Glycaemic status during pregnancy and longitudinal measures of fetal growth in a multi-racial US population: a prospective cohort study. Lancet Diabetes Endocrinol 2020; 8: 292-300. 4 Italian Ministry of Health. Linee guida gravidanza fisiologica aggiornamento 2011: sistema nazionale per le linee guida dell'Istituto Superiore di Sanità. 2011. http://www.salute.gov.it/imgs/C_17_ pubblicazioni_1436_allegato.pdf (accessed April 20, 2020). 5 Sovio U, Murphy HR, Smith GC. Accelerated foetal growth prior to diagnosis of gestational diabetes mellitus: a prospective cohort study of nulliparous women. Diabetes Care 2016; 39: 982-87.

Background and aims: To analyze lifestyle habits and weight evolution during the COVID-19 pandemic-associated lockdown, in diabetes and overweight/obesity patients (body mass index (BMI) [25e29.9] and !30 kg/m 2 , respectively). Methods and results: We collected information on participants' characteristics and behavior regarding lifestyle before and during the lockdown, through the CoviDIAB web application, which is available freely for people with diabetes in France. We stratified the cohort according to BMI (!25 kg/m 2 vs < 25 kg/m 2 ) and examined the determinants of weight loss (WL), WL > 1 kg vs no-WL) in participants with a BMI !25 kg/m 2 , in both univariate and multivariate analyses.Of the 5280 participants (mean age, 52.5 years; men, 49%; diabetes, 100% by design), 69.5% were overweight or obese (mean BMI, 28.6 kg/m 2 (6.1)). During the lockdown, patients often quit or decreased smoking; overweight/obese participants increased alcohol consumption less frequently as compared with normal BMI patients. In addition, overweight/obese patients were more likely to improve other healthy behaviors on a larger scale than patients with normal BMI: increased intake of fruits and vegetables, reduction of snacks intake, and reduction of total dietary intake. WL was observed in 18.9% of people with a BMI !25 kg/m 2 , whereas 28.6% of them gained weight. Lifestyle favorable changes characterized patients with WL. Conclusions: A significant proportion of overweight/obese patients with diabetes seized the opportunity of lockdown to improve their lifestyle and to lose weight. Identifying those people may help clinicians to personalize practical advice in the case of a recurrent lockdown.

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Introduction: While the prevalence of severe obesity is increasing worldwide, caregivers are often challenged with the management of patients with extreme weight. Case report: A 30-year-old woman (weight 245 kg, body mass index 85 kg/m²) presented with dyspnea for which investigations led to suspect pulmonary embolism. The patient’s weight made it impossible to perform adapted imaging, thus, an empirical anticoagulant treatment was initiated. A hematoma of the thigh occurred as a consequence of a transient antivitamin K overdose leading to a 15 cm necrotic wound worsened by a state of malnutrition. Multidisciplinary and comprehensive care was performed including wound trimming, antibiotics, skin grafting, treatment of malnutrition, and psychological support, but with marked difficulties, due to the lack of adapted medical equipment and facilities as well as appropriate medical guidelines. Overall, 7 months of hospitalization including 4 months of physiotherapy and rehabilitation were needed before the patient could return home. Discussion: This case highlights how difficult managing patients with extreme obesity can be and points to the importance for healthcare systems to adapt to the specific needs of these patients and to design specific guidelines for treatment dosage and malnutrition prevention and treatment in this setting.