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Body Norms and Fat Stigma in Global Perspective

Author(s): Alexandra A. Brewis, Amber Wutich, Ashlan Falletta-Cowden and Isa
Source: Current Anthropology, Vol. 52, No. 2 (April 2011), pp. 269-276
Published by: The University of Chicago Press on behalf of Wenner-Gren Foundation for
Anthropological Research
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following the introduction of television. maps well onto the high rates of enacted and felt prejudice reported by the fatter members of society in places such as the United States (Janssen et al. Elements include the recognition of obesity as a disease. Number 2. April 2011 Reports Body Norms and Fat Stigma in Global Perspective Alexandra A. Martin 2001 [1987]. 28 Aug 2016 17:08:13 UTC All use subject to http://about. and Leppert 2005). a number of ethnographic studies conducted in the 1980s and 1990s have detailed social contexts in which fat bodies express beauty. DeJong 1993. Arizona State University. we test for cultural variation in how people conceptualize and stigmatize excess weight and obesity. and social belonging.185 on Sun. For example. (1998) found that most adults expressed a slimbody ideal that was paired with a lack of appreciable negative concern about fatness despite the traditional value afforded to it.97. closeness to God. This compels us to wonder to what degree antifat ideas This content downloaded from 109. it is not well understood whether and how fat negativism might be transforming and homogenizing across groups in the same manner as the adoption of slim idealism. Slim idealism in itself need not inevitably lead to fat negativism. sexlessness. Shmilovitz. Nilsson. many Americans say they would rather die younger or be blind than be obese (Schwartz et al. not just of obesity itself.193. and an array of positive moral attributes such as control of selfish desires. All rights reserved. Fatness and obesity are by contrast associated with ugliness. appears to be well under way. Amber Wutich. attractiveness. there has been substantive globalization of slim-body ideals since at least the 1980s.1086/ 659309 269 failings. young women adopted slimmer-body ideals tied to increased use of individual body presentation as an identity anchor and supplanting an identity tied to community. intelligence. The social discrediting implicit in these moral judgments. Moreno and Thelen 1993). slimness is associated with health. teased. and it has the potential to proliferate associated prejudice and suffering. and the social undesirability of fat but also the inappropriateness of open prejudice against fat. and romantically rejected (see Puhl and Heuer 2009 for a recent literature review). Over just one decade.A. Becker’s (2004) follow-up study in Fiji in the early 2000s provides some of the most detailed ethnographic examination of this implied global shift. (alex. and laziness (Becker 1995. generosity. Brown and Konner 1987. Arizona 85287-2402. Massara’s (1989) research with Philadelphia Puerto Ricans. 0011-3204/2011/5202-0008$10. Given the moral attributions embedded in these now shared ideas about fat bodies. bullied. 1998). In sharp contrast. Sjo¨berg. and Isa Rodriguez-Soto School of Human Evolution and Social Change. Grogan and Richards 2002. we know comparatively little of any concurrent proliferation of fat-stigmatizing beliefs. and Becker’s (1995) study of a Fijian village conducted in the late 1980s. where bodies are dominant and preferred symbols of self (Becker 1995:33. or not. Using cultural surveys and body mass estimates collected from 680 adults from urban areas in 10 countries and territories.S. and Weiss 1993). Brown and Sweeney 2009. often profoundly reflecting and shaping identities and the broader social order (Bordo and Heywood 2003 [1993]. The technically obese (those with body mass index [BMI] greater than 30) have less career and educational access. 19 IX 10 CA⫹ Online-Only Material: Supplement A While slim-body ideals have spread globally in the last several decades. beauty. Results suggest a profound global diffusion of negative ideas about obesity. raising the possibility that the processes of any spread in these ideas may be connected. Douglas 1970). Degher and Hughes 1999. we find evidence of a shared model of obesity that transcends populations and includes traditionally fat-positive societies. and goodness (Caputi 1983. Profoundly. Turner 1984). 2004. wealth. fertility.00 DOI: 10. Stunkard and Sobal 1995. such as a lack of self-control. ineptitude.brewis@asu. Tempe. a globalization of body norms and fat stigma. In much of the industrialized West. Brewis et al. Using consensus analysis of belief statements about obese and fat bodies. such as through nurturing others (Becker 2004). However. grace. U. marriageability.. Brewis. Due to an absence of any comparative studies. Cordell and Ronai 1999. youth.g. the role of individual responsibility in weight gain and loss. Sobo’s (1994) study in rural Jamaica. we find most of these expressed in the middleincome and developing-country samples. as the key to shaping social stigma (Goffman 1986 [1963]). de Garine and Pollock 1995. de Vries 2007:61. and they are significantly more likely to be fired. self-discipline. Becker found young women had completely transformed their identities in relation to their Puhl and Heuer 2009. Brewis et al.jstor. whereby many of the places where large or fat bodies were reported to be valued or viewed neutrally now increasingly state a preference for slim bodies on standard body image scales (e. and undesirability but also with specifically moral 䉷 2011 by The Wenner-Gren Foundation for Anthropological Research. in Samoa in the mid-1990s. Anderson-Fye’s (2004) work on a Belize caye. social irresponsibility. 2006). Focusing on statements about fat that are explicitly stigmatizing. Big body size and fatness are imbued with cultural meaning in all human societies.Current Anthropology Volume 52. attractiveness. familial responsibility. Rubin. Ashlan Falletta-Cowden. Some of the best examples are Popenoe’s (2004) study with Azawagh Arabs in Niger. lower pay. and worse health care .

The responses to survey questions were used to conduct cultural consensus analysis using UCINET software to identify culturally specific answer keys (i. the pace of change in slim-body ideals globally suggests we need to determine whether this assumed distinction between the West and the rest is actually observable. or is the distribution of cultural knowledge rather tied more to individual factors such as education or body size (thereby suggesting a more globalized.g. Rubinstein and Caballero 2000).g. Little thought at all. have been conducted with such student populations (e.. We collected data through in-person interviews in Pago Pago. In assessing individual competencies against shared models. This content downloaded from 109. This question of how widely antifat ideas have spread is especially current given that overweight and obesity rates are rising quickly among adults in all regions except sub-Saharan Africa. Sobal 1995). and fat to which each participant responded with agreement or .S. 2004). we considered a score above 0. from predominantly white middle-class neighborhoods. body norms. and Iceland. such as studies tracing the mass promotion of very slim ideals through such media as television (e. anticipate an increase in people vulnerable to fat stigma. the culturally correct answer to each question.8 to be very high competency (i.66 to indicate strong agreement with an underlying model. April 2011 might have gained traction in recent years and are now entwined with proslim ones. We also collected an eleventh sample of undergraduates to provide a further frame of reference.193. including the very low stigma seen in places like American Samoa that are conventionally understood to be relatively fat neutral or positive. specifically.5 to indicate moderate agreement about an underlying cultural model and above 0. There is a conventional wisdom that U. Following Weller (2007:353–354). compared to places such as the mainland mainstream United States. however. our selection of sites was based on convenience. relatively affluent Scottsdale. see Hruschka et al. Weller. Asuncio´n in Paraguay. However. London. Kelly 2005). and Batchelder 1986). American Samoa. We also included a sample from the United States. Evidence of a shared cultural model was a single factor and a large ratio between the first and second eigenvalues. including several that have been glossed as fat-positive in the ethnographic record (American Samoa. including those done internationally. By “fat stigma” we mean specifically negative values placed on fat or large bodies that are socially discrediting.97. 2001). a highly medicalized and globalizing model of obesity that emphasizes its status as a sickness and thus the need for medical treatment (e. many developing countries now identify obesity as a major public health issue and express concerned about both health and economic implications (Popkin 1994. we considered average cultural competency scores above 0. We then supplemented these with Internet-based versions of the same surveys conducted through respondent-driven sampling with people living in urban Puerto Rico.g.e. with the rationale that this approach should be sufficient to identify agreement around cultural knowledge if agreement in fact existed at the local level. Akan and Grilo 1995. San Jose in Puerto Rico.270 Current Anthropology Volume 52. to compare those models from place to place.g. and the u¨ber-stigmatization of fat (e. The organizing questions are whether there is evidence of a globalization of ideas regarding obesity and fat bodies. Buenos Aires in Argentina.. By “cultural models” we refer to the ideas that form a consensus in a specific domain of knowledge (Romney. as our basic frame of reference as a known fatstigmatizing context. but problems with the surveys prevented their being included in the analysis. in the manner of Goffman (1986 [1963]). less culturally specific patterning)? Based on existing published ethnographies we would predict considerable across-population variation in ideas about fat stigma. 28 Aug 2016 17:08:13 UTC All use subject to http://about.. In terms of assessing fat stigma in particular. Samples and Methods Given that we framed our study as a pilot study to test for very basic patterns cross-culturally. Here we report on an empirically oriented cross-cultural study designed as a preliminary effort to identify potential globalizing patterns in people’s cultural models related to obesity and fat bodies in general and their fat stigma in particular.) Participants were recruited in public places at each of these sites.. the border town of Nogales.g. Mexico. Arizona. in mass production and marketing of obesogenic food (e. Tanzania. United States. Crandall et al..jstor. is being given to its possible social costs. a person who knows what others know).e. New Zealand. The sample sizes and some sample-specific characteristics are given in table 1. since the vast majority of the body image studies. to test for shared cultural models and assess individual competencies against that model. Dar Es Salaam and Zanzibar. 2008 for a detailed discussion). Our primary tool was a survey containing cultural statements regarding obesity. and with undergraduate students at Arizona State University..g. Puerto Rico. There is some evidence to support this idea. We selected nine diverse country and territory research sites where Arizona State University anthropology faculty and students have active research programs. Stearns 2007). adding increased social costs to obesity as well as with the better-documented and anticipated medical and economic ones.. we selected 25 statements from the survey that represent socially discrediting attributions related to body fat and obesity (e. and to identify variation in fat stigma specifically. however.185 on Sun. Tanzania). where widespread antifat ideas have been documented and dominant for several decades. Number 2. Data were collected between April and September 2009. hegemony in a multitude of domains is relevant to how people think about and respond to obesity. and do local differences in cultural models explain any observed patterns of variation. (We also collected interview data with Quichua speakers in Amazonian Ecuador.. The spread of cultural ideas about the negative moral meanings of fat would.

for recommendation statements. if V(i.0 for Paraguay.6 22. Centers for Disease Control and the American Medical Association. Massara 1989.9 24.7 25. We extracted statements from interview transcripts and field notes from our teams’ previous qualitative research in Samoa. average fat stigma scores ranged from a low of 10. BMI p body mass index. New Zealand.6 23.. London. To identify to what degree the mean levels of fat stigma are similar or different across samples. “people are overweight because they are lazy”).6 27. We also systematically reviewed public health Web sites. we used height and weight measures to estimate BMI using the standard formula of weight (kg) divided by height (m2). then i’s variation in fat stigma is almost completely contained within j’s variation. The statements derived from these sources emphasized the role of individual decisions and behaviors in the genesis of obesity.9 33. New Zealand.0 48.5 27. such as for the U. being overweight or obese) was included as a factor of interest in this study because it might help explain both cross-population and interindividual differences in how people respond to the cultural statements.3 53.8 28. 28 Aug 2016 17:08:13 UTC All use subject to http://about. version 18.e. and the formal consensus model assumes that respondents will guess without bias when given dichotomous response choices (Weller 2007:344). Regression analyses were conducted using PAWS (SPSS).3 40 34. This process yielded an initial pool of 150 cultural statements.2 49.5 37.4 67.5 28. This suggests fat stigma is apparent in all the samples.8 51.4 34.S.3 23. Measures were (1) taken using a portable scale and flexible tape in sites where people do not weigh themselves often (e.5 American Samoa Argentina Iceland London Mexico New Zealand Paraguay Puerto Rico United States (excluding undergraduates) U.S. If V( . Becker 1995.5 57.6 23. and from detailed readings of any relevant ethnographies (especially Anderson-Fye 2004. Results As figure 1 shows. and after removing items that people did not understand or did not respond well to or that were duplicative. American Samoa) or (2) based on self-reports in places where a reasonable correlation between self-reported weight and weighed weight in adults can be expected (e.5 25.7 24.9 28. the cultural statements themselves were derived inductively and deductively..1 26.9 37. “obese people should be ashamed of their bodies”).3 28.3 32.2 24.9 24. undergraduates.1 24.7 22.9 26. Oversight for this study was provided by the Arizona State University Office of Research Compliance and Assurance. overeating. To assess body fat status.jstor. United States).2 27.0 48. Sample characteristics Sample size (N) Female (%) Average age (yr) Average BMI Average BMI for men Average BMI for women Percentage overweight (BMI 1 25) Survey format 80 40 86 66 46 44 105 52 62.4 23. Translation and backtranslation into other languages was done only at the end of the tool development process.5 32. j) # V(j.2 63.2 37. undergraduates Tanzania Total 680 Note. In developing the tool we used “true” or “false” as the only response options because we wanted to compel people to make decisions on ostensibly judgmental items (e. Popenoe 2004.0.4 24. and the United States. The use of self-reported height and weight in some of the samples is a potential limitation of this study.0 34. j) is close to 1. out of a possible total of 25. and New Zealand samples overlap with all other samples the most (that This content downloaded from 109.5 45.1 23. self-reports tend to be reasonably accurate (see Engstrom et al..5 50 66. although in countries where people weigh themselves often.g.7 25. i) is close to 1. In other words. we were left with a final survey containing 83 statements.3 26..3 27.8 26.185 on Sun. Sobo 1994).3 26. Mexico.4 32.4 23. underexercising) but also sometimes noted factors purportedly beyond the control of individuals. Mexico. shown in CA⫹ supplement A..g. Participants’ level of body fatness (i.193. A high score on the scale (closer to the maximum of 25) indicated more expressed fat stigma.97. meaning they cannot be of very different sizes.9 In person In person Online In person In person Online In person Online 44 77 40 61.e. On this basis we find that U.2 25.9 23.1 26.271 Table 1. such as built environments or genetic predisposition.3 34.6 75.1 26. We went through several rounds of translation and back-translation between English and Spanish and piloting in both languages. (i.0 51.9 26. The items used to create this scale are shown in CA⫹ online supplement A. Nichter 2001. we computed a matrix (V) where the ijth element is what proportion of study group i’s single deviation from their mean stigma is overlapped by that of group j.4 for Tanzania to a high of 15.4 40.5 69.1 46. Iceland.g. Following Weller (2007:348). 2003).9 86.8 70.S.4 25.3 27.8 23. then the two groups can be said to have the same level of fat stigma because j overlaps i considerably and i overlaps j considerably.5 In person Online In person 60 36.

secondary.05. by country and territory Each population independently Global model .. all P 1 .63 (Puerto Rico).626 .193. i) is very close to 1.402 . high school. age level (three-level variable).052–1.185 on Sun.406 .S. we might expect women to also express greater fat stigma than men.446 .529 . or graduate/professional school.705–.531 .609 .546 .g. or gender (all P 1 . April 2011 is. When we ran the consensus analysis on each sample independently (table 2).578 . and CI contained 1. From the cross-cultural body image literature.jstor.97. and range is represented by the whiskers.501. Number 2.354 American Samoa Argentina Iceland London Mexico New Zealand Paraguay Puerto Rico United States (excluding undergraduates) U. or overweight status (two-level variable: BMI 1 25 or not.531 .621 .272 Current Anthropology Volume 52. and CI contained 1. The middle of each box represents the average.479 . Brown and Konner 1987). 28 Aug 2016 17:08:13 UTC All use subject to http://about. are the more distinctive at both ends of the spectrum). we predicted that shared understandings about the social meanings of big bodies could be Table 2. low stigma scores (≤10) were predicted by higher education level (95% CI p 1. technical training.0). which suggests women on the whole are much more concerned with body idealism and are earlier adopters of slim ideals than men. but not age level. Average competency scores.611 .586 . 95% confidence interval [CI] p .org/terms .555 . V(i..569 . overweight status.0).549 .491 . the vertical line the median.964.448 . the average competency scores ranged between 0.e. P ! . j) # V(j. Given the findings of prior ethnographic surveys (e. the boxes the twenty-fifth and seventy-fifth percentiles. This content downloaded from 109.05).05. Based on a logistic regression model combining all individuals from the different samples.566 .05). Similarly. we instead found that higher fat stigma scores (≥16) were predicted by lower education level (a five-level variable based on completed primary. P ! .0).45 (American Samoa and Mexico) and 0. but not gender.563 . indicating that population samples fall within a range Figure 1. Boxplot showing variation in average stigma scores across the samples. undergraduates Tanzania found within all of these 11 surveyed groups and that the models derived for each sample would vary across groups. while Paraguay and Tanzania overlap least (i.

we combined all 680 participants in a pooled cultural consensus analysis. Answer keys for each of the samples are found in CA⫹ supplement A. answer key and estimated the proportion of items that were in agreement.S.S. Interestingly.S.S.988 .867 . We do see some evidence of more mixed cultural models balanced between fat neutral/positive and fat negative ideas—which may indicate an ongoing period of cultural transition—in sites like Mexico and American Samoa. obesity as dangerous and a disease. we found little difference by gender in individual competency scores against the global model. model American Samoa Argentina Iceland London Mexico New Zealand Paraguay Puerto Rico United States (excluding undergraduates) U. sum- Table 3.97. average competency score for all participants was 0. cultural model for those who were born and are still living outside the United States.928 . did not feature in any noticeable way in the shared global answer . marized in Table 4.867 . as with the stigma scores. model was significantly different (P ! .976 . model.867 . To specify the degree to which other country and territory samples (vs. based on a reading of the answer keys.S to 94% for London being the same. These are shown in table 3 and range from 62. we then tested the relationship between individual demographic variables and individual competencies against the U. the shared cultural model also suggests the culturally correct perspective that expressing those judgments too obviously or forcefully is not acceptable. and Paraguay were the only samples in which the culturally correct answers associated overweight and obesity with laziness. While some negative ideas about fat/obesity were evident in the answer keys of all our samples. Predictor variables included age. Mexico.273 that indicates each has shared cultural model about the meanings of fat/obesity. In all our samples.S. however.51.S. cultural model.56 times increased with each level of education and was two times higher for women. The answer key for this global model is also given in CA⫹ supplement A. only Argentina showed significant gender differences (P p . and a binary variable related to being overweight or not (BMI 1 25).867 . and the reading of the culturally correct statements in this regard speak to the idea that that fat is highly undesirable but that extreme fat stigma and prejudice is not socially acceptable. Correlation of answer keys for different samples compared with the United States answer key Overlap of answer keys with the the U. Elements evident in the answer key for this global model included those expressing slim as desirable. We also ran a separate analysis to test whether individual BMI predicted variation in individual levels of cultural competency against this U.6) against the U. and the role of both personal responsibility and genetic or biological predisposition in the etiology of obesity. higher competency was not associated with age level or overweight status (P 1 . the result was also not significant (both P 1 . There also proved to be no association between a continuous measure of BMI and individual participants’ competency scores against the global cultural model of obesity of individuals (as shown in table 4) in a pooled multipleregression analysis.jstor.S. and the global model suggests that the cultural shared idea that fat or obesity is a basis for judging the social and personal qualities of the individual.S. However. Using Student t-tests to compare withinsample competency scores and stigma scores between women and men.05 ) and estimated to be 1.807 .185 on Sun. gender. The most stigmatizing statements. Key ideas in the global model of obesity include the notions that obesity is a disease and that fat reflects personal and social failing. 28 Aug 2016 17:08:13 UTC All use subject to http://about.047).05).94 . in Tanzania as elsewhere. and critically. Following evaluation of the cultural models derived for each of the 11 samples. Conclusion Based on this analysis of a limited but reasonably diverse set of cross-cultural samples.627 Note. Only Tanzania had a cultural model that can be char- This content downloaded from 109. showing the commonalities and differences across the samples. globalization of a cultural model about obesity and the globalization of fat stigma are clearly evident. Agreement scores generated by comparing each sample’s answer key to the United States answer key.05). American Samoa.7% of the culturally correct answers from Tanzania being the same as the U. individuals) showed similarity to the U. However. Using logistic regression. We termed this our “global” model in the sense that it is not specific to any site and includes the fuller range of cultural diversity captured by our study. we first pooled all U. the cultural model recognized obesity as a disease with negative health effects.The resulting odds ratios and confidence intervals suggest that the likelihood of having higher competency (defined as a score 10. The results suggest this global sample also has a shared cultural model in the domain of obesity/fat. undergraduates Tanzania . it is important to pair this with the observation that many of the sample-specific culturally correct answers also included statements that did not endorse the most negative statements around meanings applied to fat/obesity.771 . some fat stigma is evident.193. However. Tanzania had a more fat-neutral cultural model than the other groups.-born participants (excluding territories) into one further consensus model and compared the answer key for each sample against this additional U. American Samoa and Mexico had the greatest degree of mix of fat-positive and fat-negative statements. education.

. nothing from Asia) and sample sizes were modest. including global public health campaigns.193. Tanzania appears as an outlier that warrants specific explanation. Both of these factors would make it more likely that respondents would be exposed to.725 .745 .749 . One of the most noteworthy findings is that the highest fat stigma scores are not in the United States or London but rather in Mexico.765 .S. The findings and limitations of this study both suggest ways forward in researching these .786 . in Mexico. and—perhaps mostly unexpectedly—in American Samoa. it is important to understand the dynamics of fat-stigmatizing cultural models because of their potential influence on both physical and social well-being of individuals in a wide range of socioecological contexts. The findings around the role of education sug- This content downloaded from 109. individual fat stigma scores and individual cultural competency scores against the global model were both best predicted by education. these analyses suggest that norms about fatas-bad and fat-as-unhealthy are spreading globally and that cultural diversity in conceptions of ideal or acceptable body size appears to be on the decline.65 acterized as largely fat neutral.. and American Samoa. These higher scores reflect their agreement with several fat-stigmatizing items on the survey. In summary..762 .757 . The cultural and geographic span represented by the samples included in this study was limited (e. Our findings hint that newer forms of educational media. April 2011 Table 4. we are unable to offer one at this juncture except to recognize that sub-Saharan Africa is the one remaining part of the world not affected by rapidly rising obesity rates and where hunger remains a daily challenge for many. Number 2. For example.666 .g. In the other sites. The difference is thus not necessarily in the underlying beliefs attached to fat bodies but rather the presence of norms regarding the importance of masking these beliefs. obesity is afforded significant public health attention in the island Pacific. likely representing homogenization in beliefs in this domain just within the last decade or two. and most people living in urban areas in the region would be regularly exposed to fat-as-unhealthy types of messages (e.g. but these results certainly suggest that more comprehensive studies examining the global dissemination and impact of fat-stigmatizing ideas are warranted and should prove fruitful.758 . based on a careful examination of the answer keys and confirmed by our own ethnographic experience in several of the sites. Whatever their source.65 .632 .758 .S. Interestingly. In this regard. with an absence of fat-stigmatizing beliefs. and the fact that some sites (e.751 . Paraguay. not gender nor country of residence.757 . model Proportion correct against the global model . regardless of sample group. 28 Aug 2016 17:08:13 UTC All use subject to http://about.732 . Certainly. We propose. Education may emerge as the best predictor of this variation because it provides a proxy measure of respondents’ exposure to antifat ideas via mass media (e.765 . For example. This process of cultural change appears to be happening very quickly. it is understood that it is impolite or otherwise socially inappropriate to express highly stigmatizing opinions about overweight people and obesity—even if one thinks them. Average proportion of individual’s culturally correct answers against the United States and the global (pooled) shared cultural model answer keys American Samoa Argentina Iceland London Mexico New Zealand Paraguay Puerto Rico United States (excluding undergraduates) U. undergraduates Tanzania Proportion correct against the U.274 Current Anthropology Volume 52. Iceland) agreed almost universally with slim-idealizing statements yet did not endorse these highly fat-stigmatizing statements. they did not relate within or across groups to respondents’ actual body fat status. that this is due to differences in the consciousness of these populations about politically correct responses to certain kinds of overtly fat-stigmatizing statements. and express stigmatizing ideas. adopt. negative and especially discrediting ideas about fat/obesity are now seemingly much more widespread than a thorough reading of the available ethnographies would suggest.. This leans us toward the age-old anthropological challenge of better understanding what drives the cultural diffusion of new ideas and feeds their gaining salience.727 .jstor. including in American Samoa. television and film) and public health messages.775 .672 . Further. may be driving this trend. in contrast (and reflected in the shared model). Further support for this interpretation can be found in the association between more education and lower expression of the stigma statements. including those associated with the relationship between overweight and laziness. not agreed with in the other samples.g.752 .97. WHO 2000).g. Paraguay.661 .185 on Sun. there is not a high social value placed on self-censoring stigmatizing statements about fat/obesity.

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