To increase transparency, PeerJ operates a system of 'optional signed reviews and history'. This takes two forms: (1) peer reviewers are encouraged, but not required, to provide their names (if they do so, then their profile page records the articles they have reviewed), and (2) authors are given the option of reproducing their entire peer review history alongside their published article (in which case the complete peer review process is provided, including revisions, rebuttal letters and editor decision letters).
The authors have update the manuscript carefully taking into account the suggestions of the reviewers.
Please update the manuscript according to the inspired comments of the two reviewers, thank you.
Nothing to report here. All reporting standards appear to be met from my perspective. I did not see a statement about conflicts of interests or funding but presume it has been submitted separately. All data is included in the manuscript.
One of the probabilities used at Step 6 (0.001) needs to be confirmed as I suspect the incorrect denominator may have been used. There is also an inconsistency between the probabilities of Step 7 between the text and the Figure (see my notes on the PDF file).
My only other minor concern is the description of the statistical analysis which suggests the use of simulations without describing the method in details. In fact, simulations are not needed since one is able to calculate the cumulative probability by multiplying the probabilities at each stage within each of the 4 possible "paths" (one split at Step 2 + one split at Stage = 4 possible scenarios) of the flowchart and then calculating the sum of those 4 probabilities.
I would therefore suggest removing any reference to modelling and simulations as those terms suggest more complex computations than what is required here.
The conclusions otherwise reflect the results and the authors acknowledge the main limitation which is the large number of assumptions made when calculating the probabilities at each stage.
I have added some notes/comments directly in the manuscript PDF (see attached).
The present paper contains sufficient introduction and background material to set the context for this paper. The paper is clearly separated into relevant sections.
A few minor points the authors may like to take on board:
It would be beneficial for the reader if the sentence in line 28-31 was more concise/clearer.
At the end of the sentence in line 37-39 it states e.g., with refs (5-8). Would be useful to note some examples and then back up with the references, or, get rid of the e.g. (5-8) and just reference the statement.
Lines 44-55: rather than listing these it might be preferable to just refer to the figure
Line 69: replace with - aged 12 years
The authors do acknowledge in the discussion the limitations with the accuracy of probabilities, however, my main comment on the methods/results is the use of ‘assumptions’. The term assumption is used repeatedly in the result section and is not a v scientific term. Some improvements could be made, for example, in step 2 lines 107-108 the authors reported an average of 2 PCP visits – is it not possible to have used the data to calculate the range of visits as opposed to saying we assumed 3 and 1 visit as best/worst case estimates? If this is what the authors did it is not clear and should be re-worded.
Line 140: ‘will likely be limited to’ – can this be changed to include what topics are covered in the discussion and so remove the ‘assumption’
As above, the findings are based on a considerable number of assumptions, however, the overall conclusions are satisfactory
Overall this is an interesting paper, I’m not convinced that ‘what are the odds?’ at the end of the title is suitable.
The topic of primary care management of childhood obesity is highly relevant considering the current levels of childhood obesity nationally and internationally. The points noted by the authors such as initial recognition/measurement by health professionals; referral of children to weight management programs are appropriate conclusions. How to transfer this into practical application is the challenge.
All text and materials provided via this peer-review history page are made available under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.