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Should Morbid Childhood Obesity Be Considered Child Abuse?

The views expressed are those of the author and are not necessarily those of Scientific American.


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Now that the battle against the bulge in the U.S. has reached the grade school level, plenty of efforts have begun to fight childhood obesity and its dangers. They range from educational efforts, such as First Lady Michelle Obama’s Let’s Move! campaign, to new pediatric surgical programs nationwide. Now two researchers float a legal approach: make severe obesity a crime. 

Lindsey Murtagh of the Harvard School of Public Health and David S. Ludwig of the Children’s Hospital in Boston present their case in the July 13 issue of JAMA, The Journal of the American Medical Association. Their commentary, "State Intervention in Life-Threatening Childhood Obesity," makes the point that kids with a body-mass index in the 99th percentile face serious health threats: 

Obesity of this magnitude can cause immediate and potentially irreversible consequences, most notably type 2 diabetes. This complication, reflecting years of progressive metabolic deterioration, carries a dire prognosis. In addition to hyperglycemia, youth with type 2 diabetes typically have severe insulin resistance, low diet quality, sedentary lifestyle, and poor adherence to medical treatment.

 Allowing your kids to develop such a condition, which leads to severe cardiovascular damage on all levels and a shortened life, could be seen as bad parenting. Although the authors also point out the existence of other "obesigenic" factors, such as the marketing of unhealthy foods, the primary responsibility falls on the parents. And as such, existing laws could be applied: 

Federal law…defines child abuse and neglect as “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm…or an act or failure to act which presents an imminent risk of serious harm.” The seriousness of neglect is judged according to the magnitude or risk of harm and by its chronicity. Improper feeding practices, causing undernourishment and failure to thrive, have long been addressed through the child abuse and neglect framework.

As a result, Murtagh and Ludwig argue, state intervention "may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors." (The American Medical Association press office was quick to note in an email to reporters that the commentary does not reflect the position of the AMA or JAMA.)

The emotional devastation of separating a family, the authors say, could be ameliorated by the prospect of return if the parents presumably get their act together. And the emotional pain may be less severe than the physical pain and risk of gastric bypass surgery—a serious procedure for adults, let alone kids.

Defining childhood obesity as abuse would place a tremendous burden on parents—and an unfair one. Considering the marketing and low cost of sweetened cereals, high-fat fast-food meals and other treats aimed squarely at kids, others also bear responsibility for our childhood obesity epidemic. Even the U.S. government could be blamed, considering that the Department of Agriculture promotes the consumption of U.S. foods.

In writing their thought-provoking essay, Murtagh and Ludwig recognize the real long-term solution, at least as far as government’s role in it. "Ultimately, government can reduce the need for such interventions through investments in the social infrastructure and policies to improve diet and promote physical activity among children," they conclude.

Image: nycshooter/iStockphoto

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  1. 1. jsolebello 7:05 pm 07/13/2011

    We have a sports competition in the United States called football that rewards the widest and tallest with million-dollar contracts. That probably spurs childhood obesity quite a bit. You won’t be fixing any childhood obesity as long as we’re still playing football.

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  2. 2. Bill Noble 7:23 pm 07/13/2011

    From my perspective, the researchers have selected the usual – and exactly wrong – target, the poor and minorities. The obesity epidemic is primarily the direct product of huge economic institutions, all focused on profit and all acting without social conscience, under the purview of a political process so compromised by corporate influence that it is passive in the face of these abuses.

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  3. 3. mzsam 8:16 pm 07/13/2011

    You cannot make something like this a matter of legality.The parents who allow their children to eat whatever is easy and fast are probably the same kids who were fed the same diet as they were growing up. We can’t incarcerate people for their culture! The consequences are there, and so it goes. Having a government that regulates every little thing we do is not the answer. There is simply no way to govern how people raise their children, nor should there be!

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  4. 4. mzsam 8:22 pm 07/13/2011

    You must keep in mind that the people who are feeding their kids fast food probably are not reading this article or any other referring to this problem. So how do you reach them? Through the police? Food cops breaking down the door? Of course that is an exaggeration, but how else would the problem be addressed?

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  5. 5. mzsam 8:28 pm 07/13/2011

    So I say it is not abuse, simply folks trying to feed their kids. And it is making them fat. But they don’t know any other way to feed their kids. You can put up billboards explaining why that is not a good thing, but if the people are functionally illiterate, they will not be able to read that either, and if they can, will not believe it anyway. It is a dead end. Keep trying, though.

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  6. 6. sleekmason 8:46 pm 07/13/2011

    The short answer is Yes. The slightly longer answer is that we cannot determine something so ambiguous without creating "police state" tactics used against otherwise innocent people. We simply do not have the right to accuse our populace based on assumption. One that begins, we might as well throw in the towel.
    Long term education should be our goal. The schools are involved in our family life in all the wrong ways. We have created a society of ‘us against them’ rather than ‘We the people’. You can’t try to change the parents behaviour and expect lasting rewards. Educate the children properly, without all the excess society fed morality based on current mores, and we might have a chance for the next generation of parents to produce the desired ethical goals that will advance our civilisation on a worldwide scale. Short term stop-gaps designed to make those currently in charge feel less impotent wont work.

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  7. 7. lilolme 10:23 pm 07/13/2011

    Please keep in mind they are not referring to the many young children running around with old man spare tires. Watch a news reel from the 30s and note how many fat people are shown. More people were uneducated and poor then than now in our poor-me-society.

    What would you think if you saw a 10 year old boy who looked like he came from a concentration camp? You’d say they better save him because starvation is not acceptable. What if the child is covered with cuts and bruises? What if that boy weighs 250 pounds and his whole body is being abused?

    Recently there was talk of removing sodas from the welfare program. People were up in arms about this unrighteousness. 180 hollow calories is okay but don’t punish the fat. Come on people. There has to be a give. We’re literally paying for it and so are those children. What else will motivate those parents than losing their children? Ignorance is not a reasonable excuse when you can see your child’s is extremely obese.

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  8. 8. oldvic 5:18 am 07/14/2011

    Another aspect of this problem needs to be considered. Those who adopt unhealthy lifestyles create a greater burden on the rest of society, the entity that pays for health care, disability and lost productivity.

    If we accept that people have the freedom to live life as they see fit, we must also accept that those who forcibly subsidize the unwise have the right to refuse handing over their money.

    Those who say they refuse a "nanny state" when society tries to steer them towards a sensible life, if they want to be logic, should also refuse the social expenses their self-inflicted problems require.

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  9. 9. Not 'Tarded 7:15 am 07/14/2011

    Why not? We arrest people for doing crack, and that is a "cultural" thing. We arrest people who supply crack to kids.
    Letting your kids get fat is criminal, plain and simple. It is a parents job to do right by their kid, and letting them get fat, either through poor diet or through lack of exercise should be treated as negligence. Seriously.

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  10. 10. promytius 8:12 am 07/14/2011

    Sure, ok and while you’re at it, let’s just go right to the heart of the matter and invoke the THOUGHT POLICE, why waste time letting CRIMINALS think things like "have another" let’s just catch the thought, catch the perp! Anyone even THINKS about feeding their kid an extra dessert and POW they’re up the river for good. And let’s not forget these heinous crimes as well:
    Using your outside voice inside.
    Not saying thank you, even once.
    Thinking about a breast.
    Cheating in all forms and venues, especially TAXES.
    Spitting.
    Staring.
    Breathing too deeply (deprives others of oxygen)

    People. Relax. Put that fat-hating pen down and just walk away – you’ve completely lost it.

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  11. 11. bosjack 8:21 am 07/14/2011

    Putting parents in jail or fining or removing their children isn’t the right answer. What do you think will be the emotional impact on that child when they are removed from an environment where they feel loved and safe? Also, it’s not easy to get kids to eat the right things all of the time. Have you ever tried to force a 3 yr old to eat cauliflower? Perhaps we should force them to eat right by depriving them of food when they won’t eat healthy things? Sure, we could take away toys and privileges but that doesn’t work with all kids and in many cases we end with a crying kid that won’t eat at all. At what point do we draw the line?
    We need to focus our efforts in areas where kids are most influenced, and in my opinion that occurs in school. Kids spend the majority of their day in school. Cutting funding to schools shouldn’t be an option for our government. Schools shouldn’t be allowed to remove gym classes or sports programs just because of a lack of funding. How we judge success in this area needs adjustment as well. Walking instead of running a mile in gym shouldn’t be considered passing. Also, we need all school breakfasts and lunches to meet certain nutritional guidelines. Serving hot dogs and chicken nuggets as a protein on a regular basis shouldn’t be an option. We could make getting or staying healthy a requirement for passing a grade as well.
    I’m not saying that parents, caregivers, and grandparents don’t deserve some of the fault. I am saying that as a society we need more options and better ways of doing things than what’s presented in this article.

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  12. 12. sleekmason 8:22 am 07/14/2011

    Just for that, I’m going to think about two breasts. They’ll never stop me!! Mwahhahahahaha!! :)

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  13. 13. GeekStatus 8:32 am 07/14/2011

    Maybe you don’t fully comprehend the article. Or maybe you just didn’t bother to read it and are completely ignorant of obesity in general. Obesity carries many long and short term health risks (many mentioned directly in the article) and severely dampens quality of life throughout. It is the parent’s fault for allowing their kid to become obese and they should be held responsible for it. It’s really an open and shut case in my opinion.

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  14. 14. brerlou 8:43 am 07/14/2011

    It will have to be a positive system of rewards for children with a healthy BMI.

    There are too many, non-abusive factors in childhood obesity to consider. We can’t have a draconian law, since those same, or other, ignorant parents would use it instead to starve their offspring of essential nutrients.

    The cost of the rewards will be counter-balanced by the reduction in health costs for treating non-communicable diseases where obesity is a contributing factor, such as diabetes, chronic cardiac/circulatory conditions, and all the other associated LIFETIME illnesses arising out of these two illnesses, including kidney failure, amputations and blindness, not to mention the astronomical costs of heart, liver and kidney, transplants.

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  15. 15. 98point6 9:47 am 07/14/2011

    Is there any evidence this would actually help children? What level of success is a foster family likely to have in reducing the weight of a morbidly obese child?

    From a policy perspective, we’d be much better off redirecting money from corn subsidies to summer and afterschool recreation programs. Junk food would no longer be artificially cheap, and kids would have something safe to do other than sit around and eat in front of the screen. Also, keep PE, recess, and health education in the schools. Trimming the so-called fat from education budgets is coming back to bite us.

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  16. 16. over_here 11:01 am 07/14/2011

    weird to punish an individual for a disease that’s the result of public policy: in the UK (as well as US) high-calorie foods were introduced into school meal programs AS A MEANS to increase the caloric intake of a post-war generation at a low nutritional and BMI ebb.. so much of what we have on supermarket shelves now is a direct result of social engineering after the war: canned food? after the war, the only interests it fed were commercial – hi fructose corn syrup added to products has had its day – time to re-visit social engineering – which we as Americans tend to pretend doesn’t exist (along with bioengineered crops..)

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  17. 17. sci-ed 11:58 am 07/14/2011

    It seems there is a lot of shared responsibility here. What about schools that serve calorie loaded nutrition poor lunches, especially for kids in federally funded free lunch programs who depend on them. what about companies that produce, sell and ADVERTIZE to a child targeted audience junk food. What about schools that have been reducing physical and health education programs for decades? Wouldn’t it be better to provide physical education programs and health education to children and parents than to remove kids from homes on the grounds of child abuse and put them in foster care which could be even more damaging to a child and a LOT more expensive to the tax payer.

    It is absurd to consider legal action against millions of parents for childhood obesity when there was no conscious intent to make their children obese. If we can jail pushers of illicit drugs, then why not those who manufacture, advertize and sell junk food? We have become a punishment oriented society rather than a solution oriented society which is a sure path to failure.

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  18. 18. CarolT 1:47 pm 07/14/2011

    Just what we need: A good hard shove down the slippery slope. And without the public even being allowed to realize how much scientific fraud these health fascists have committed! They’re guilty of flagrant fraud for deliberately using studies that ignore the role of infection, in order to falsely blame peoples’ lifestyles. Poorer people are more likely to have been exposed to the pathogens that cause cancer and heart disease, so their scam cynically exploits those class differences. In the case of sodium, their health claims are pure fraud. So they just keep repeating their Big Lie over and over again to brainwash the public. Then, once they’ve succeeded in filling peoples’ minds with rubbish, that is when their accomplices start commanding the public to make their deliberately misinformed "choices!"

    http://www.smokershistory.com/fastfood.htm

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  19. 19. EyesWideOpen 2:09 pm 07/14/2011

    If saving obsese kids’ lives means extracting a 400lb+ kid from a dwelling (possibly requiring opening the roof and airlifting the kid to an emergency center, if the kid is too big to fit through the entrance) then YES!

    Logically, criminalize JUNK FOOD that’s poisoning humans for the sole purpose of making a few financially fat executives and board of directors members even richer. However, since we live in a Flintstones era (yabadabadoo!!) the fat Congress members suffering from brain tumors (I assume that’s why their judgment is impaired) will never criminalize poisonous foods sold at major fast food outlets and comprising over 90% of foodstuff in supermarkets! Likely these Congressslobs own stock in major junk food manufacturers, and risk planting their big fat a’s in their custom leather chairs, smoking that Cuban cigar and stuffing their faces with potato chips to feed those wickedly fat bellies that perhaps aliens use as gestation chambers.

    End of rant.

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  20. 20. HowardB 4:26 pm 07/14/2011

    "Should Morbid Childhood Obesity Be Considered Child Abuse?"

    The answer is a definite YES.

    Guidelines operated through doctors and schools with trigger points for referral to social services.

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  21. 21. EyesWideOpen 4:35 pm 07/14/2011

    The kid in the picture is obese and the parents need counseling but NOT "morbidly" so… the kid needs to be monitored. Morbidly obsese kids often cannot carry their own weight when walking, don’t fit into conventional car or aircraft seats (requiring two airline seats) and many must be airlifted from freight helicopters through openings in the roof (when conventional doors are too narrow). Why make this article a fight against obesity itself, when there are two issues: chronic obsesity in our society (requiring strict diet), and morbid obsesity (immediately life threatening)? If we legislate obesity regardless of morbidity, we’re on a slippery slope to the touchy-feely system used by homeowners associations where strict appearance is legislated by committee (brown spots on otherwise green grass, ugly car parked in driveway, obnoxious paint color of house, unsightly antenna on roof).

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  22. 22. lamorpa 5:13 pm 07/14/2011

    When I see a 12-year-old who is 90 pounds overweight drinking a 64 ounce soda his parents bought for him, I fell they are abusing the child. They are condemning them to a life of sickness and early death. Is there anyone who says this is OK to do?

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  23. 23. lamorpa 5:14 pm 07/14/2011

    @jsolebello: "You won’t be fixing any childhood obesity as long as we’re still playing football."

    Does anyone really need to detail how idiotic this comment is, or can it just be left up to the reader.

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  24. 24. allamp 5:33 pm 07/14/2011

    May I respectfully disagree with your supposition that, "You cannot make something like this a matter of legality." We can, and do, legislate acceptable and unacceptable behavior. No doubt you can think of thousands of instances, such as starving your child, reducing your speed in a school zone, not stealing, not beating people up, not driving while drunk, etc. etc. An argument that child abuse is tolerable because the parent was abused as a child is terribly weak.

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  25. 25. allamp 5:35 pm 07/14/2011

    The problem would be addressed in the same way that other instances of child abuse are addressed. The difficulty would be in determining when child obesity becomes child abuse.

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  26. 26. allamp 5:44 pm 07/14/2011

    I doubt these are any parents of an obese child who do not realize that the food they are allowing their child to eat is unhealthy and contributing to that obesity. The fact that they allow it is a choice they are making; a choice for which they are responsible. True, the food manufacturers, distributors, retailers, and advertisers share some responsibility, but the parents share a far greater responsibility.

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  27. 27. regina.qc 5:51 pm 07/14/2011

    Why only punish the parent-s? One of my kids became obese due in part to a babysitter who allowed him to refuse my healthy lunches and fed him candy instead. Would it have been better for society if I had stayed at home instead of earning my and my children’s keep?

    And in his teacher made them collect money for a end-of-class trip, which she replaced with an ice-cream bar after a spaghetti supper (in school! with half of the class overweight!).

    And what about all the adults today who don’t want to be disturbed by playing and running kids? Or all those mean comments if a child is seen without adult supervision/climbing a tree/having bruised knees/etc.? I can’t go to work or take care of our home while constantly having my children under my eyes, let alone stimulate them to exercise.

    Our society has become very child-unfriendly, and as long as junk food manufacturers have more right to their profits than our children have a right to health nothing will change. Punishing parents for having little to say in their children’s lifes wont change anything.

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  28. 28. larkalt 5:57 pm 07/14/2011

    I did read anecdotes about morbidly obese children being in foster care and losing a lot of weight.
    Often when someone is very obese, there is some psychological cause for it. Like they have a relationship with someone who feeds them fattening food as a kind of "love" and in order to "be loved" and not offend the "loving" person, they eat.
    So yes, if a child can be gotten out of a family environment that is making them overeat, it could be a lifelong blessing. It’s very, very likely that an obese child will struggle for a lifetime with their weight. So stopping it at a malleable age is VERY important.
    However, a practical problem with such a policy would be that children sometimes could become morbidly obese because of a medical problem. That’s probably not a common cause, but you would have to be very sure that it’s not caused by a medical problem, before doing something drastic and traumatic like taking a child away from their family.
    I don’t know how difficult it would be to check for medical problems as a cause for morbid obesity. If difficult I think it would kill any such policy.

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  29. 29. Magoonski 6:28 pm 07/14/2011

    Usually the parents eat poorly and the children just follow suite. So essentially, parents would be punished for feeding their children what they eat which is absurd.
    Human Health service are overburdened already with cases of abuse of children who are starved, beaten and/or molested. I would hate to think that resources that protect children who are purposefully and intentionally abused would go towards something that would take an entire cultural shift to fix.

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  30. 30. larkalt 6:52 pm 07/14/2011

    I had a friend in high school who was very fat. I ate dinner with her family once. Both her parents were very fat, and dinner was very heavy food. Very few vegetables, potatoes with a lot of butter on them.
    She took speedy weightloss pills in high school. She complained that the pills made her do unpleasant compulsive things, like compulsively cleaning the closet.
    Shortly after she graduated from high school, she committed suicide, I was told.
    I don’t know what was going on in her mind. But I do know that being very fat really distressed her a lot. Any young woman in our culture, pretty much, would find being very fat, very distressing.
    Point is that raising a child to grow up fat causes lifelong, serious emotional pain. It’s not a minor harm.
    And children who are so fat they are suffering serious physical consequences like type 2 diabetes, so fat it’s going to shorten their life even if they don’t commit suicide, are being harmed much more.
    I know she was very distressed about her weight and was unable to

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  31. 31. lamorpa 9:02 am 07/15/2011

    "Usually the parents eat poorly and the children just follow suite. So essentially, parents would be punished for feeding their children what they eat which is absurd."

    What? Is it? Let me just change a few words: Usually the parents steal and murder and the children just follow suite. So essentially, parents would be punished for allowing their children what they do which is absurd.

    Does this make sense too? Childhood obesity is debilitating and leads a shortened life of suffering with medical problems. Is this something a parent has an untouchable right to inflict on a child?

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  32. 32. bucketofsquid 4:50 pm 07/22/2011

    Don’t see a lot of people able to think logically posting on this discussion. The culprit is food with toxic additives and over processing as well as extra large packaging. Obviously the real solution isn’t attacking families. The real solution is to impose child abuse charges on the advertising and food companies. Make their products carry pictures of clogged arteries. Incarcerate their board of directors. If a few children die then execute the greedy vermin. Problem solved.

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  33. 33. lamorpa 5:07 pm 07/22/2011

    It’s not as though you would want to hold people responsible for their own actions or anything. Poor, poor victims. It’s very hard following the rule that says you must consume the whole package, extra large or not.

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  34. 34. gail ra 6:01 pm 09/23/2011

    please view this video about what is causing the world wide problem of obesity before passing judgment. It is the proverbial smoking gun.

    We have obese babies all around the world; they are obese at 6 months old and have NOT had time to develop bad eating habits. When babies are hungry, they eat; when tired they sleep. They satisfy their urge to eat by eating a normal amount of food, and no more … and they sleep as long as they need to sleep, and no more. THIS ALONE tells us there is something ELSE terribly wrong – there is something else completely out of whack. Find out what it is, and do something about the problem.

    http://www.youtube.com/watch?v=dBnniua6-oM

    there is strength in numbers.

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  35. 35. magmusik 8:10 pm 09/9/2013

    All the whining here is a perfect example of why all these people have no business being parents. Yes, parenting is hard. It includes saying no to your child. It involves being a role model.

    Kids who are four or five don’t have jobs or cars. They aren’t buying their own food. So if they are obese, yes it *is* the parents fault. Except in the 5-10% of cases where a kid has a thyroid or other health related reason for it.

    i am *so* sick of the whine of the american parent… oh but that’s HARD. wah. Guess what? Life is freaking hard. Parenting is hard. You need to think about all these things before having a child. Think the whole process through from birth through to age 18. Not just the cutsie pie baby stage.

    Over 50% of americans don’t belong as parents.

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