Title: TITLE A randomized controlled trial to evaluate the acceptability and effectiveness of
two eating disorders prevention interventions: The HEIDI BP-HW project.
Version: 1 Date: 22 Feb 2023
Reviewer's report:
This manuscript addresses a need for prevention programs for body image concerns in the
French-speaking region of Switzerland. The authors compare two active interventions to a wait
list control condition. Comments intended to strengthen the manuscript are below.
Review
1. In the abstract, the authors should include the prevalence of eating disorders in Switzerland.
2. After reading the abstract, it is not clear whether there were differences between the
intervention conditions on outcomes.
3. In the abstract, the authors should be clearer about what aspects of the study were not feasible.
Make clear what was assessed to determine feasibility.
4. The authors hypothesize no differences between intervention conditions. The reader may
wonder why both interventions are being tested if they are both expected to be effective. Please
provide more justification for this in the introduction.
5. The numbered hypotheses and bulleted inclusion and exclusion criteria are distracting. I would
recommend the authors use paragraphs to present this information.
6. Participants section should include how many were randomized to each condition.
7. Including the proposed sample size in the participants section is confusing. Please report
the total N collected as well as the n per condition in the participants section and remove the
proposed N.
8. Why did the WLCG receive the body project intervention after waiting if both prevention
interventions were hypothesized to be equally effective? Please provide justification for this.
9. Please clarify in the methods section whether self-reported weight and height have been shown
to be consistent with measured height and weight and provide citation.
10. The criteria for what the authors deem “acceptable” seems arbitrary. Please explain how
the authors determined these criteria. If the criteria are not based in prior literature, I would
recommend the authors simply report the mean of scores and use descriptives to interpret the
score rather than creating a dichotomous “acceptable/not acceptable”.
11. The authors should include information about how many participants will be used in analyses
within the text. Is it 33?
12. Please explain the issues with normality and homoscedasticity that were found.
13. Provide a citation rather than link to a website in the text for Wilcoxon effect size.
14. The first sentence of the results section is out of place and would fit better as a limitation
in the discussion.
15. Please be more specific when reporting nationality if possible (e.g., which other countries
were participants from?).
16. The authors report that “No significant differences emerged between the interventions from
the comparisons between the scores on the satisfaction subscales.” I cannot find a report of the
statistical test for this statement in the manuscript. Please report the results of this test.
17. The authors report “Regarding feasibility, the number of participants who did not start the
intervention was comparable between the BP and the HW (n=2 in BP and n=2 in HW).” This
should be a chi-square test and should be reported in the manuscript.
18. Why were the interventions not compared to each other. Each is compared to the control
condition, but it would be important to know whether they are statistically different from each
other.
19. In general, the authors should report p-values and effect sizes for statistical tests in the results
section at minimum.
20. Figure 2 is a very helpful visual. Is there a way to change the y-axis labels so that it is easier
to interpret?
21. The authors state that all hypotheses were confirmed, but the study was not shown to be very
feasible. This should be clearly stated in the first paragraph of the discussion.
22. Why did the authors chose not to conduct intent to treat analyses? Why did they exclude
participants who did not finish? Should do some comparison of drop outs vs completers if you
are going to exclude them
23. Overall, word choice, grammar, and phrasing should be edited with a close eye. For example,
the authors should remove or replace the term “fat-free” when describing the thin ideal. There
are numerous concerns with word choice and sentence phrasing throughout.