psychologically and physically dealing with sudden weight gain?
June 29, 2016 11:27 AM   Subscribe

Within six months of starting a prescription known for its tendency to induce weight gain, I gained over 50 pounds. I went from a size 0/2 to a size 12/14, just under 110 pounds to just over 160. I don't recognize myself in the mirror and feel like my body isn't even mine anymore, but I know losing this weight is going to be incredibly difficult. Can you help me find a way forward from here?

I am female, mid-30s. I had struggled with keeping weight on since I was a kid so needing to take weight off is completely new territory for me. When I started to feel like something was up, I went to my doctor for a full slate of blood tests, but the results were/are great -- B12 and iron are perfect, no thyroid issues, no Cushing's, no cortisol wonkiness, no menstrual cycle weirdness.

After getting the results back from my blood tests and noting that none of the results explained the weight gain, my doctor suggested adding another prescription (Wellbutrin) on top of the existing one specifically in order to suppress my appetite, which I declined. After I declined the Wellbutrin, the doctor nonchalantly referred to me as "obese" and intimated that maintaining my current weight indefinitely is likely to involve serious health risks. Going off of the prescription that is causing the weight gain is not an option. I am still gaining weight at a fairly rapid pace.

I am mostly sedentary (long hours at a desk job). I've been tracking my meals for a few weeks and I eat between 1,200-1,800 calories a day, usually with a ~20/50/30 split on fat/carbohydrates/protein. I eat lots of fresh fruits and vegetables, whole grains, no animal products, very little junk food. I develop disordered eating habits very easily so restricting my caloric intake is a daunting proposition. I can't keep a scale in the house without going full-bore self-starvation.

I've had to replace my entire wardrobe twice as my weight has ticked up because not a single piece of the clothing I'd been wearing for years fit anymore, not even underwear. The weight gain is mostly around my midsection, with the rest split between my thighs and chest. I have stretch marks everywhere. I feel so uncomfortable and wrong in my body absolutely all of the time. I am emotionally devastated by my physical self and I don't know what to do.

Two questions:
- How can I deal with this psychologically? I thought I had escaped a lot of the body shame and hatred that comes with the territory of being raised as a girl, but it has come out with such force now that I can't even bear my own reflection anymore. I want to hide in a dark cave so no one ever has to look at me again. To say that I hate my body feels like a grievous understatement. How can I get over it when I might be this overweight (or even more) forever?
- How can I deal with this physically? Should I see a nutritionist, a new PCP, a personal trainer? Should I consider taking the prescription appetite suppressant my doctor recommended? How can I lose weight via calorie restriction without falling off the cliff into disordered eating?
posted by anonymous to Health & Fitness (27 answers total) 13 users marked this as a favorite
I gained a lot of weight in a short amount of time when I started working in computers and moved in with a chef. It's not fun, I'm sorry.

I am not at all qualified to help you with dealing with how it might be a trigger for you to count calories, but I can say for sure that taking simple carbs and sugary fruits out of my diet when possible always helps me. I know you don't have a lot of room if you're a vegan anyway but maybe some small adjustments will allow you to turn this around without counting calories.
posted by getawaysticks at 11:40 AM on June 29, 2016

Have you tried googling the medication to see what other women's experiences have been, like if the weight gain stops, if dieting even works to reduce it?

I'm not a doctor but your nutrition/amount of calories sounds fine and I can't imagine going much lower than 1200 even if you are sedentary.

Things you can do:
-work out regularly - brisk walking can also help to suppress appetite a bit, you could focus on building muscle which might boost your metabolism and at least stop the weight gain. This might also help you feel better in your skin thanks to feeling strong and the endorphins.
-wear clothing that you really love, that makes the best of your size right now. is great for advice on dressing different body shapes.
-make lunch your biggest meal of the day, stop eating after 7pm, no snacking - this is how I try to eat and it helps me maintain my weight, it's advice from ayurvedic approach to diet

I was on an SSRI several years back and almost instantly gained 30 pounds, I remember how frustrating it was, I was able to get off the medication and the weight eventually.
posted by lafemma at 11:44 AM on June 29, 2016 [5 favorites]

Can you get a new doctor? It seems like they are insinuating that it is your fault about the weight gain (trying to supress your appetite with medication?) when I assume the only thing that has changed is a new medication. If you feel like you are being dismissed and not given solutions for your legitimate concerns, it's probably best to find someone else that will actually listen to you. Perhaps you can get switched to a similar medication without that particular side-effect.

I started taking Lexapro and gained 30lbs almost instantly with no change in diet/level of activity (I'm always on my feet). Told my doctor and they said weight gain was rare and pretty much dismissed my I know how maddening it is not to be taken seriously.
posted by littlesq at 11:48 AM on June 29, 2016 [21 favorites]

This sounds awful, I'm sorry you're going through this.

How can I deal with this psychologically?

There was a recent FPP about a recent This American Life episode regarding weight. It featured a few different ladies and their thoughts and approaches to fatness. It was a good episode, but if you listen to it keep in mind that these women's stories aren't yours and so if they don't really resonate with you that's fine.

Also therapy, obviously. That's a huge change in 6 months, it's reasonable to have feelings about it. Plus it seems to hit on things that you were already deeply uncomfortable with yourself about.

How can I deal with this physically?

If the first prescription caused you to eat more (because your appetite increased) then some kind of appetite suppressor seems, to me, like a reasonable trade-off. All you're doing then is treating the side-effects of one med. Wellbutrin however, has lots of effects and it seems like you don't actually need the primary ones so maybe ask for something different?

If it was just a metabolism slow down, but your eating habits stayed the same, then a nutrionist and/or trainer to help you figure out how to eat/exercise for your new metabolism seem like they would be helpful.

BUT you can get more exercise without a trainer -- a 20 minute walk after lunch, an hour bike ride when you get home, that kind of thing, just to get you out of being "mostly sedentary." This level of exercise might not effect your weight/health all that much but I bet they'd help you feel better in general.
posted by sparklemotion at 11:48 AM on June 29, 2016 [1 favorite]

Can you try alternate medication? Or add the appetite suppressant, is there a reason not to? Once you've been at the heavier weight for a few years it'll be even harder to lose so I'd act now if possible.
posted by fshgrl at 12:00 PM on June 29, 2016

Did the same doc that prescribed the weight-gain-causing meds dismiss you as "obese" and blame you for it and offer Wellbutrin? If so, find a new one. If we're talking two different docs, maybe have the two of them work together, or make sure the Wellbutrin doc knows about the other meds.

I gained significant amounts of weight from PCOS, and know the heartache of adjusting to a new body with different aches and pains, mobility challenges, etc. I don't want to give diet and exercise advice, because if you didn't gain the weight from overeating and being lazy, then diet and exercise may not help you lose it. It might take adjusting your meds to accomplish that. I will give advice on clothing and personal care, though. Stretchy clothes are your friends. Leggings, jeggings, tunics, flowy sweaters with fitted tops underneath, scarves, things that are "bo-ho chic" if you search Pinterest, for example. They accomodate fluctuating weights, they cover areas you're not comfortable exposing yet, they stretch and let you breath and move comfortably without waistbands cutting into you. Try out new makeups and hairstyles that make you feel pretty. Wear bright jewelry that draws eyes up towards your face, and brings out your eyes. You're still you, no matter what the scale says.

Take care and keep us posted!
posted by jhope71 at 12:11 PM on June 29, 2016 [3 favorites]

Can you ask to try a different medication? There is usually more than one option for any treatment. Continuing to gain weight at such a fast rate is a very dangerous side effect and should be treated as a medical issue, not a diet and exercise issue. You can't fast your way out of a side effect.

If this is truly your only option for medication, start looking at removing foods that react the worst with your medication. Mid-section weight gain is associated with too much sugar (you may want to test your blood sugar several times a day just to see on your own if you are in the normal range). The medication may be messing with your blood sugar, triggering this reaction.

I am so sorry that you are going through this. It is a medical issue and not your fault. Don't let this break you. Go for long walks and continue to eat healthy. There are new medications coming out all the time. Hopefully something better will be available for you soon.
posted by myselfasme at 12:13 PM on June 29, 2016 [12 favorites]

If you gained the weight because the medicine increased your appetite, that's one thing, and you can fight it with something that reduces your appetite.

But if you aren't eating more than before (it's often very hard to gauge this without an accurate food diary, by the way) then the weight gain is from hormonal effects - or some other pathway - I don't claim to know all the physiological possibilities, and as far as I know they're not all that well understood, anyway. There are some drugs that cause massive weight gain as a side effect, and this is known*. It flies in the face of the standard scolding fat people get to eat less and exercise more, but it's a fact.

You need a different doctor, one who knows more about weight regulation.

*known, but downplayed to the point of cover-up. A friend who works for a pharma company responsible for certain antidepression medicines was telling me about this. It's pretty terrible - not that being fat is the end of the world in itself, but it sure as hell isn't trouble you want to borrow if you can avoid it, and these companies have the data on the incidence of the side effect, and they just hush it up.
posted by fingersandtoes at 12:13 PM on June 29, 2016 [11 favorites]

I went through something similar where a medication caused weight gain because it gave me type 2 diabetes. Cutting carbs a lot, cutting ALL simple carbs really, was the easiest fix in my own situation.

I lost the 50 pounds by making small changes that I would sustain. Whole wheat breads, sweet potatoes, less starch. Never a big soda drinker but give it up or switch to seltzer. Carbs and sugar, not fat, are usually the issue. Except if you at both at once in high quantities they can both have an impact. Google high fat low carb diet for more on the science of this.

I joined a gym and worked hard to create a habit if going first thing in the morning. I had too many excuses to back out if I didn't get it out of the way.

So small diet changes, small steps to increase exercise. I had a dog who got really excited for walks so that motivated me to walk him more, then I began to walk/jog, then just jogging. Then gym and weights and all of that.

Psychologically, I just didn't accept my new reality. I used my resistance about it as motivation to make changes. I also got off that medication as soon as I could.
posted by crunchy potato at 12:34 PM on June 29, 2016 [2 favorites]

You can ask for a second opinion from another doctor, if you don't trust/feel comfortable with this one. But just because the doctor was a jerk, it doesn't mean his recommendation is necessarily bad, and it might actually be the reasonable/right recommendation to avoid the physical and severe-sounding psychological consequences of continuing to feel no control over your body and mind. I am very medication-averse, but it sounds like the side effects of not treating this side-effect could be harmful enough that adding another medication could be much less harmful (especially considering your doctor, with knowledge of your medical history, recommended it). I also fall into disordered eating rather easily, and it comes to dominate my every waking second. If I was looking down the barrel of that versus adding a pill, I know I would choose the method that would ease that kind of non-stop mental distress. But it would still be a hard choice. Good luck to you.
posted by thegreatfleecircus at 12:38 PM on June 29, 2016 [1 favorite]

I’ve had a less dramatic weight gain, but it is significant enough that I don’t recognize myself in the mirror and don’t know how to dress. I’m not at peace with it yet, but some things that have helped me:

Prior to the weight gain, I never thought too much about what I was eating, and I always ate more than most women. (My metabolism was such that my body stayed in the “normal” range regardless of what I ate though.) I very briefly tried dieting and it didn’t do good things for my mental health. I decided that my lack of food worries, which is unfortunately pretty uncommon among women in our society, is something I really like about myself. So I’m looking positively at that aspect of my personality, which I value, and not fixating on the body consequences of it.

I tended to dress in somewhat more androgynous clothing with clean lines. It was my preference but not a part of my identity, and those styles are unflattering on me now. I’m starting to learn more about more “feminine” (for lack of a better word) styles that make me feel like I look better, and that helps with my self-confidence.

I do my best to maintain a decent sex life, which makes me feel more desirable.
A number of physical problems prevent me from doing physical activities that I’d like to. My weight is probably not a significant contributor to that, but looking at the limitations as my new reality rather than something I have complete control over, and reminding myself how much worse other people have it, is useful to me.

If you do decide to diet, I second the low-carb option… many people eat fewer calories on higher protein-and-fat diets because they feel more full, and it may allow you to avoid fixating on calorie counting. (Carbs also make me bloated, so even without losing weight I tend to look better when I eat fewer.) If those restrictions are triggering for you, you could try limiting yourself to set mealtimes… no restrictions during those times, but fewer opportunities to eat. (it is obvious from these suggestions that I’m someone who does better with set restrictions than moderation.)
posted by metasarah at 12:43 PM on June 29, 2016 [1 favorite]

I have some guesses about the type of medication. I could be wrong! But I wonder if there is any part of this that has anything to do with how you feel about accepting the chronic condition the medication is treating. I wonder if thinking through that in addition to the body image stuff might prove fruitful. I could ABSOLUTELY be wrong, and I am definitely not saying "This is what is going on." It's a question that might be relevant to parsing what is and is not going on.
posted by listen, lady at 12:56 PM on June 29, 2016

This sounds terrible; I'm sorry you're having to deal with it. I would feel the same way.

Regarding the second of your two questions, I have to agree with some others above that this doctor doesn't sound too great. If the medication is an atypical antipsychotic, they should have been monitoring you for metabolic side effects from the get-go, including your A1c and cholesterol levels in addition to your BMI. Even if the weight gain itself is the only symptom (so far), they should have been much more concerned and offered you more options than just "do you want to try Wellbutrin." For example, here's one healthcare organization's physician guidance for patients experiencing weight gain of more than 5 lbs. on an antidepressant (p. 17):

• Consider a medication change. Mirtazapine and paroxetine may be associated with more weight gain than similar agents. Bupropion is not associated with weight gain.
• Recommend a consult with a Registered Dietitian.
• Consider adding metformin or topiramate. One large trial showed an average 3-year weight loss of 2.5% (maintained over 10 years) with metformin. A meta-analysis of 6 trials showed an average 6-month weight loss of 6.5% with topiramate.
• Lorcaserin, a selective serotonin receptor agonist, has recently been approved as long-term therapy for overweight/obese patients with at least one
medical comorbidity. Long-term data are sparse, but current safety data suggest a beneficial effect on CV and diabetes risks.

I apologize if I have made a poor guess about the medication in question --- there are certainly many drugs for which weight gain is a common side effect. But in any case, this is a serious and dramatic change that clearly seems to be related to the med, and your doctor should be much more concerned about it than it sounds like they are.

IANAD, just someone tangentially related to the healthcare industry.
posted by slenderloris at 1:02 PM on June 29, 2016 [1 favorite]

Few or no Mefites are medically qualified to answer either question, but since you are asking us, I’ll venture my layman’s opinion:

Psychologically, you probably are dealing with a sort of body dysphoria and also concerns about attractiveness. By body dysphoria, I think your mind is probably shouting “this is not my body!”, since the change has come upon you involuntarily and suddenly. I don’t have advice on how to reconcile that, except to say to remember that what makes you you is your mental and emotional qualities much more than what your physical appearance is.

If you are concerned about attractiveness to existing or potential partners, it may not be the manner you’re used to, but it may help to know that women at your current weight are often considered attractive because the increased curviness can come across as an emphasized femininity.

Physically, you may want to speak with the doctor who prescribed the prescription that caused this weight gain and see if there’s an alternative medication. I also agree with others that if the doctor who gave you that prescription is the same doctor who called you obese and prescribed Wellbutrin (which is an anti-depressant) solely for appetite suppression, then were I in your shoes, I’d seek someone else. In any case, I recommend trustworthy medical advice, because you will need to adjust your weight loss efforts (which already sound impressive) based on whatever process that the medication involved is doing to cause the weight gain.

If any of this proved unhelpful, I apologize; it is a tough issue for me as a large man, and I do not know if I spoke inelegantly here.
posted by WCityMike at 1:04 PM on June 29, 2016 [1 favorite]

I've gained eighty pounds in the past two years from a combination of hormones and medication, so I really feel what you're going through.

First, it's okay to raise a fuss with your doctor about this, or find a new doctor. This is a medical issue. This is not a moral failing. This is on the person who prescribed it to you. An appetite suppressant is the opposite of useful. You don't need to fix your appetite, you need to fix this side effect.

Like other posters above I have success with lower carb diets - Mediterranean style eating, where sugar isn't really used much, but bread is okay in moderation. Lots of vegetables and fish and chicken, etc. However, I had success with this after I got off the medication and addressed some (not all) of the hormonal issues. And the success is largely that I've stopped gaining weight and have slowly started losing.
posted by annathea at 1:07 PM on June 29, 2016 [5 favorites]

I don't want to give diet or exercise advice from the perspective of losing the weight, because if you gained it as a result of new medication, traditional diet and exercise advice may not help you lose it. And there are a lot of other comments with advice about meds and doctors and such. But from a psychological perspective and to help you feel like your body is you own again, I think an exercise regimen that is NOT focused on weight loss might really be helpful.

I've always been (and probably always will be) a somewhat heavy woman. After a lifetime of not being very athletic, I got into weightlifting in my late 20s. It gave me an entirely different perspective on my body, what it was good for and what it was capable of. This sounds kind of dramatic, but it was the first time that I had thought of my body not as something for other people to look at (and judge), but as an extremely capable machine that I could use to do cool stuff. Several years later, I don't think my body is really any more conventionally attractive than it's ever been, but I am SO much more comfortable in my skin.

So even if this weight gain ends up being a permanent part of your life, it doesn't mean you're doomed to hate your body forever.
posted by mjcon at 1:49 PM on June 29, 2016 [11 favorites]

I went from 140ish to 198 in 6 months on Paxil. Normal weight all my life prior to that. I could be mistaken in my retrospective estimation (I know I had a mid-morning muffin most days at the time, that was new), but there is NO chance I ate 20,3000 calories over my TDEE in six months. (BTW I am pretty good at estimation.) I've heard people suggest that SSRIs can fiddle with actual metabolism a little, as well as increasing hunger and decreasing activity.

My doc at the time said that if I gained, he'd take me off it. (He didn't, long story, but anyway that was his thinking, also the thinking of other doctors I've had about various meds, when there are good alternatives - if the side effect profile is unacceptable, there is something else to try.)

You cannot get acceptable nutrition (i.e. meet RDA values) through food on 1200. No chance on less than that. Doctor's suggestion is unacceptable, so is this side effect for you, please review med & doctor. (Never mind that you're vulnerable to EDs, and it's either that or the other medical risks... this is unworkable on multiple levels)
posted by cotton dress sock at 2:06 PM on June 29, 2016 [5 favorites]

Is this an SSRI? I experienced something similar and ultimately decided that it was simply not worth it to me.
posted by showbiz_liz at 2:31 PM on June 29, 2016 [2 favorites]

Physically be careful with exercise with this new weight. It takes six months or more for bone to adapt to stress and at least six weeks for ligaments etc. It'll be easy to injure yourself. Swimming would be good, or biking. Be careful walking too much all of a sudden. Your body is carrying what would 've a very heavy backpack now so treat it as such.
posted by fshgrl at 2:34 PM on June 29, 2016 [4 favorites]

I had a similar experience (medication, significant weight gain). I also felt horrible about my body. For a while, I avoided wearing anything that would draw attention to me (unlike my previous svelte life, when I had fun with clothes). And it seemed like spending good money on fun, fashionable clothes in the new size would be admitting defeat and investing in the new body I didn't like. But that was what did make me feel better--buying a few really cute dresses and looking the best I could at that size at that moment. I felt like myself again. (I also made sure they had side seams, so they could easily be taken in if need be.) I hope that you can lose the weight you gained, but also try to feel good about the body you're in now.
posted by pangolin party at 3:23 PM on June 29, 2016 [3 favorites]

Psychologically I made an effort to surround myself with pictures of women who looked like me. A woman I know puts stretchmarks on all of her images and it makes a difference to see them. Same with seeing pictures of women with bellies like mine, or hips, or whatever. Psychologically it lets me see my body where it is, instead of where it was. Same with taking lots of selfies, and focusing on the sensory aspects of my bodily changes. I had a different change to you, but I had a similar reaction to what it meant in my head. I couldn't recognise myself in photos, I couldn't look at myself in the mirror much. So I surrounded myself with artistic representations of bodies like mine, and took as many photos as I could. Some were 'bad' but mostly I focused on taking ones that looked like me, or how I look in my head.

I still have days where I am uncomfortable with what I look like, how my body feels, but I try really hard not to expose myself to body hatred of any kind, and to be kind to my body. It's been through a lot, and I am still here.
posted by geek anachronism at 4:13 PM on June 29, 2016

Re stretch marks - you can talk to a derm about options like laser, Retin-A (can lighten new but not old stretch marks), glycolic acid + vitamin C, or micro needling.
posted by cotton dress sock at 4:17 PM on June 29, 2016

Well, eating disordered gal here. I can only offer advice in the food and exercise arena. You need to eat to live. I gained weight on anti-depressants and it was particularly devastating for me because I have an eating disorder..although I was able to switch to a different medication eventually. But I went through a period where I was facing a lot of pressure to both lose weight and learn how to eat again and it required a lot of mental gymnastics. I think a second opinion can help; maybe there's a combination of drugs that might do the same thing for you without the weight gain. I am actually on Wellbutrin despite fears about the appetite suppression -- I didn't find it had that strong of an effect on me after a few weeks on it. Something like adderall or vyvanse, which have stronger effects on appetite, would have been out of the question.

Starting to exercise can be a fragile thing if you are prone to disordered eating...I find that it can be both helpful and triggering depending on my attitude. It helped for one to find something that I could enjoy and also, to echo others, lift weights because it helped me focus on strength rather than the notion of burning calories. It's triggering when I start beating myself up for not exercising and fixating on it and suddenly I'm throwing up lunch -- try to find something you enjoy, set an attainable goal and start out easy. For example, I just started walking to do errands or going on long walks and listening to podcasts every other day. I tried to frame it as time with myself.

While pursuing treatment I found it helpful to see a nutritionist and plan out my meals by category, like "for breakfast I need 2 proteins, fruit and a dairy." I definitely was not always good about following it, but it eventually helped me feel more at ease with changing my eating habits, by focusing on food categories rather than calories.

I made a few rotating grocery lists consisting of healthy staples and alternating snacks to keep things interesting and I allowed myself to indulge too. In between my busy life, it helped me stay on track and took a lot of the agonizing out of it. I think that's important...spend a lot of time making plans and intentional decisions up front -- recipes and ingredients and grocery lists that you can feel comfortable with -- and it will cut down on some of that in-the-moment agony.

This is time consuming, but for awhile I had a bunch of index cards with meal ideas. When I was feeling anxious and indecisive I would pull out any card (ie. Breakfast - "Oatmeal and apples"/ Snack - Hummus and carrots) and eat that. I have a tendency to obsess so much while selecting food that it gets me all riled up so that by the time I eat it I'm convinced I've done something terrible. It helped me a lot to just remove the number of choices I had to make in the process of eating any individual meal.
posted by mmmleaf at 12:03 AM on June 30, 2016 [3 favorites]

Weight gain due to medications is a bummer. I gained 75 lbs in 3 months for the same reason, it's not fun. All the sympathy to you.

Welbutrin has different effects for different people, and may not actual suppress appetite for you. It can in some people, but it's not like an amphetamine - it's not guaranteed. There's still a lot of research going on to understand HOW it works in the brain, so I would be cautious with the answers that say "why not just take it?". At minimum, it's worth getting a second opinion from another medical professional. Note that I'm not saying "don't take it". I'm trying to say, it's not a magic bullet. If it was, I would have lost ALL the weight I gained with the other medication. I have not. I have lost 10lbs over the last 2 years, and that can easily be attributed to a better diet and more consistent exercise regimen.
posted by RogueTech at 5:00 AM on June 30, 2016 [1 favorite]

I have a family member who went through this several years ago due to the atypical antipsychotics - slenderloris's advice was right on target for her. The result was that she was able to stabilize her weight. More recently, she started to work with a nutritionist and found that if she increased her calories to a minimum of 1400 a day, she had a healthier diet and actually lost a little bit of weight . However, trying to count calories to make the minimum was very dicey (history of disordered eating) and when other life stressors got worse, she had to give up on that. Telling you this not to recommend it but to strongly suggest (1) working with doctor who really understands the medications and the options and will listen to you about your own preferences and your understanding of your own body and (2) a nutritionist or dietician who will also listen to you. This can be hard to find but it makes a big difference.
posted by metahawk at 10:10 AM on June 30, 2016 [1 favorite]

Is the weight gain due to an anti-psychotic? If it is, there are alternatives that are weight-neutral (Geodon, Abilify, Trilafon). You may have more options than you think.
posted by foxy_hedgehog at 6:32 PM on June 30, 2016

Can you get a second opinion on switching to another medication? I gained a bunch of weight on SSRIs that I'm still working to get off, my doctor worked with me to find something that worked without the weight gain

One thing she mentioned because we were having so much trouble finding a medication that worked for me (I had so many side effects I went through about 6) is that if the last one I was on didn't work, apparently now they do something where they swab your mouth and send it off to a lab and that can match you up to a medication that will work for your condition with minimum side effects
posted by raw sugar at 10:55 PM on June 30, 2016

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