households overeat and rely on ultra-processed cheaper
foods. They also discuss the beliefs toward weight status. However, the next paragraph, they state
there is a dearth of information on women’s eating behaviors and their beliefs on weight status.
While I agree with the authors that it is very important to investigate the beliefs and practices
of Malawian women, I recommend a sentence or two about why it’s important to investigate
within this population.
Minor Comments:
• Line 46: Please revise to “Overweight and obesity rates are increasing globally…” Please do
the same with the other sentences
• Line 56, Please change the semicolon to a comma after “portion size [10]”
• Line 57: Healthy women – do you mean women with a BMI considered healthy weight or do
you mean without disease? Please clarify.
• Line 59: Please revise “ones” to “one’s”
METHODS:
Minor Comments:
• Excellent job walking me through the method process.
• Line 128-129, the sentence on reviewing against the quotes to avoid losing meaning is a bit
unclear to me. Could the authors rephrase?
RESULTS:
Major Comments:
• Recommend reorganizing the results section a bit differently. Due to how the authors titled
the manuscript, it would be easier for the reader to read about the eating behaviors first, and
then the attitudes and beliefs that could contribute to those eating behaviors and obesity. Eating
behaviors can also help orient us with the population’s current dietary practices.
• Recommend including number of participants when using “Most.”
• Line 193: Did the overweight/obesity group ever discuss about finances? If not, the authors
could mention the absence of any financial-related discussion to draw out the differences
between the two groups (normal weight vs. overweight/obesity groups).
• It seems as if there are no differences between the two groups any of the themes within attitudes/
beliefs. Is this correct? If that’s the case, I remain confused of why respondants within normal
weight ranges would be dieting (Line 186) if there is a social expectation that women need to
gain weight. Please provide further results on this or address this in the discussion. I think what I
may not be grasping in this manuscript is how the women feel about the weight gain. Do they feel
some weight gain is good, but now it’s going to the extreme? Are there differences in attitudes/
beliefs between those with and without overweight/obesity?  Please address.
Minor Comments:
• Line 138: Please revise to “… 26% had obesity.”
• I recommend reorganizing the results section a bit differently.
DISCUSSION AND CONCLUSION:
Major Comments:
• Please provide citations to rationale and sentences that discuss concepts outside of the actual
results of the study. For example, Lines 234 to 236 (energy requirements and adipose tissue).
• Please provide citation for Line 252 and revise “bavioural” to “behavioral.”
• Lines 255 to 259 is a run-on. Please separate into two sentences.
• Please rephrase 290-293. I am a bit lost as to the message.
• Line 299: Please revise “purposifully” to “..to conduct purposive sampling in this ancillary
study.” Please revise this in the abstract as well.
• Recommend really explaining how participants feel about their weight since the dieting implies
that they want to change their weight, but the conclusion states that they prefer to gain weight.
This delineation should be made clear.