What Should Fat People Have to Do?

Public HealthAll kinds of things are being floated as things that fat people should have to do either by social pressure or government edict until we are thin (at which point we can ostensibly do whatever the hell we want as long as we don’t get fat.)  I’ve seen it suggested that we should be forced to exercise, forced to undergo mandatory counseling, forced to have our food and exercise monitored by the government etc.  The media publishes studies with highly questionable research methods funded by corporations which directly benefit from their findings as proof that fat people can’t be trusted to make decisions for ourselves.  It is suggested that completely untested interventions should be made mandatory for all fat people.  That’s how fat people become  unwitting- sometimes obligatory – participants in experimental medicine, sometimes with some truly horrible results and almost always without success.

This is all done under the guise that”fat people need to be healthier for the greater good”.  But upon even a light inspection this falls apart.  First of all, fat is not a behavior or set of behaviors – it’s a body size.  Just like thin isn’t a set of behaviors – it is a body size.  Just like there are fat athletes there are thin couch potatoes.  You can’t look at someone and tell from their body size what their habits are. or how healthy they are.

Upon examination the choice to focus on fat people is, at best, the result of people being incredibly lazy and trying to find a group that is identifiable by sight to blame for things study.   At worst it is simply thinly veiled bigotry.  Anytime we take a group of people who we can identify by sight and then attempt to calculate their cost on society, then create an initiative to eradicate them we are going down a bad road.  Researchers take “everybody knows” size prejudice and solidify it using poor research techniques and confirmation bias.  As Linda Bacon and Lucy Aphramor found when they reviewed the research around weight and health “Researchers have demonstrated ways in which bias and convention interfere with robust scientific reasoning such that obesity research seems to ‘enjoy special immunity from accepted standards in clinical practice and publishing ethics'”

Researchers base their work on “everybody knows” assumptions without even an attempt to provide proof of these assumptions.  Researchers claim to calculate how much fat people cost in extra fuel, when they don’t even have basic information like how many fat people own cars, and what kind.  The media continues to report that fat people are causing massive increases in healthcare costs when the evidence is clearly to the contrary.

Even if you believe that you can tell that fat people don’t prioritize our health just by looking at us, focusing on fat people is highly questionable when there are so many people who don’t prioritize their health who we celebrate.  We love Olympic athletes, but going 80 miles an hour down an ice track face first does not prioritize health.  We love pro football and basketball players but look what they do to their bodies.  We love our pop stars but the schedule that they keep to go on tour and all the publicity that they do to sell tickets does not prioritize health. Not to mention that plenty of people don’t get the recommended amount of sleep, don’t look both ways before they cross the street, eat soup while driving, and any number of things that don’t prioritize health, and that for every fat person you can find a thin person with the exact same habits but a different body.  The research shows that healthy habits are the best chance for a healthy body, instead of talking about what fat people “have to do” and having a war on us, why isn’t there a war on sedentary people or a war on people who don’t eat their vegetables, or a war on elite athletes?

Or, hey, here’s an idea – how about if we don’t have wars on people at all.  How about if stop acting like it’s our job to tell people what they “have to do” for their health for the greater good, because that becomes a slippery slope pretty fast. Who gets to dictate what healthy habits fat people, or people in general, “have to” practice – the person who eats paleo?  The one who eats raw foods vegan?

This is exactly why public health should be about providing options, information and access and not about saying that all people who look a certain way should have to do this or that. Let’s remember that health is multi-dimensional and not entirely within our control, and agree that health and healthy habits are not an obligation nor a barometer for worthiness.   Let’s make sure everyone has access to the foods they want to eat, any movement options that they may choose, and affordable evidence-based healthcare.  Then let’s start to spread true information, like the fact that 30 minutes of moderate movement about 5 days a week provides tremendous health benefits to most people but will likely never lead to weight loss.  Of course nobody’s obligated to exercise but it would be nice to have true information about what “exercise” means so that we don’t get fooled by posters at the gym that suggest that we have to be miserable for hours every day to get any health benefit, when the truth is that three 1o minutes sessions a day of dancing around the living room in our underwear would get the job done.  Let’s quit assuming that we can look at someone’s size and know anything about them other than their size and our prejudices about their size.  Let’s stop trying to dictate what fat people “have to do” based on assumptions of what fat people do and don’t do as if that’s not just stereotyping and bigotry.  Let’s start giving everyone options, information, and access, and then respecting people’s individual decisions about prioritization and path for their health.  Voila – public health.

Cool news (well, at least cool to me):

My book (Fat:  The Owner’s Manual) now has its own website!  If you’ve read the book and would like to submit a review that would be awesome, just e-mail it to me at ragen at danceswithfat dot org!  I would also love to do a page with pictures of people reading the book so if you want to submit a picture just shoot it to the e-mail above and I’ll get it posted.

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Sticking Up for Ourselves – Too Fat to Tan?

fight backMaybe you’ve already heard the story of Kelly McGrevey.  She bought a tanning package for $70 on a Monday at Aloha Tanning in Norton, Ohio.  When she went back on Tuesday she was told hat the stand-up bed she had been using was broken and that there was a weight limit of 230 pounds on all the rest of the beds so she couldn’t tan.  She asked for a refund and  the tanning salon refused.  Seriously.

So Kelly called the police and filed a report, and got the media involved.  The tanning salon finally gave her a refund.  Damn skippy.

Even if there is a weight limit on the tanning beds, this is just a bad business practice – you don’t tell someone that you are keeping their money and not rendering services.  What I wonder about is if they did this because they didn’t expect her to stick up for herself?

One of the effects of the tremendous amount of fat stigma, bullying, and oppression that fat people face in this culture, is that we become embarrassed of our size, and we start to feel like the solution to things like businesses not accommodating us is to try to change ourselves, rather than demand better treatment. We can start to feel like we don’t have a right to stick up for ourselves, or that we don’t deserve to be treated well.  There’s also the legitimate fear that the people we turn to for help (friends, coworkers, the police, doctors, the media etc. ) may be bigoted against our size and make the situation worse.

I wonder how many times people and businesses use that to their advantage.

I think about the way fat people are treated by airlines.  Not only are we treated differently because of how we look, but it’s completely arbitrary.  Different planes have different sized seats so we often don’t even know if we need a second seat.  Often their policy about whether or not we need to buy a second seat is based on a gate agent looking us up and down and making a guess so that people have actually flown the first leg of their trip only to be told that they need to buy a second seat to get from their connection to their destination.  Meanwhile the airlines continue to make seats smaller and closer together and insist that it’s “only fair” that fat people pay more for the same trip.  This only works because fatphobia is so prevalent.  If the airlines decided to put in four additional seats per row by making seats that are made to fit a size 0 woman, I think that you would find people much less cavalier about saying “If you don’t fit in one seat, you just need to buy a second seat!”

Doctors take advantage of this to do everything from refusing us care, to diagnosing us as fat and prescribing weight loss for any and every health issue for which we go to them for help.  Restaurants don’t bother to have seats the fit us, massage therapists don’t bother to have beds to fit us, hospitals don’t have equipment to fit us, the government is waging a war on us for how we look, meanwhile the diet industry cleans up to the tune of 60 Billion dollars a year for a product that has lost so many deceptive trade practice lawsuits that they are legally required to disclaim it as not effective every time they advertise it.  This only works if we don’t fight back as a group. According to the statistics we are 60% of the population in the United States.  We are an oppressed majority. We can control the vote, yet our oppression can make us feel unable to stand up for ourselves, makes us believe that we aren’t worth standing up for, make us believe that we are obligated to change our bodies to deserve civil rights, make us scared of the consequences of demanding basic human respect.

There is no shame in feeling this way.  It’s no wonder so many fat people feel that the solution to the social stigma we face and the poor treatment that we receive is to continually try to change ourselves – to try desperately to pour ourselves in the mold that society says is required of us.   Politically we use the argument that trying to change ourselves rarely works since weight loss fails almost all the time.  That can be a successful political argument and I think that’s a fine use for it, but I also think it’s important to remember the truth:  that it doesn’t matter why we’re fat or if we can change – we have the right to exist in the bodies that we have, and to get respectful treatment.  We have the right to decide that we are worth sticking up for, worth finding allies, worth filing a police report to get our money back, worth shopping around for a doctor who isn’t a size bigot and a massage therapist with an XL table, worth the activism that it takes to get what should never have been taken  from us to begin with.  Fat activism doesn’t ask people to confer upon us our civil rights and respectful treatment – those were ours all along and aren’t someone else’s to give. Fat activism says that we insist that others stop trying to keep our civil rights and respectful treatment away from us through an inappropriate use of power and privilege. Activism for social change is never an obligation, but it’s always a possibility.

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Define Self-Respecting Women

OrganizeSamantha Brick, no stranger to writing horrific things to get attention, has written another missive about how awful  it is to be fat and how absolutely laudable it is that she will do anything to remain thin. She called the piece “Joan Collins is right. Any woman who wants to stay beautiful (like me!) needs to diet every day of her life.”  Her views of life are so different from mine and many people I know that I thought I would take a stab at some translations before I give my thoughts:

So when one friend arrived and thrust a hefty box of chocolates into my hands, I rewarded her with ice-cold contempt rather than the grateful smile she was clearly expecting.

I am a fucking rude person who has no class.

For three decades, self-denial has been my best friend. And one of my biggest incentives is that I know men prefer slim women.

I prefer to ignore what I want in the pursuit of being attractive to men.

I am 42 years old and have been on a permanent diet for the past 30 years. The logic is simple and irrefutable: any self-respecting woman wants to be thin, and to be thin you need to spend your life on a diet.

I do not know what the words logic and irrefutable mean.

I have only ever dated men who kept a strict eye on my figure. My partners are not only boyfriends but weight-loss coaches. My first love continually reminded me that one can never be too rich or too thin, and my husband of five years frequently tells me that if I put on weight he will divorce me.

I prefer to date men who are very likely to leave me when time or circumstance changes my outward appearance.

The world admonished Kate Moss for claiming that ‘nothing tastes as good as skinny feels’ but I’d go further. As I see it, there is nothing in life that signifies failure better than fat.

I’m a bigot making a random reference to Kate Moss that doesn’t really make much sense in context.

She goes on to describe some eating habits that sounds like they could be disordered  (eating a pack of mints for breakfast and one for lunch, dieting until she passes out, dieting where “the side-effects mean that I don’t have the mental or physical fortitude to work.”, renting a house without a kitchen, enjoying hunger pangs etc.)  I’ll say now that it’s possible that this woman is suffering from an eating disorder, and if that’s the case then I very much hope she gets the help she needs.  It’s not my job, or my intention, to diagnose her – I just want to make it clear that I understand the possibility is there.

It’s also possible that this is an attention grab (maybe hyperbolized or entirely made up.) If that is the case then I would say that this woman is allowed to live her life any way that she wants – spend huge amounts of time, money, and attention pursuing thinness and making choices about how she looks, dresses and behaves based on what men think.

The problem for me is when she confuses what she chooses to do with what “any self-respecting woman” should do.    I actually find it hard to put self-respect and “one of my biggest incentives is that I know men prefer slim women” in the same piece but if that’s her definition of self-respect that’s fine for her.

For those of us who want to move away from a society where both women and men expect that women will make choices based on what we think men want, or base our self-esteem on whether or not men claim to want to have sex with us, it can be really frustrating when a women is eager to not only capitulate but actually assert as obligatory the idea that women should judge their attractiveness, worthiness, and right to like themselves based on what some shallow men think seems like a step in the absolutely wrong direction.

Missives like this one can actually seem like a threat, essentially saying “You’d better conform and base your life around pleasing men because if you don’t I will.”  I think one of the reasons that many fat women continue to diet even after they find out that it almost never works, and the reason that a lot of women aren’t willing to step outside the status quo, is that they know women like Samantha exist who will cling to the status quo regardless of the consequences, and so stepping out of the mainstream is a risk that may have negative consequences.  I have often said on this blog that risk is the currency of revolution, and so if we want change some people are going to have to risk.  It doesn’t have to be you and there’s no shame if you’re not ready to take the risk or if you don’t want to, but it could be you if you want.

If you are wondering what kind of activism you can do around this, I suggest this exercise:  If you woke up tomorrow and you knew that you would meet the stereotype of beauty forever without any more work – what would you do with your time, money, and attention?  How would your life be different? Considering making some of those changes right now.

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Bitching and Complaining

DefendOne of the ways that people derail activism, whether intentionally or accidentally, is to suggest that the person who is pointing out what they feel is an example of stigma, oppression, bullying etc is just “too sensitive,” is “overreacting” etc.

This is sticky because there can be a lot of disagreement about what does and doesn’t constitute bigotry, stigma and oppression.  To me it’s not about if we disagree, but rather about how we deal with the disagreement.  Someone says that something feels oppressive/stigmatizing/bullying etc.  Someone else disagrees.  So far so good.

The person who disagrees now has options, some of which are:

a.  Note their disagreement and choose not to sign the petition, e-mail the business, etc.

b.  Open a discussion asking if the person is interested in discussing it more.

c.  Write the person a nasty e-mail telling them that their experience is invalid and their belief is wrong.

We are all the boss of our underpants and we can all make any of those choices, I would ask that we really consider if choice c is the one we want to make, especially within our community.  We don’t have to agree with each other, I’m not suggesting that we need to support something we disagree with, I’m just suggesting that we take a pass on tearing down people who speak up by suggesting that we are somehow the Authority on oppression and stigma and that our opinion is the only correct one, or that if it’s good enough for me then it should be good enough for everyone.  I believe that we can have respectful dialog about these disagreements without tearing each other down, and that it would be awesome if we would do that.

If you are the person who is dealing with this, know that you are not alone.  I doubt that anybody who has ever fought against oppression has avoided this type of criticism.  Sometimes the person doing the criticizing is well meaning but has an over exaggerated sense of self-importance.  Sometimes they can’t tell the difference between their opinion and actual fact.  Some people just like to criticize.

If this is happening to you know that you have a right to your opinion and to be a witness to your experience.  One thing I have learned is that the only way to avoid criticism is to do absolutely nothing, so sometimes it helps me to remember that if I’m being criticized, it is proof that I’m doing something.

Somebody left this quote in one of my posts a while ago and I thought it was perfect for this post as well:

“It is not the critic who counts: not the man who points out how the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself for a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat.”

~Theodore Roosevelt

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The War on Ice Cream Eating – a Parable

Things you can tell by looking at a fat personFirst let me say that I’ve missed you all.  Last week there was a decided lack of blogging because I managed to hurt my neck in a way that made me unable to use my right arm.  I’m on the road to recovery now but there were some really scary days and I’m very luck to have an amazing care network here in Austin to help me (thanks to Dr. Robin and Dave for their incredible help!), though I would expect that a ranty blog about my inability to get health insurance because of my size is probably just around the corner. But not today…

We talk on this blog a lot about how almost nobody succeeds at weight loss long term, and why that is.  Today I want to talk about the rationale that we are given for pursuing weight loss in the first place.  It’s a bit shaky when you realize that there is no study that shows that people who are able to maintain weight loss long term are healthier or stronger, and that almost every bit of “evidence” linking weight and health problems is correlational, not causational.  Often the suggestion is that if enough studies show a correlation between size and health problems, we can safely assume that size causes the health problems and that changing someone size will cure health problems.  Since weight and health are such charged subjects, let’s look at this through some other lenses.

The problem with correlational research is that it only shows that things happen at the same time, it does nothing to prove that one thing causes the other, and that’s where the trouble starts.

Many studies show a link between increased ice cream eating and increased murders.  All I can definitively say from this is that ice cream eating and murders often happen at the same time. I cannot say that ice cream eating causes murders.  I cannot say that murders cause ice cream consumption.  If more murders take place I can’t say that there is an ice cream epidemic.

Since all I know is that there is a correlational link, I must acknowledge that it’s possible that the ice cream eating causes murders, that murders cause ice cream eating, that they are unrelated, or that they are both caused by a third factor.

Let’s say that the latter is true –  that the cause of both issues is heat – when people get hot they tend to eat more ice cream, or become cranky and murder people.

But let’s say I don’t know that, and I assume that since there is so much evidence linking ice cream and murders, I can assume that eating ice cream causes murders.  So I start a War on Ice Cream Eating!  I lobby to get ice cream off the shelves, to get everyone to look at people who eat ice cream as horrible people who deserve to be shamed.  I work tirelessly to get ice cream out of schools and away from our kids.

Not only is this misguided, if the truth is that when people are hot they either eat ice cream to cool off or they murder someone, by taking ice cream off the shelves I may actually increase the murder rate.  And that’s why assuming cause from correlation is a bad idea.

Men who have male pattern baldness also have a higher risk of heart issues. The reason for that is that the same hormones responsible for male pattern baldness are responsible for increased risk of heart issues.  But let’s say I assume that the baldness causes the heart issues.  So I start a War on Baldness!  I work with companies that claim they can grow hair and inform the public that bald men who aren’t using Rogaine or joining the Hair Club for Men are increasing all of our health care premiums.  I create workplace incentive programs where men who are showing signs of balding are fined thousands of dollars unless they join “voluntary’ hair regrowth lunch meetings.  I suggest that bald men may be unfit parents since it’s possible that they may be more likely to raise bald children.  I pour millions into programs that give out toupees to bald men.  By treating one of the results instead of the cause I can take attention away from treating the actual issue and increase heart issues in bald men, or delay treatment that is actually shown to help the heart issues because I’m busy trying to treat the wrong thing. And that’s why assuming cause from correlation is a bad idea.

Large bodies have been correlated with some health problems.  Let’s say that I assume that body size causes those health problems.  So I start a war on obesity.  I direct all public health efforts toward trying to figure out how to make people thin, I direct public health messaging to be about how fat people need to become thin to be health.  Doctors start to tell fat people that becoming thin is the way to prevent these diseases, even though thin people get them too.  By doing so I direct attention and treatment away from actual healthcare interventions and toward body size interventions, rolling the dice that changing body size will lead to health and blaming fat people if it doesn’t work.  And that’s why assuming cause from correlation is a bad idea.

For more fun with correlation, check out this article!

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What’s Stopping the Fatty Uprising

Wrong RoadI’ve been thinking about the policies directly aimed at fat people – paying for extra seats on airplanes, penalities of thousands of dollars from work insurance companies if you aren’t thin enough, etc.  I think that one of the main things standing in the way of a fatty uprising against all of the stigma, bullying and oppression of fat people is the belief that weight loss is possible, even likely, for all fat people. It’s not just that the people doing the stigmatizing buy into this idea, it’s that fat people do too. That’s pretty problematic since in over half a century of research there has never been a single study where weight loss worked long term for more than a tiny fraction of people.  The truth based on the information that we have now is that most fat people will always be fat.

For me the realization that I would always be fat was painful, since I had believed for so long that societal acceptance was just a diet away, but it was also the impetus for my activism.  It allowed me to clearly see that when I attempted to change myself in order to escape poor treatment, I had been working the wrong end of the problem.  The problem was the social stigma, bullying, and oppression and the cure for poor treatment is to fix the poor treatment, not to change myself.

When people get charged more for the same plane ride because they are fat, when they get charged more for their insurance because they are fat, when they are treated poorly because they are fat, they often think that the solution is to lose weight.  What if fat people accepted that they will probably never lose weight long term. I think a lot more people would become activists.

So many things are only acceptable because of fat phobia and because people (including fat people) believe that fat people not only can, but actually should, be obligated to lose weight in order to be treated better.  Imagine what would happen if the airlines decided to fit in more seats by creating seats that are designed to fit the average  7 year old boy?  Do you think people would be so cavalier to say that the seats are the size they are and if you are bigger you should just pay extra? I seriously doubt it. That system works because of fat phobia, because people think that if you are fat you can and should get thin and you should be punished until you do. What if fat people stopped believing that the insurance penalties are only going to be in effect until the work-sponsored Watchers Meeting that they have to give up their free time for makes them thin (despite WW’s own studies which show that they are likely to maintain only a 5 pounds weight loss for 2 years.) What if instead, fat people all realized that the Thin Fairy is probably not showing up and that the only way to stop paying more for every plane ride and being paid less than our thin counterparts, the only way to stop the stigma, shaming, bullying etc. is activism

A tiny fraction of people survive skydiving falls when their parachutes don’t open, but we don’t encourage people to try to beat the odds and jump out of planes without chutes, nor do we shame people who go ahead and grab that parachute before jumping.  A tiny fraction of people win the lottery, but we don’t encourage people to try to beat the odds and quit their job because today’s ticket could be a winner, nor do we fine them if they fail to win the lottery.  A tiny fraction of people succeed at longterm weight loss but that doesn’t mean that we should recommend that every fat person should try it, or that we should penalize people for failing.

How would things be different if every fat person operated from the knowledge that they are probably going to be fat their whole lives?  I think it would be a better world and I’m ready for the fatty uprising.

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Why Can’t They All Be a Staxi?

Dream WorldMany of you know that my partner suffered a knee injury a couple of months ago – her medical care has been a pretty screwed up experience from start to finish but there was one shining moment.  The first time we went to the emergency room, we were given a Staxi. To be clear, I’m not a paid endorser for the Staxi, I’ve never even talked to them, I am quite certain they have no idea that I’m writing about them.  I just want to encourage the kind of thinking that they are engaging in.

The Staxi is a wheelchair that was built by people who displayed exactly the kind of thinking that I think we need in medical care.  They created a wheelchair that uses 70% less storage space than the competition, holds hundreds of pounds more, and works better for virtually everyone who uses it. Because of the design, it works for people up to 500 pounds and because the armrest comes up and people can sit down from the side, it’s easier to get in and out. The armrest can stay up allowing a very wide range of hip measurements to be accommodated.  It’s not perfect and it is important that people who weigh more than 500 pounds be accommodated and I’m not trying to downplay that, but compared to the normal scramble to find the one wheelchair in the hospital that accommodates someone up to 300 pounds as long as they have narrow hips, this is a major step forward.  This thing was obviously designed by someone who asked themselves “How can I make this work for more people.”

This may not seem like a big deal, but contrast that with Julianne’s recent trip to the orthopedist.  The doctor prescribed a knee brace.  The medical student responsible for getting her the prescribed brace came back and said, with finality, that they didn’t have one in her size.  When Julianne asked her to order one, she explained that they only order them in bulk in certain sizes and that she didn’t need the brace, the doctor just said that it would be help her, so she wouldn’t be getting one.  Julianne asked for a supervisor and after more than an hour of fighting for the medical care she would have already received if she were thin, they finally gave in.

Imagine if the people who made the braces had been thinking “how can we make these braces work for the most people?”  Or if the person responsible for ordering braces for this huge medical center had asked themselves “How can I make sure that I have braces in as many sizes as possible?” Or if the medical student who was in charge of helping Julianne had, upon finding out that they don’t have a brace in her size, asked herself “How can I get this patient the medical care she needs?” Any of the people involved in this chain could have saved Julianne an hour of fighting, instead, a person training to be a doctor didn’t bother, because she thought that instead of the brace the doctor prescribed, it was completely reasonable to say that it was just too inconvenient to provide Julianne with basic medical care.

Size prejudice should be eradicated everywhere, but medical care would be a really good place to start.  So thanks Staxi, Julianne and I appreciate what you do, and think that other areas of medical care have a lot to learn from you!

If you struggle with what to say to the doctor or how to deal with size prejudice in healthcare settings, you can still get your Doctor’s Office Survival Kit 

Activism Opportunity:

Have you ever been mistreated or underserved at a doctor’s office, hospital, or clinic because your were fat? Have you ever been stereotyped by a medical care provider or had your health judged based on your body size? These things happen every day. Thanks to the amazing Tiffany Cvrkel and the Size Diversity Task Force, we have a fantastic opportunity to let our stories be heard by people training to become Medical Advocates. It’s easy to do – if you’d like to be involved please email sizediversitytaskforce@gmail.com for details.  Please spread the word as well! Sunday 4/14 is our FINAL DEADLINE. Thank you!!!

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