DebraSY

Shhhhh, They’re Talking about US! Let’s Listen and then Talk about THEM

In Weight-Loss Maintenance on November 12, 2010 at 1:02 pm

First, I would encourage everyone to come join the roulette table.  You still have time before the wheel spins, the winner is named and I reveal my hypothesis.  BUT, in the meantime, if you have already placed your bet, or you otherwise have an extra 26 minutes to spare, you may wish to watch the entertainment in the Obesity Studies Lounge.  Please know that there is NO particular reason I post the following picture.

Bosley and the Angels

 Or this one:

Lee Majors

Any resemblance of our entertainers to the above pictured cast and/or ex-spouse of a cast member is purely coincidental, and we will only talk about them with the utmost respect.

But, can you believe that the Scientist Who Looks like Farrah so casually and cheerfully states that we (as a society) can claim a sense of success from the notion that 20 to 25% of us can maintain a stinking 10% loss for one year?  Who gets to decide what success is?  Why don’t journalists ask her that question?  Would ANY of us feel successful maintaining a mere 10% loss for only one year?  The good news we may pick up from her spiel is that her group of scientists now regard loss and maintenance as separate issues.  I believe this conference took place in 2007.  How long will it take the MDs (and PhDs in less advanced think tanks) to pick up on that?   I was sad that she defined the “changed physiology” of a reduced-weight person narrowly as “metabolic efficiency.”  Our changed physiology is likely multi-dimensional and related to our individual endocrine profiles.  She seemed to be asking only whether set-point theory as it relates to energy expenditure is true or false.  There is so much more to it than that.  Based on her own narrow definition of “changed physiology” she concludes that the literature doesn’t support that our bodies are fighting us.  Hmmm.  I beg to differ.  And, I would posit, the reason “low metabolism” is not related to weight-loss maintenance may have little to do with our environment or behaviors, as she suggests, and much to do with how clever we are in managing our body’s new endocrine signals.  I absolutely agree with her that we need more research into intake, which would cover what I call binge impulses.  But I disagree that it’s hard to study.  As I pointed it out in my letter to the NWCR, we are here!  Take our blood samples!  Analyze our saliva (and our poop, if that’s your thing)!   Look at our gut flora!  Ask us questions!  We’re smart enough to go a little deeper than “do you eat breakfast?” 

Then, the Scientist Who Looks like Kate describes her pool of “very successful” maintainers:  6,000 people who lost, on average, 72 pounds, and, at six years, are maintaining 30 pounds of loss.  Huh?  Has anyone bothered to ask whether regaining 42 pounds feels like “very successful” to a maintainer?  Wouldn’t it be lovely if the spokesmodel on the Slim4Life commercial would gush at us in all honesty:  “I lost 72 pounds, and six years from now, I plan to be maintaining 30, because that’s VERY successful!”  How many clients would sign on?  Our Kate Jackson then goes on to state that we report to eat 1300 calories a day.  Huh?  Is my form incomplete?  Perhaps they were asking that before my time?  Do any of you other NWCR registrants remember them asking directly for your calorie intake?  She, of course, accuses us of “underreporting” (lying?) and adjusts that number upward to (what I would report, if they did bother to ask me) 1800.  Yeesh.  The other stuff she reports rings true to me:  high physical activity, low TV watching, clean and consistent diet (including breakfast) and compulsive self-weighing.  Check on all.  Her optimism about the STOP Regain study is premature.  Let’s hear about these people again in five and ten years; eighteen months is insufficient.

Then the Scientist Who Looks like Lee Majors finally gives us a little perspective.  A mere 6,000 “very successful(?!)” maintainers is NOTHING compared to 70 million people who have been failed by our cultural mythology (brought to you, in part, by your local MD). 

He studies the drugs of our dilemma, which is an area that I know little about.  In short, I have not partaken, but faithful readers may have something to say on the topic.  I provide here a concise dictionary to translate some of our Six-Million Dollar Scientist’s musings into American English.

  • Sibutramine = Meridia.  Appetite suppressant, no longer available in the US
  • Orlistat = Xenical or Alli.  Inhibits fat absorption.
  • Rimonabant = Accomplia, Monaslim and Slimona.  Appetite suppressant, no longer available in Europe, but was at the time of this conference.

“Underwhelming” = artful understatement.

  • 4.6 kg = 10.12 lbs
  • 2.7 kg = 5.94 lbs
  • 8 kg = 17.6 lbs

The rest of his talk on Leptin resistance I would call useful and incomplete.  Science discovered Leptin first at the chemical cotillion, but Ghrelin, Peptide YY3-36 and the rest of the dancers are proving integral to the dilemma too.  Additional dictionary entries, for your pleasure:

  • Metformin = An oral diabetes drug that helps control blood sugar.
  • Octreotide = Sandostatin.  An injectible drug used to treat acromegaly (gigantism).  Lowers insulin, glucagon and growth hormone, among other things.

The last two drugs are not yet studied, so I summarily left them out of my dictionary.  I think he’s right to say that we are a long way from getting anything helpful from Big Pharma.  I think he’s wrong, in the Q&A, to say that any amount of weight loss is helpful.  We need to consider individual circumstances and the cost.  I would add, too, that we, the common citizens, should be particularly careful as drugs are introduced, tested (on us) and approved.  If the scientific community won’t even ask our opinions on what we think constitutes success, how careful are they with the drugs they pump into us?  (Recall Fen-Phen and Redux.)  I’m not signing on to be a lab rat.

So, what say you, gentle readers?  What are your thoughts?  While I’ve been too wordy, I do leave you the Q&A virtually untouched.  

I do think that, in the end, we’re all left with one burning question.  Assuming the panel moderator was Bosley (David Doyle), why wasn’t the Scientist Who Looks like Jaclyn (whoever that may be) also included on the panel?  Jaclyn always got short shrift.

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  1. She’s annoying to listen to.

    (Well, I should rephrase that – listening to her annoys me. I don’t like her sentence structure and some of her grammar patterns. Yes, I know I’m not even focusng yet on analysis of her theoretical content.)

    What I’m wondering about immediately is whether they have anyone on their panel, or commission, or lounge or whatever they call it, lol, who is attempting to maintain a weight loss.

    I’d like to hear someone in that group speak (Deb? Anyone? Bueller? 🙂 ), so that actual people are not just treated as data points.

    Plus, did I hear the second speaker correctly? Is she touting a low-fat diet?
    Brains need fat.
    Maybe that’s part of the problem with the coherence of their data, lol.

    *looks around*
    *sits down*

  2. The one who annoys you — Farrah (Dr. Wyatt) or Kate (Dr. Phelan)? Having made my tacky post, I think we have to cut them some break on “style.” They didn’t go into science to be performers. Actually, for scientists, this group is lucky to be so telegenic.

    And, yes, what a novel thought: including a maintainer on the panel. But I’m confident Hell would freeze over.

  3. Wait – I spent all that time filling out their form and trying to remember all I have eaten for a year and then generalizing it to fit their over-broad categories and THAT BITCH accuses me of under-reporting?!

    And, seriously, why did they never ask how many calories I get each day?

    Oh my, how I so, so wish any of those scientists would just come and talk to me.

    Then they could tell me how easy it is to maintain weight loss and how my metabolism isn’t at all different than it was before and how I am TOTALLY, DELIRIOUSLY HAPPY to only get to eat cake once a month because any more than that and each additional piece of cake = 1 pound of gain.

    Grrr.

  4. This discussion seems to be about what makes people’s bodies want to stay fat and what to do about it. How can fat people become and stay thin?

    But, my response to that is that being fat isn’t something that really needs to be changed. What needs to be changed is the bias against fat people in our society – including among medical professionals – and the self loathing we’re taught to have because of our size. It’s those things that are our greatest problems, in my opinion.

    I’ve been fat all my life. I wore a size 20 when I was 12 years old. I had the chassis of a car land on my midsection in a roll-out accident when I was nineteen and I survived it. When the trauma-induced osteoarthritis that resulted from car accident – the breaks and dislocation in my left hip – made it necessary for me to get a hip replacement at forty, I made it through that with only a little weight gain and a relatively minor and temporary reduction in my level of fitness. I was off the prescription painkillers and back at work two weeks after the surgery, and a year later, I can walk all day and do step aerobics again. I don’t take any drugs. I don’t have any health problems.

    How would losing weight make me healthier? How would it make my life better? The answer: it probably wouldn’t make me healthier, and it would only make my life better because I’d be considered more attractive and I’d be less likely to be discriminated against. And fuck that. Seriously.

    I’d like to tell those scientists that it’s all very interesting to try to figure out how our bodies’ weight regulation systems work – a fine idea. But, please don’t do it with the idea that being heavier than average is a disease or a disability; something that needs to be cured. Because, that just gives people a reason to let the bias and discrimination go on unhindered.

    • Dee, you are admirably healthy and gifted with beauty to boot (I recall your wedding pictures well, my Brick-House friend). I think the issue is defining fat or, their word, “obesity” with a dumb number: 30, as in BMI. They’ve taken on the philosophy of the Hitchhiker’s Guide to the Galaxy. Isn’t it revealed there that the answer to everything is 42?

      Fat as it relates to “disease” is so complicated, and it’s not just one issue and it’s certainly not simply BMI = 30 and up. Actually, someone with a BMI of 29, if her fat is concentrated in her core and around her vital organs, likely has a medical concern she needs to manage and stay on top of, while a big-butted woman with a BMI of 35 may be fine, if she’s got her mobility and a good blood panel. But that BMI = 35 woman is assaulted by the slings and arrows of a fat-phobic society, while the BMI = 29 woman “hears” that she doesn’t need to worry.

      There comes a point for evenly-fatted and big butt people when the fat itself becomes a problem — it may impede mobility, damage joints, harbor tumors, etc. But arbitrarily picking 30 is as dumb as arbitrarily picking 42 as the answer for everything.

      Simply, obesity itself is not a disease. BMI = 30 is not a disease. Fat may be a symptom of other issues. Fat may exacerbate other issues. Fat is a characteristic. How we as individuals carry our fat may be a diagnostic tool, but BMI is. . . . something else.

      In the doctor’s tool kit, BMI is the sledge-hammer. It’s imprecise and of limited use except in extreme circumstances. And in society’s hands, BMI has become a cruel and vulgar weapon.

      • But, being healthy isn’t admirable. For the most part, it’s lucky. And, a lot of people who are heavier than I am are healthy, too. Healthier and more active, in many cases. I used to think I was some kind of an exception to the “rules” about fat people. I don’t think that anymore.

        There are people with 40+ BMIs who can climb all the stairs in the CN tower. In fact, I’m talking about a friend of mine, and she’s apple-shaped. She trains by walking up the 30? 40? – can’t remember – stories to her apartment. I don’t think I’m capable of doing that, myself. Or, okay. I’m too lazy to even attempt it. I took the elevator when I lived in a 12th floor apartment, except when I was forced to walk up the stairs by a fire drill or power outage (and the same thing can be said of all my thin neighbors). There are people who run marathons and who ride their bikes 20 miles a day who have 40+ BMIs. I know a woman with a 50+ BMI who can easily ride her bike 20 miles. She, a thin friend from out of town, and I went shopping together once, downtown and on foot. The house guest had to bail out early and almost passed out from exhaustion when she got back to my place. Our bodies adjust to the level of activity that we ask of them – regardless of our size.

        Doctors just don’t see healthy fat people very often, because we tend not to have health problems and because we don’t like doctors. Why do we avoid doctors? Because we get weight loss lectures every time we go for checkups – and those lectures always come along with insulting, condescending and inaccurate assumptions. Few doctors bother to ask us how active we are and how we eat, and if they do ask or we manage to interject the information, the doctors don’t believe us. They either say so directly, or they give advice that doesn’t make any sense, in context. Often, our real health concerns are ignored and our weight gets harped on endlessly. At best, we get put into a little “exception to the rule” box.

        But, the older I get, the more I realize that most fat people are exceptions. Very few match the stereotypes. And the ones who do tend not to be ignorant plebs, as always seems to be assumed. They’re the ones who’ve swallowed the fantasy of being thin whole and believe themselves incapable of leading a normal life, and/or have messed to their bodies with yo-yo dieting and overexercise.

        If fat people would just be allowed to have the self respect to take care of themselves in a moderate, sustainable way – the same way thin people do! – then we’d be so much healthier as a group. The problem is, the medical establishment doesn’t want to help fat people be healthier. They want to eliminate us from the population. And, yeah, that sounds alarmist. But when a person comes to a doctor with a legitimate health concern and the doctor, in effect, refuses to treat them until they become thin, then what would you call that? People are getting forced into weight loss surgery (which carries significant long term health risks and, let’s not forget, can kill you) this way. It’s disgusting.

        As far as I’m concerned, it’s my doctor’s job to diagnose and treat any health problems I may have. It is not their job to refuse to give me proper care until I force my body into as many low risk categories as possible. And, BMI? Well, I don’t see why a focus on weight is ever necessary. Even where someone’s weight does affect their health in what appears to be a fairly direct way, focusing on weight doesn’t work or is counterproductive in most cases.

  5. Enjoying the discussion!! Can’t participate!! Sanity points overdrawn after reading issue of Weight Watchers magazine! It was loaned to me by a friend(!), hidden in a stack of New Yorkers! Exposure happened before I realized it!!! Will recover ASAP! AND I WILL GET TO GOAL!!!!! Er, I mean: I will return to sanity! Please pray for me, or chant, or light candle, or sacrifice chicken (breast meat only), or simply take pity!!!! Thank you!!!!!

  6. I once read a “Diane” (Curves’ publication) and had the same reaction. Fortunately, I didn’t require institutionalization.

  7. Ah, Dee, the “exception to the rule box.” How funny that you’re in it and I’m not. And you also bring up the avoidance of doctors issue. Wow. How much medical AWOL happens undetected because of fatphobia? How could that be studied?

    I know that if I were to regain my weight (not that I plan to — I actually get pleasure out of being a personal scientific experiment), I’d be hard pressed to keep my current docs (internist and ob/gyn). Mostly I’d be ashamed of letting them down and I know I couldn’t explain the complexity of the issue in a 12-minute meeting, and so I’d quietly disappear and find others. Would they miss me?

    • Debra, frankly I think that people like you are unusual and people like me are fairly common. It’s just that most people like me aren’t as direct and honest as I am.

      Doctors put a lot of pressure on fat people to lose weight. They’re alarmist and paternalistic, and they may even withhold treatment. Because of that, a lot of people continue to lie both to themselves and their doctors. If they were honest, they’d admit they know they can’t stay thin, because the habits that are necessary to get them there aren’t sustainable for them. So, they make half-hearted tries at dieting and exercise every once in a while and when it “doesn’t work,” (doesn’t make them permanently thin), they lapse into doing whatever’s most comfortable, without regard for their health. If they and their doctors would just set aside the weight issue, then people would have an easier time making healthy changes to their habits – finding that balance where they have time to do the things they want and where they’re maximizing their energy level and feelings of well-being.

      As far as the AWOL issue goes, I can tell you that I know that I should be in for a checkup every year, but it’s more like every 2 to 4 years. It’s always an annoying experience, I don’t have chronic health issues, and I don’t get sick very often. However, I do occasionally go in for checkups. People who’ve re-gained lost weight are probably even more likely to stay away from their doctor if at all possible. I’d imagine that they’d never go in unless they had a pressing health concern.

  8. I guess what upsets me about this discussion are the statistics about type 2 diabetes, (yeah “teh diabetes” that so many make light of until they or a loved one gets it, perhaps in their 50s or 60s after decades with few health problems, are forced to go on insulin when all else fails, and/or gradually go blind, and/or watch their feet and legs slowly amputated piece by piece, and/or endure slow kidney damage); I mean, this is a horrible effing way to suffer through your life, then die. Granted, if you are rich and have fabulous health care then it is often not quite as horrible a fate (isn’t that true for most chronic illnesses?) Its origins are so complex, its progression so horrifying, and yet its prevention or treatment is frequently reduced to the simple concept: “lose weight and exercise.” The coldness and barbarity reflected in the blaming of individuals for their own suffering…and by people who are paid to provide “care”…

    Really, it all makes me cry.

    • My dad’s had type II diabetes since he was in his forties. It runs in his family, as does a very large body size. He’s in his mid-seventies now, and even with his crappy diabetes management (he basically ignored it for the first 20 years) and a few heart problems, he was still working last year; he hadn’t retired. He gets insulin injections now. He has circulation problems in his feet and sometimes he has trouble healing, but he’s still amazingly resilient. My impression of type II diabetes as a relatively mild disease that’s not hard to control is based on my dad’s experience with it. In the course of his life, he’s put a lot less effort into staying healthy than I have, and he was shockingly remiss in addressing his diabetes in the first couple of decades. Still, it hasn’t been the way you’re describing for him. The diabetes hasn’t had that great an effect, even though he was never a good patient. He’s insulin dependent now and he walks with a cane, but he won’t die of it.

      • ” My impression of type II diabetes as a relatively mild disease that’s not hard to control is based on my dad’s experience with it. In the course of his life,”

        And, with respect, it may be the interplay of genetics and a certain degree of self-care that affect the disease’s impact. My grandmother was an amputee, and my mom’s not in the best shape with hers either.

        So I think it’s tricky to generalize.

    • “Lose weight” as a prescription for avoiding diabetes is as stupid as “whiten your teeth” to avoid lung disease. If you whiten your teeth by quitting smoking, you may do some good, but other methods will not help. Actually, “lose weight” is worse advice because without any thoughts on maintenance it’s an invitation to yo-yo weight cycle, which has health consequences of its own. Tooth bleach is relatively harmless by comparison. (She tips her hat to J. Eric Oliver for tooth bleach analogy.)

  9. Dee, my dad was diagnosed with lung cancer in 1979 and is still going strong. If I based my impression of lung cancer on his experience, then lung cancer is a “relatively mild disease” too. I work in a free clinic (for people who have no medical insurance), and the view of diabetes is, indeed, MUCH different than yours.

    I guess this is why I don’t enjoy getting into these kinds of discussions. I dislike wasting my time dragging out stats and research that folks often quickly discount when their own anecdotal evidence shows them a different story. It’s the same reason why I don’t bother to argue with republicans anymore.

    • RNegade- the difference is that you’re seeing diabetics who have received very little treatment or guidance over the years – worst case scenarios. You’re using anecdotal evidence as well. Type II diabetes IS, in many cases, a relatively easy to control disease that people can manage for many decades with minimal impact on their quality of life. Also, it’s not particularly expensive to treat.

      I’m just sick of seeing it used as an excuse for dangerous treatments for obesity when it only affects a minority of fat people, and when the long term effects of obesity treatment (WLS in particular) aren’t necessarily less severe.

    • Well, my dad was diagnosed with merkel cell carcinoma last year and is still going strong. In fact, he’s beaten it for the time being. That doesn’t mean that I think it’s a mild disease.

      However, the diabetes that he’s had for thirty five years? In his case, yeah. Relatively mild, or he’d be dead or at least horribly disfigured by now. Please feel free to drag out statistics. What’s more common with type II diabetes? My dad, or the amputees? I’m guessing my dad.

      I have the impression that most type II diabetics die of other things (chiefly heart disease – although I’m aware the two are linked), in the same age range – maybe 10 years earlier at most – when non-diabetics tend to expire: 70-90 years old. I’ll look up some statistics later if I have time. Then, we’ll see who has more in common with Republicans. LOL.

      • “What’s more common with type II diabetes? My dad, or the amputees? I’m guessing my dad.”

        Are you done guessing and generalizing now?

      • If my generalizations were wrong, littlem, then I’m sure that you or RNegage would have corrected me with statistics by now.

  10. RN and Dee, you know you are on the same page, don’t you? Dee, RN isn’t saying diabetes will be cured by an MD’s simplistic “lose weight” lecture; and RN, Dee does know how to separate her anecdotal life from statistics. You guys are cool, right?

    • Okay, I posted that quite a while ago, before the barrage, and it got moved down, so I look pretty silly now. You all, obviously, er, disagree. Now, pulling this back to the topic at hand. The hopeful take-away message about obesity is that the simplistic regard it receives from the medical community is EQUAL OPPORTUNITY. Doctors tell both poor and wealthy people to just lose weight, and then they’re abandoned to fight it out amongst the cultural mythology. It’s not that the doctors don’t know the failure rate of diets. It’s not like these scientists aren’t speaking plainly, publishing frequently. Even the biased ones who spin the idea that it’s peachy for 20% to maintain a 10% loss for a year are clear. If a doctor would quote that stat with a straight face at his or her patients, they might enter the process a little more thoughtfully. But the doctors don’t say that. They tell people to walk 30 minutes a day and eat fresh produce, and when the patients don’t lose weight, they call them noncompliant. With diabetes, you’re mostly screwed only if you’re poor. Happy thoughts!

      • The local diabetes center recently asked me to come and participate (volunteer) with a “Fall kick-off to health” weekend, which was a promotion to get people with diabetes to sign up for a diet and exercise commitment. The RN in charge is a very caring person and a veteran nurse. I said, “Well, I really hate what diabetes does to these patients but I can’t, in good conscience, encourage them to try another diet. Statistically, diets don’t work.” Oh, the *discussion* that followed made my exchange with Dee look like a make-out session. Lol. Her main argument focused on the terrible ravages of the disease’s progression. She could not understand how I could agree with her assessment of the diseases’s progression, and yet not encourage patients to lose weight (through diet and exercise).

        As much as I realize the futility and potential harm in recommending weight-loss dieting (or surgery) as a treatment for diabetes, I refuse to deny the severity of the disease’s progression. This is a pattern I see more and more: deny the severity of suffering associated with obesity-linked diseases (or blame that suffering on social prejudice) because the alternative (lack of humane options) is so painful to accept.

        One need not be poor to lose medical insurance in this country. One need not be poor to suddenly find themselves unable to get medical insurance or to afford adequate health care. Medications for diabetes are not “cheap”, for that term is relative to one’s resources. People tend to purchase food (due to our hunger drive as human beings and the need to eat) before medication, and when there is not enough for food, rent, utilities and medication, then guess which need is sacrificed? It can be as simple as one spouse becoming unemployed, due to lay-off, injury, or extended illness.

        Even when speaking with loved ones, people often remain silent about their symptoms (caused by diabetes) because they feel ashamed; for example, I often hear, “I brought it on myself by getting fat”. Peripheral nerve damage as a result of diabetes seldom is discussed (even among caring family members), but it can be a source of almost constant pain and can keep people from sleeping. That symptom, alone, can ruin quality of life. People avoid talking to their adult children about such suffering, many times, because they feel that their children (although loving) will believe that it was the parent’s fault “for not staying on my diet.”

        I apologize for seeming to stray off point. Yet the patients (being encouraged by professionals, family, & the public to lose weight and of course keep it off for their “own good”!) are often times already burdened by so many other serious issues (such as diabetes, disability, fear of impending homelessness, etc); it is no wonder I hear bitter laughter from clinic patients when the subject of diet and exercise arises.

      • RNegade – It’s great that you’re fighting the conventional wisdom about diabetes being the fault of the sufferers, easily fixed by dieting.

        I just wanted to note that when I said that diabetes wasn’t particularly expensive to treat, I didn’t mean “to a poor person without insurance.” Obviously, everything is expensive to someone in that situation, since they’re probably having trouble covering their basic needs. Please don’t think that I don’t know what that’s like. I spent most of my twenties without health insurance because I couldn’t afford it.

        I meant it’s not particularly expensive to the healthcare system. Again, it was in response to something that probably nobody here agrees with: the oft-repeated idea that fat people are somehow willfully causing the increasing cost of healthcare in the US – through diabetes, which is entirely their own fault. Diabetes treatment isn’t what makes the US healthcare system so expensive. Diabetes management is relatively cheap – from a systemic point of view, anyway.

        It sounds to me like you’re seeing the results of discrimination against fat people by insurance companies in your practice.

        I spent years without insurance because the insurance companies wanted to charge someone with my BMI (which was under 35) twice the going rate. I was young and healthy at the time, and no harm came of it. However, I can see someone going on for decades and decades like that. If their diabetes had been caught and managed early, then they would have had an experience like my dad’s. Instead, they develop horrible and expensive to treat complications because the insurance companies weren’t willing to risk having to pay for a few doctor’s appointments, a blood sugar tester, and some insulin injections. I mean, those situations can be usually prevented with proper care.

        This is a problem with the health care system, not something that should be blamed on the patients. I expect that you agree with at least the gist of that.

  11. I haven’t had the time or the inclination to watch the whole thing, but like others, I was struck by the slimness of all the experts. They wouldn’t know the trials and tribulations of losing/maintaining weight loss if it hit them in the face.

    For the most part, all the “experts” seems to have no first-hard knowledge of how horribly difficult weight management can be. I say, let them eat cake, but keep them away from me! It’s sort of like having a man give classes in natural childbirth. Puh-leeze.

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