Responses to reviewers
Associate Editor comments
" Two independent reviewers have assessed you manuscript. We are sorry to say
that we are unable to accept the proposed manuscript in its current form. However,
we would be ready to reconsider our decision if you could address in a detailed way
all of the reviewers’ comments.
The most important comment, with which the Associate Editor fully agrees, is related
to the critical lack of references incorporated in the paper.
We would like you to follow exactly all of the reviewers’ comments on this issue, i.e.,
considerably increase the number of references in all parts of the article and update
the references (by providing numerous references from the last few years). We
would like you to note that we will transfer your revised manuscript to the reviewers
(if you decide to revise it) and will ask them to specifically assess whether the
reference list was sufficiently completed and updated.
 We have added citations – mostly from articles published within the last
five years – throughout the article, bringing the total number of
references up from 39 to 122.
Another important aspect is that you should perhaps try to reach a more balanced
point of view between policy interventions and community based interventions
following the arguments provided by Dita Wicvkins-Drazilova, or at least indicate
very clearly in your manuscript why you do not agree with these arguments."
 The paragraph comparing policy interventions with community-based
interventions has been revised to reflect the reviewer’s concerns, and to
include the reviewer’s valuable comment regarding the ability of
community-based interventions to target low socio-economic and
education groups (pages 9 and 10, lines 189-205).
Reviewer's report 1
(1)
Title:
Public health campaigns and obesity: A critique
Version:
1
Date:
3 November 2010
Reviewer:
Robin McKinnon
Thank you for the opportunity to review your manuscript. The issue of alarming
high obesity rates are of great concern globally, and policy-level interventions
appear to be important tools to improve diet and activity behavior, and reduce
obesity levels. However, I have several major concerns about the manuscript in its
current form. These concerns are broken into the areas below.
Major Compulsory Revisions
1. For every declarative statement, one or more citations must be included. The
number of cases are too numerous to mention here, but using the Background
section as an example, each of the sentences here should have one or more
citations from authoritative sources, preferably published in the last five years.

We have added citations – mostly from articles published within the last
five years – throughout the article, bringing the total number of
references up from 39 to 122.
2. Update your citations. Many of the citations currently used to substantiate the
points you are making in the text are outdated. This is a fast-moving field, with
new results becoming available all the time. For example, using only one citation,
(from 2004) to substantiate the point "The industry has strongly opposed
legislative and regulatory approaches that encourage healthy eating when these
may restrict its profitability" seems inadequate.
 The citations have been updated throughout the article, so that most
citations are now from articles published within the last five years. To
substantiate the point the reviewer has used as an example (page 10,
lines 207-209) there are now 3 references, 2 of which have been
published in 2010.
3. Related to the above points, I don't feel you provide enough substantiation
throughout the paper, via citation, or by conveying rigorous methods of having
adequately surveyed the literature, to support the argument your paper develops.
Considerable updating and revision of citations would help address this concern.
For example, in the Discussion, 4th para, you say that "There is sparse evidence
that even the most well-designed of such interventions are effective at
addressing obesity, either weight gain or maintenance, and virtually none in the
long term", with one citation, from 2002. For such a statement, I would expect 5+
citations, preferably published within the last 5 years.
 The number of citations has been increased throughout the article and
some textual changes have been made to improve the clarity of our
arguments, and/or nuance our argument. (Examples of textual changes
to nuance the argument are: page 3 line 54, page 4 lines 76, 77, 83, 84,
page 7 lines 142 and 143, page 9 lines 190 and 191). To substantiate the
example the reviewer has mentioned (page 4, lines 80-82), there are now
6 references, 4 of which have been published in the last 5 years.
Minor Essential Revisions
1. Define clearly whether your paper and its recommendations refer to all
developed countries, to a subset, or to Australia only
 The paper refers to all developed countries. Accordingly, we have
added “in all developed countries” to the abstract (page 2, lines 29-30).
Australia is only mentioned once the article (page 10, line 223) as an
example illutsrating likely future obesity levels in developed countries.
2. Define what you mean by "community-level interventions." The distinction
between community-level interventions and policy and legislative changes(your
recommended approach) is not clear to me. For instance, calorie labeling or
mixed use zoning changes might be considered by some to be both
community-level interventions, and policy/legislative changes (at the local
government level), and therefore seems confusing.
 We have added further detail to the explanation of community-based
interventions and social marketing campaigns for obesity reduction and
how we differentiate them from regulatory interventions (page 3, lines
61-67). The terms “community-level” and “community-wide” have been
changes to “community-based” (page 6 line 125; page 9 line 192).
Reviewer's report 2
Title:
Version:
Date:
Reviewer:
Public health campaigns and obesity: A critique
1
28 September 2010
Dita Wicvkins-Drazilova
Major Compulsory Revisions:
This is a good review paper, which uses many interesting references. I generally
agree with the main message of the paper that policy and legislative changes
focused on healthy eating and physical activity are more beneficial than
community-based interventions and social-marketing campaigns focused on
obesity. However, this claim is not properly argued or based on strong evidence.
The main argument you use is not logically sound: you state that proper evidence
of benefits of community-based interventions and social-marketing campaigns
focused on obesity is missing, and then argue that policy and legislative changes
focused on healthy eating and physical activity will be beneficial. However, there
is also no (or very little) evidence that these will be beneficial at all.
 We agree that the logic regarding these issues requires strengthening.
Accordingly, we have set out that “there is currently little evidence... in
support of a regulatory approach to addressing obesity...” (page 7, lines
148-150). We have couched this statement in a new paragraph
describing past successes in public health using regulatory reform,
including an analogy from tobacco control, and suggest such an
approach would also be highly likely to appropriately address obesity
(page 7, lines 146-160).
You also need to explain why you dismiss the idea of community-based interventions
and social-marketing campaigns focused on healthy eating and physical activity.
 Community-based interventions and social marketing campaigns
focused on healthy eating and physical activity have been dismissed
based on the fact that such interventions rely on individual behaviour
change and are thus ineffective. To clarify this, the explanation of this
has been rewritten (page 7, lines 136-145). An explanation of the
historic achievements of regulatory approaches to public health has
also been added (page 7, lines 146-160).
Also, there is no mention of other factors that might have impact on obesity
levels, such as stress, lack of sleep or socio-economic factors.

A mention of the impact of stress and lack of sleep on body weight has
been added (page 4, lines 78-79). We have also added further
discussion of inequalities in obesity by socio-economic status (page 9,
lines 189-203).
Below are other comments to various parts of the paper:
1) Second last sentence of 'Background': I would recommend replacing the word
'normal body weight and shape' with 'healthy body weight and shape'.
 This change has been made (page 3, line 56).
2) First sentence of second paragraph in 'Discussion' (starting with “Most
community-based...”: It is a very strong statement. What evidence is it based on?
 The statement has been modified to reduce its strength and provide a
more nuanced perspective. Six citations have been added to
substantiate the point (page 4, lines 75-78).
3) Second last sentence of second paragraph on pg. 4 (starting with “The only
substantially...”): Again, a very strong statement. What evidence is it based on,
one reference?
 The statement has been modified to reduce its strength and provide a
more nuanced perspective. Eight citations now substantiate the point
(page 4, lines 83-85).
4) Last sentence on pg. 4: The paper referenced (10) is on adolescents and
young women, so I would recommend saying “young women and female
adolescents” instead of “women”.
 This change has been made (page 5, line 96).
5) Whole third paragraph on pg. 5 (starting with “Anti-obesity...”) This whole
paragraph is based on no references. It also doesn't mention serious negative
effects of pharmaceuticals.
 This paragraph (pages 5 and 6, lines 108-113) is now supported by
seven references. A mention has also been added of the adverse effects
of pharmaceuticals (pages 5 and 6, lines 111-112).
6) Whole fourth paragraph on pg. 5: Affordability is surely not the only problem of
weight-loss surgeries. There are very serious risks associated with all types of
weight-loss surgeries – this is well described in existing literature.
 A mention has been added of the serious adverse effects associated
with surgery (page 6, lines 120-121).
7) First sentence of second paragraph on page 6 (starting with “The history...): It
is a very strong statement. What evidence is it based on?
 Four citations have been added to this statement, which has also been
slightly modified to provide a more nuanced perspective (page 7, lines
136-140).
8) Last sentence on page 7 (starting with “Without such a whole-system...”): This
is not a possibility, it is already happening. For example, the system of
subsidizing fruit and vegetables and increase taxation of 'unhealthy' foods is
already undermined by strong agricultural subsidies into production of sugar,
meat or diary products (in both the US and EU.)
 We agree, and have added the reviewer’s example to the paper (page 9,
lines 185-188).
9) Second last sentence of the first paragraph on page 8 (starting with “Policy
and legislative...”): It is false to believe that policy and legislative changes
focused on healthy eating and physical activity will have the same effect on all
population. For example, the system of subsidizing fruit and vegetables and
increase taxation of 'unhealthy' foods might simply lead increased costs of foods
for populations with low SES and poor education, while decreased costs of foods
for populations with high education and higher SES. On the contrary,
community-based interventions can focus specifically on areas (e.g. schools)
with high density of families with low SES and poor education.
 This paragraph has been revised to reflect the reviewer’s concerns
(page 9 and 10, lines 189-205). A mention has been added of the
potential for community-based interventions and social marketing
campaigns to address low socio-economic groups and people with
poorer education levels (page 9, lines 195-197). An addition has also
been made which sets out which type of policies are more likely to have
a whole-population reach. Supporting citations have also been added
(page 9, lines 197-202).
10) Second last sentence on page 8 (starting with “Improved high-risk...”) This is
questionable and needs to be defended; there are serious risks associated with
all types of weight-loss surgeries.
 Four citations now substantiate this point (page 10, line 220).