Background: Metabolic syndrome (MetS) is a constellation of components that includes type 2 diabetes/hyperglycemia, central obesity, hypertension, and dyslipidemia. Its prevalence is increasing dramatically in Africa, where it is predominant in obese females. Incomplete fatty acid β-oxidation is among the complex mechanisms that increase MetS risk. However, it remains unclear whether MeS components are associated with increased acylcarnitine categories. Objective: The aim of this study was to analyze the relationship between acylcarnitines and all components of metabolic syndrome in females with obesity from two populations with distinct ethnicities and dietary habits. Methods: We investigated the association of obesity (BMI > 35) with acylcarnitines determined by LC-MS/MS with MetS components in women from Benin, West Africa, and French women. Acylcarnitines and biological and clinical outcomes of MetS according to International Diabetes Federation (IDF) criteria were assessed in 428 ambulatory women recruited at the market of Dantokpa, Cotonou, and 220 women of Aldepi/Obesepi cohort recruited in the North-East of France. Results: Compared to those without MetS, we observed an association of short-, medium-, and long-chain acylcarnitines (SC, MC, LC) with MetS (p = 0.0001; p < 0.0001 and p = 0.0004, respectively) in African women and of SC acylcarnitines with MetS (p < 0.0001), blood glucose (p < 0.001), low HDL-cholesterol (p < 0.05) and high triglycerides (p < 0.01) in French women. We also observed significant associations of MC and LC total and mono-unsaturated acylcarnitines with hypertension in both African and French populations (p < 0.001 and p < 0.01, respectively). The independent determinants of systolic blood pressure were age, body mass index, glycemia, long-chain acylcarnitines, LDL-C and HDL-C. Conclusions: An association of acylcarnitine indexes of altered SC, MC, LC fatty acid β-oxidation with hypertension was reported in the two contrasted women populations, while an association of altered SC fatty acid β-oxidation with glucose and hypertriglyceridemia was reported in French women only. The association of altered acylcarnitine indexes with high SBP could be related to the effects of impaired β-oxidation on endothelial dysfunction. This study was registered at clinical trials.gov as NCT02663388.

Selon la Haute Autorité de santé (HAS), l’éducation thérapeutique du patient (ETP) est au cœur de la prise en charge de l’obésité, pour l’organisation et l’implantation des parcours de soins. L’ETP permet une approche centrée sur la personne et pas seulement sur l’excès de poids. Les parcours de soins multi-composantes et pluri-professionnels sont nécessaires pour mieux appréhender la situation parfois complexe des personnes en situation d’obésité et pour personnaliser et graduer le parcours de soins. La relation soignant–soigné est la pierre angulaire de l’ETP, dont le but est de développer (1) les compétences d’auto-soins (self-management et automesure) pour permettre à la personne de changer progressivement son mode de vie ; (2) les compétences psychosociales ou d’adaptation qui sont cognitives, émotionnelles et sociales ; elles permettent au patient de faire face à la maladie et de vivre au mieux en s’adaptant à la situation et à son environnement. Nous proposons d’intégrer à la démarche éducative différentes approches pour améliorer l’engagement des patients : empowerment, résilience, partenariat patients–professionnels de santé, médecine narrative. Le résultat attendu est une amélioration de la relation soignant–soigné, bénéfique aux deux parties.

Les experts de la Haute Autorité de santé (HAS) ont établi récemment (2022–2024) des recommandations pour la prise en charge chirurgicale des obésités sévères et un guide pour les parcours de soins pré- et postopératoires. Nous proposons ici une « lecture médicale » de ces nombreux textes qui ouvrent la voie à une « médecine bariatrique ». Des indications aux modalités des parcours, de l’éducation thérapeutique aux médicaments de l’obésité, tous les points importants ont été analysés et précisés. Des parcours structurés, gradués et personnalisés sont mis en place. La HAS insiste sur le rôle des équipes pluriprofessionnelles de proximité (niveau 1) ou spécialisées (niveaux 2 et 3) dans le cadre d’une filière bariatrique de l’obésité en cours de développement. Ce travail de la HAS permet d’analyser plus précisément la cinétique, la variabilité et la durabilité des variations pondérales. Une définition consensuelle des critères de perte de poids et de reprise pondérale est proposée. Une porte est ouverte pour la pharmacothérapie de l’obésité en respectant les procédures récentes nécessaires pour la qualité et la sécurité des soins.

BACKGROUND:Primary hyperparathyroidism is associated with an increased cardiovascular mortality, and its underlying mechanisms remain unclear. Insulin resistance has been suggested with low level of evidence. The goal of this study was to evaluate glucose metabolism and insulin resistance in primary hyperparathyroidism patients, to compare with control subjects, and to identify risk factors for insulin resistance in patients with primary hyperparathyroidism. METHODS:Cross-sectional study of consecutive primary hyperparathyroidism patients without history of diabetes or severe chronic kidney disease (glomerular filtration rate ≤30 mL/min/1.73 m2). Fasting glucose and insulin were evaluated before parathyroidectomy. Glucose metabolism was compared with population-based control subjects (n = 171). RESULTS:One hundred and seventy-four patients with primary hyperparathyroidism (140 females) were included. Mean fasting glucose was 0.983 ± 0.129 g/L, and 63 patients (36%) had prediabetes (>1.0 g/L). Mean Homeostatic model assessment of insulin resistance (HOMA-IR) was 3.386 ± 3.111 mUI/L, and 78 patients (45%) had insulin resistance (HOMA-IR >2.6). Blood calcium levels (0.171; P = .023) and body mass index (0.450; P < .001) were correlated positively with HOMA-IR. Insulin secretion (HOMA-B%) was correlated positively with preoperative systolic blood pressure in mm Hg (0.187; P = .013). In multivariate analysis, classic hypercalcemic primary hyperparathyroidism (18.47, 6.84-49.87; <.001), mild hypercalcemic primary hyperparathyroidism (5.35, 2.40-11.95; <.001), and body mass index (1.27, 1.17-1.38; <.001) remained independent predictors for insulin resistance (HOMA-IR >2.6). When compared with control subjects, mean HOMA-IR was significantly higher in primary hyperparathyroidism patients (3.386 ± 3.111 vs 1.919 ± 1.158; P < .001). CONCLUSION:Insulin resistance was significantly higher in primary hyperparathyroidism patients than in control subjects. The impact of parathyroidectomy on insulin resistance should be evaluated in patients with higher calcium levels.

Purpose Craniopharyngiomas are tumors located in the hypothalamic region which leads to obesity in about 50% of cases. Long-term efficacy and safety of bariatric surgery are lacking in this peculiar population. The aim of this study is to determine the 5-year weight loss and resolution of type 2 diabetes (T2D) after bariatric surgery in patients operated on craniopharyngioma who had developed hypothalamic obesity. Materials and Methods This is a multicenter french retrospective case-control study. Subjects with craniopharyngioma (n = 23) who underwent sleeve gastrectomy (SG) (n = 9) or Roux-en-Y gastric bypass (RYGB) (n = 14) (median age 35 years [25;43] and BMI 44.2 kg/m2 [40.7; 51.0]; 8/23 with T2D) were individually matched to 2 subjects with common obesity for age, gender, preoperative body mass index, T2D, and type of surgery. Results TWL% after 1 and 5 years was lower in the craniopharyngioma group than in the control group: 23.1 [15.4; 31.1] (23/23) vs 31.4 [23.9; 35.3] at 1 year (p = 0.008) (46/46) and 17.8 [7.1; 21.9] (23/23) vs 26.2 [18.9; 33.9] at 5 years (p = 0.003) (46/46). After RYGB, TWL% was lower in the craniopharyngioma group compared to the control group (p < 0.001) and comparable after SG both at 1 and 5 years. No difference between the two groups was observed in T2D remission rate and in early and late adverse events. No hormonal deficiency-related acute disease was reported. Conclusions Bariatric surgery induced a significant weight loss in the craniopharyngioma group at 1 and 5 years, but less than in common obesity. SG may be more effective than RYGB but this remains to be demonstrated in a larger cohort.

Le but de cette revue est de proposer une vue intégrative des rôles respectifs du tissu adipeux (TA) sous-cutané, du TA viscéral (TAV) et du foie pour capter et utiliser les acides gras (AG). Il s’agit ici de faire le lien avec l’insulino-résistance, la dyslipidémie athérogène et la stéatopathie métabolique. Les conséquences de la capacité d’expansion limitée du TA, responsable de sa dysfonction, sont nombreuses : augmentation de la disponibilité des acides gras libres (AGL), débordement du stockage des lipides vers d’autres tissus que le TA (dépôts ectopiques), insulino-résistance et inflammation de bas grade dans le TA et le foie, augmentation de la synthèse hépatique de VLDL et de leur sécrétion, augmentation de la lipémie postprandiale (LPP), présence de LDL petites et denses, réduction du HDL-cholestérol et augmentation du non-HDL-cholestérol. Les AGL sont impliqués dans le développement de l’insulino-résistance dans la majorité des tissus cibles de l’insuline et leur trafic entre les organes explique les liens entre la dysfonction du TA, le syndrome métabolique et les maladies cardiovasculaires. Il est donc important de comprendre quelles sont les sources et les flux d’AGL et comment ils contribuent à expliquer la variation des triglycérides (TG) plasmatiques et de la teneur hépatique en lipides. Les AG circulent sous trois formes : (1) les AG non estérifiés libérés par la lipolyse du TA et transportés par l’albumine, (2) les TG des chylomicrons après la prise d’un repas, et (3) les TG des VLDL produit par le foie. La variabilité de la LPP peut être considérée comme un marqueur des phénotypes d’insulino-résistance. Parmi les différentes classes de nutriments, les lipides et les glucides sont les principaux inducteurs de la LPP et de la stéatopathie métabolique. Les modifications de la disponibilité, du captage et de l’oxydation des AG jouent un rôle majeur dans la trajectoire qui mène à l’insulino-résistance et à l’inflammation de bas grade. Les facteurs génétiques, impliqués notamment dans la répartition des dépôts lipidiques, influencent l’efficacité du stockage des graisses des repas. Les principales modifications du mode de vie, qui peuvent limiter l’excès de TAV et la stéatopathie métabolique, comprennent l’augmentation de l’activité physique, qui améliore la clairance et l’oxydation des AG, et les mesures pour obtenir une perte de poids, laquelle améliore la sensibilité à l’insuline et réduit le contenu hépatique en TG.

Psychological disorders, early-age psychological traumas and eating disorders may contribute to the development of severe obesity in vulnerable individuals. Resilience may serve a protective role against binge eating disorder or depression. The current study aimed to investigate the relationship between adverse childhood experiences (ACE), resilience, and current psychological disorders. It also examined whether resilience plays a protective role in this pathway in a cohort of patients seeking bariatric surgery. Two hundred patients (153 women, 47 men) with severe obesity scheduled for bariatric surgery at the CHRU Nancy were included between September 2016 and April 2017. Participants completed the Resilience Scale for Adults (RSA) questionnaire and underwent a structured interview on ACE and current psychological disorders. Mean total RSA score was 5.16 ± 0.87. The most frequent ACE were emotional neglect (90.5

Context A recent study identified 14 low-frequency coding variants associated with body mass index (BMI) in 718 734 individuals predominantly of European ancestry. Objective We investigated the association of 2 genetic scores (GS) with i) the risk of severe/morbid obesity, ii) BMI variation before weight-loss intervention, iii) BMI change in response to an 18-month lifestyle/behavioral intervention program, and iv) BMI change up to 24 months after bariatric surgery. Methods The 14 low-frequency coding variants were genotyped or sequenced in 342 French adults with severe/morbid obesity and 574 French adult controls from the general population. We built risk and protective GS based on 6 BMI-increasing and 5 BMI-decreasing low-frequency coding variants that were polymorphic in our study. Results While the risk GS was not associated with severe/morbid obesity status, BMI-decreasing low-frequency coding variants were significantly less frequent in patients with severe/morbid obesity than in French adults from the general population. Neither the risk nor the protective GS was associated with BMI before intervention in patients with severe/morbid obesity, nor did they affect BMI change in response to a lifestyle/behavioral modification program. The protective GS was associated with a greater BMI decrease following bariatric surgery. The risk and protective GS were associated with a higher and lower risk of BMI regain after bariatric surgery. Conclusion Our data indicate that in populations of European descent, low-frequency coding variants associated with BMI in the general population also affect the outcomes of bariatric surgery in patients with severe/morbid obesity.

L’hyperparathyroïdie primaire est associée à une augmentation de la mortalité cardiovasculaire [1]. L’une des explications de cette association est une augmentation de l’insulinorésistance [2], [3]. L’objectif de cette étude était d’évaluer s’il existe une différence concernant le métabolisme glucidique et l’insulinorésistance entre les patients porteurs d’une hyperparathyroïdie primaire (HPTP) et les patients contrôles. Une étude transversale a été menée chez des patients HPTP non diabétiques sans atteinte rénale chronique sévère. La glycémie a jeun (GAJ) et l’insuline ont été évalués avant parathyroïdectomie et comparés à une population contrôle (n = 119). Résultats 174 patients HPTP ont été inclus. La GAJ moyenne était de 0,983 + 0,129 g/L et 63 patients (36 %) étaient porteurs d’une glycémie a jeun > 1,0 g/L. L’HOMA-IR moyen était de 3,386 + 3,111 mUI/L et 78 patients (45 %) étaient porteur d’une insulinorésistance (HOMA-IR > 2,6). Après ajustement sur l’âge, le sexe et l’IMC, l’HOMA IR restait significativement plus haut chez les patients HPTP en comparaison aux patients contrôles. Notre étude confirme que l’insulinorésistance est significativement plus élevée chez les patients HPTP en comparaison aux patients contrôles. Il sera intéressant d’évaluer l’impact de la parathyroïdectomie sur le métabolisme glucidique chez ces patients.

Patients with obesity are at increased risk of severe COVID-19, requiring mechanical ventilation due to acute respiratory failure. However, conflicting data are obtained for intensive care unit (ICU) mortality. To analyze the relationship between obesity and in-hospital mortality of ICU patients with COVID-19. Patients admitted to the ICU for COVID-19 acute respiratory distress syndrome (ARDS) were included retrospectively. The following data were collected: comorbidities, body mass index (BMI), the severity of ARDS assessed with PaO2/FiO2 (P/F) ratios, disease severity measured by the Simplified Acute Physiology Score II (SAPS II), management and outcomes. For a total of 222 patients, there were 34 patients (15.3%) with normal BMI, 92 patients (41.4%) who were overweight, 80 patients (36%) with moderate obesity (BMI:30–39.9 kg/m2), and 16 patients (7.2%) with severe obesity (BMI ≥ 40 kg/m2). Overall in-hospital mortality was 20.3%. Patients with moderate obesity had a lower mortality rate (13.8%) than patients with normal weight, overweight or severe obesity (17.6%, 21.7%, and 50%, respectively; P = 0.011. Logistic regression showed that patients with a BMI ≤ 29 kg/m2 (odds ratio [OR] 3.64, 95% CI 1.38–9.60) and those with a BMI > 39 kg/m2 (OR 10.04, 95% CI 2.45–41.09) had a higher risk of mortality than those with a BMI from 29 to 39 kg/m2. The number of comorbidities (≥2), SAPS II score, and P/F < 100 mmHg were also independent predictors for in-hospital mortality. COVID-19 patients admitted to the ICU with moderate obesity had a lower risk of death than the other patients, suggesting a possible obesity paradox.

The nutritional sequelae of COVID-19 have not been explored in a large cohort study. Objectives To identify factors associated with the change in nutritional status between discharge and 30 days post-discharge (D30). Secondary objectives were to determine the prevalence of subjective functional loss and severe disability at D30 and their associated factors. Methods Collected data included symptoms, nutritional status, self-evaluation of food intake, Performance Status (PS) Scale, Asthenia Scale, self-evaluation of strength (SES) for arms and legs at discharge and at D30. An SES <7 was used to determine subjective functional loss. A composite criteria for severe disability was elaborated combining malnutrition, subjective functional loss and PS >2. Patients were classified into three groups according to change in nutritional status between discharge and D30 (persistent malnutrition, correction of malnutrition and the absence of malnutrition). Results Of 549 consecutive patients hospitalised for COVID-19 between 1 March and 29 April 2020, 130 died including 17 after discharge (23.7%). At D30, 312 patients were at home, 288 (92.3%) of whom were interviewed. Of the latter, 33.3% were malnourished at discharge and still malnourished at D30, while 23.2% were malnourished at discharge but no longer malnourished at D30. The highest predictive factors of persistent malnutrition were intensive care unit (ICU) stay (OR=3.42, 95% CI: 2.04 to 5.75), subjective functional loss at discharge (OR=3.26, 95% CI: 1.75 to 6.08) and male sex (OR=2.39, 95% CI: 1.44 to 3.97). Subjective functional loss at discharge (76.8%) was the main predictive factor of subjective functional loss at D30 (26.3%) (OR=32.6, 95% CI: 4.36 to 244.0). Lastly, 8.3% had a severe disability, with a higher risk in patients requiring an ICU stay (OR=3.39, 95% CI: 1.43 to 8.06). Conclusion Patients who survived a severe form of COVID-19 had a high risk of persistent malnutrition, functional loss and severe disability at D30. We believe that nutritional support and rehabilitation should be strengthened, particularly for male patients who were admitted in ICU and had subjective functional loss at discharge. Trial registration number NCT04451694.

L’approche patient partenaire de soins (APPS) implique de considérer le patient comme un membre à part entière de l’équipe de soins.

L’Approche Patient Partenaire de Soins (APPS) propose de considérer le patient comme un membre à part entière de l’équipe de soins. Les établissements hospitaliers (ETS) sont des acteurs clés pour la développer, mais qu’en est-il en pratique?Objectif : Evaluation des pratiques mises en place s’alignant sur le développement de l’APPS au niveau des E>TS en Lorraine. Méthode : Etude par auto-questionnaire avec relance réaliséeauprès des directeurs des ETS en 2018. Le questionnaire comportait 67 items répartis en 6 chapitres (Caractéristiques, ETS, vision/Mission de l’ETS, soins, organisation, éducation, recherche), développés dans le cadre du projet INTERREG. Résultats : 28 ETS ont répondu totalement au questionnaire (taux d’exploitation 50%) presque 90% des directions encouragent le partenariat avec les patients. Mais le plan stratégique de l’ETS intègre cet aspect pour seulement 25%.un comité de patient est présent dans la moitié des ETS. Plus de 80% affirment que l’implication des patients dans leur parcours de soins est une priorité, notamment à travers les programmes autorisés d’ETP (61%). Des patients experts/ressources en ETP interviennent dans la moitié des ETS. Plus d’un tiers des ETS impliquent des patients dans la production de ressources ( ex. Brochures) destinées aux patients. Seulement 8% des ETS ont des patients qui participent à la formation ou à la sensibilisation des professionnels.Conclusion : Si l’on considère une hétérogénéité des pratiques selon le type d’établissement, la démarche APPS est en cours d’implantation dans presque tous tes ETS lorrains. L’ETP permet le développement assez significatif de cette approche par ailleurs assez avancée par rapport aux autres pays participant au projet INTERREG.

L’évolution du tissu adipeux viscéral (TAV) et sa répercussion clinique sont peu étudiées chez les personnes transgenres sous traitement hormonal (TH) du sexe opposé. Analyser le TAV, composition corporelle et paramètres métaboliques chez les sujets transgenres non obèses un an après l’introduction du TH en comparaison aux sujets témoins Vingt huit hommes transgenres (FtM) (âge moyen 24 ± 3 ans) ont été comparés avec 24 sujets contrôles de même sexe de naissance (âge moyen 22 ± 5 ans), et 16 femmes transgenres (MtF) (âge moyen 33 ± 9 ans) ont été comparées avec 30 sujets contrôles de même sexe de naissance (âge moyen 28 ± 10 ans). Chez les sujets FtM, la quantité du TAV (p = 0,007), les rapports TAV/masse grasse (MG) % (p = 0,003), MG androïde/gynoïde (p = 0,0006), MG tronc/membres (p = 0,001), acide urique (p < 0,001) et triglycérides (p < 0,01) sont plus élevés, et HDL est plus bas (p = 0,02) que chez les sujets contrôles. Il existe une corrélation positive entre le rapport TAV/MG % et l’acide urique (rs = 0,41, P= 0,03), entre TAV/MG % et triglycérides (rs = 0,38, p = 0,04), et entre TAV et triglycérides (rs = 0,43, p = 0,02). Aucune différence significative n’a été observée chez les sujets MtF en comparaison aux contrôles. Les sujets FtM non obèses sous TH ont le TVA et TAV/MG % significativement plus élevés que les sujets contrôles. Ces modifications sont associées à une augmentation de l’acide urique et triglycérides et peuvent être à l’origine d’un risque cardiométabolique.

Despite repeated efforts by the international scientific community, academic societies, and the combined actions of patient associations, public authorities have difficulties in admitting that obesity is not just a risk factor but a disease. Could our current experience with the coronavirus disease (COVID-19) pandemic be a lever to advance the cause of people with obesity? In this crisis, it seems pertinent to report on the French experience with the actions of stakeholders that were able to challenge the status quo in this field. Over the past decade in France, the mobilization of professionals and government-supported initiatives has generated great hope that obesity management could be improved together with substantial research investment. Political willingness, albeit with limited financial resources, has enabled some changes in the obesity landscape. The first French national Obesity Program begun more than 10 years ago led to the creation of 37 Specialized Obesity Centers (Centres Spécialisés Obésité [CSOs]), whose objective was to harmonize and coordinate obesity management ((1)). Five of these centers were recognized as Centers of Excellence, combining health care and research. Annual funding for an administrative coordinator was designated at the 37 Centers. These Centers have been instrumental in developing integrated care pathways for the management of persons with obesity, including medical and surgical approaches. Under this program, no funds were dedicated to research. National coordination efforts around obesity have advanced clinical care and research. In 2012, a partnership for organizing healthcare resources has been established between the CSOs' coordination and the Directorate of Health Care Supply (DGOS), a division of the French Ministry of Solidarity and Health. Then in 2014, as part of the government's "Investments for the future," the French Clinical Research Infrastructure Network (FCRIN) funded the obesity research network FORCE (French Obesity Research Center of Excellence) with the aim of centralizing France's clinical research efforts in the field of obesity. Then the Minister of Health launched a new obesity roadmap 2019-2022 last October, which is steered by the Directorate of Health Care Supply and the CSOs' coordinator. Placing obesity in the clinical care and research networks almost certainly has influenced the French public health approach to the COVID-19 crisis. At the beginning of the pandemic, a joint task force between the French Association for the Study of Obesity (AFERO), FORCE, and CSOs was created. On April 3, based on scientific concerns, an alert was sent to the Ministry of Health regarding the potential impact of COVID-19 in increasing the risk of disease severity in persons with obesity. The following urgent needs were highlighted: reinforcing information regarding measures for people with obesity without creating panic, providing recommendations regarding lockdown and work stoppage if necessary, facilitating virus screening access, and specifying good practices in the acute and medium term, including post–bariatric surgery follow-up, while trying to limit the potential double stigma of obesity and COVID-19. At the time of this alert, only several intensive care units in the United Kingdom ((2)) and France had produced warnings. On April 7th, an article in the newspaper "Le Monde" discussed the potential role of obesity as a risk factor of COVID-19 severity. That same evening, the CSO/FORCE/AFERO alliance was informed of the following results from a French survey at the Lille University hospitals ((3)): severe obesity increases the risk of invasive mechanical ventilation in intensive care, regardless of age, sex, and diabetes status. These data were complemented by the Lyon University hospitals ((4)), where the odds of developing severe COVID-19 versus non severe COVID-19 were higher in patients with obesity than in patients without obesity (adjusted ORs ranging between 1.80 and 2.03). Another French survey in persons with diabetes resulted in similar findings; the association between BMI and the primary endpoint (intubation and/or death) remained significant after adjusting for other risk factors ((5)). Similar results have also been observed in China ((6)), UK ((7)), and the United States ((8-10)). However, caution should still be exercised when interpreting studies in countries where the prevalence of obesity is high, resulting in a high proportion of hospitalized people with obesity. Based on the first AFERO/FORCE/CSO alliance warning, some measures were taken in record time. Obesity was finally recognized as a disease, providing an incremental risk to develop severe forms of COVID-19. The French Ministry of Solidarity and Health produced a "Care sheet for people in a situation of obesity during the COVID-19 epidemic" ((11)). The High Council of Public Health revised its initial position of March 31st, and the BMI threshold defining the risk to develop severe COVID-19 was reduced from 40 to 30 kg/m2 as of April 20th in agreement with the report from French National Authority for Health (April 16th). General practitioners have been authorized to provide work stoppages for individuals with obesity. A free telephone line has been opened for psychological follow-ups but not dedicated only to those with obesity. Despite this progress, the demand for follow-up care with dieticians has not yet been met. To date, the "AFERO-FORCE-CSO" alliance has produced various documents for patients, guidelines for practitioners, and five Newsletters that take stock of clinical and scientific advances and organizational issues of the national lockdown and its recovery. Patients' associations were involved in disseminating information via the media. Today, the challenge is not to watch the "soufflé" fall but instead to build on authorities' awareness. This pandemic highlights the importance of multidisciplinary care for patients with obesity and the need to support the associated medical and paramedical costs (dietician, psychologist, nurse, exercise instructor). An equally important issue COVID-19 has raised is the need to develop therapeutic education programs in ambulatory care facilities, using telemedicine. This is what the obesity roadmap is about. All of these efforts have a cost, and the future will tell us whether the COVID-19 experience will have been just a small blip of improvement or a real change in the status quo in a sustainable way. Accessibility of care as well as fighting against stigmatization remain great tasks ahead. The French experience with COVID-19 has proven to be a lever for some acceptance of obesity as not a matter of body size but instead a disease that needs to be taken seriously, both in treatment and research. The pandemic has revealed the need at better integrating obesity into the overall health and research systems in France with dedicated budget. Outcomes of the French Obesity Roadmap will tell if the COVID-19 lever will have long lasting implications for obesity in France. Moreover, the research effort in obesity still needs to be sufficiently funded. Will this crisis be helpful by pointing to the importance of promoting the research effort or will it worsen the situation with funds siphoned off from research for chronic diseases including obesity? Time will tell. The authors thank "Investissements d'Avenir" F-Crin, FORCE network. The authors also thank Tim Swartz for critical editing of the manuscript. The authors have declared no conflict of interest. KC and OZ conceived the perspective article. KC wrote the first draft. All authors were involved in reviewing the paper and had final approval of the submitted and published versions.