Dear Dr Groves
Re: Paper: 'Increasing levels of obesity in primary school children'
We were delighted that the BMJ is interested in publishing our short report. I enclose a copy of the revised paper and disc, along with our response to the two referees.
Yours sincerely
Dr Mary Rudolf
Consultant Community Paediatrician
Revisions made to paper :
Increasing Levels Of Obesity In Primary School Children: a cohort study
Referee 1: Dr J McKiernan
| 1. | Reference 6 corrected to read reference 5 |
| 2. | Both referees correctly wondered why we cited the 1962 Tanner reference for triceps standards. We had in fact inadvertently made an error in citing these standards. The standards were revised in 1975, and these revised references were used in the Castlemead Growth Package that we used to interpret our own data. I have revised the reference accordingly. |
| 3. | The referee suggested we might speculate on the whether a new pattern of obesity might be emerging. We have not attempted to do this, as we have now discussed our findings in relation to D Chinn's work and thus space was not available |
Referee 2: Professor T Cole
| 1. | The sentence at the foot of page 2 has been corrected to read "These definitions set the percentage expected to be overweight at 15% and obese at 5%, relative to British children in 1990". |
| 2. | The table has been corrected to give data to only one decimal space |
| 3. | We had not intended to imply trend, which we were unable to test for as the data set was semilongitudinal. We have therefore adjusted the last sentence of the results section to read "A significant increase in the proportion of overweight and obese children was observed in children aged 9, 10 and 11 years." |
| 4. | As noted above the standards were in fact 1975. The relevant sentence has been revised to read: |
| "Anecdotal evidence suggests that these standards were based on overweight children [6], and this may prove to be the simple explanation. However, a larger study is required to establish new references." | |
I have attempted to compare our results with those from the National Study of Health and Growth as suggested by Professor Cole. However these are presented as mean values rather than centile charts and thus cannot be used to show how many children are in excess of the 85th and 95th centiles as discussed in our paper. I contacted Dr Chinn, the author, and she confirmed that she had not produced growth reference charts from her data and that there are no more up to date charts than the Tanner Whitehouse ones that we used. I have however referenced her work as suggested by both referees.
Editorial issues
The referees comments, (along with the requirement not to use abbreviations and to put reference numbers in brackets) has resulted in a word count of 655, and 7 references. I have tried hard to reduce both, but would have real difficulty in doing so further (although the reference to the personal communication might be expendable?). I hope that despite this the paper is still acceptable as a short report.
We were unsure whether to include Julian Barth's consultancy work for Roche as a competing interest. The nature of our paper is epidemiological, and therefore did not feel this really comprised a competing interest. Can we leave it to you to decide whether to delete it or not from the paper?