key: cord-1051534-02evo08p authors: Clément, Karine; Coupaye, Muriel; Laville, Martine; Oppert, Jean‐Michel; Ziegler, Olivier title: COVID‐19: a lever for the recognition of obesity as a disease? The French experience date: 2020-06-04 journal: Obesity (Silver Spring) DOI: 10.1002/oby.22924 sha: 463b26ea653522111e557f68f9d49d4c8699f735 doc_id: 1051534 cord_uid: 02evo08p 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 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. 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 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 last 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, have enabled some changes in the obesity landscape. The first French national Obesity Program begun over 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 healthcare and research. Annual funding for an administrative coordinator was designated at the 37 Centers. These Centers have been instrumental in developing This article is protected by copyright. All rights reserved This article is protected by copyright. All rights reserved 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, 9, 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. To date, the "AFERO-FORCE-CSO" alliance has produced various documents for patients, guidelines for practitioners and five Newsletters which 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 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, exercice 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 This article is protected by copyright. All rights reserved 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 a disease, that need 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 Road map 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. Moreover, 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 is another aspect to follow? Author contribution : 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. ICNARC report on COVID-19 in critical care 17 High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring) Accepted Article This article is protected by copyright. All rights reserved Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study Obesity Is a Risk Factor for Greater COVID-19 Severity. Diabetes Care Factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City Obesity Could Shift Severe COVID-19 Disease to Younger Ages Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission Acknowledgements: the authors thank "Investissements d'Avenir" F-Crin, FORCE network.Authors thank Tim Swartz for critical editing of the manuscript.