Food Policy

The Bogus Public Health Attack on Sugar

What we eat and drink is, first and foremost, a matter of individual responsibility.

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Health activists are in a tizzy over sugar and fast food, which they blame for the obesity "epidemic." Responding to these concerns, politicians have sought to tax or regulate the alleged culprits. Tort lawyers, smelling tobacco-settlement-scale greenbacks, have been gearing up to sue companies producing sugary beverages. Last week, in an attempt to pre-empt this barrage of legislation, tax, and litigation, the Coca Cola Company announced that it would from now on "market responsibly, including no advertising to children under 12 anywhere in the world." But none of these actions are likely to have much impact on our waistlines; indeed, some may be counterproductive, while others are likely to burn a hole in our wallets. And for most of us, life just wouldn't be as sweet. Fortunately, there are better ways to achieve a healthy weight.

In the 1950s, less than 10 percent of the U.S. population was obese on standard measures; being overweight was viewed as a risk factor for some diseases; and weight control was considered a matter of individual responsibility. Today, more than a third of Americans are classed as obese. Meanwhile, obesity is widely described as a disease in its own right, which is blamed on companies seeking to sell us pre-prepared food and drink. If those claims were true, then the lawyers would make like thieves. But are they true?

Let's start with the claim that food and drink companies have made us fat. In The End of Overeating, published in 2010, former FDA commissioner David Kessler argued that we live in an "obesogenic" society in which companies are constantly tempting us with products high in salt, sugar and fat. This meme has caught on: in Salt, Sugar Fat, released in February, New York Times journalist Michael Moss repeats Kessler's accusation that food manufacturers seek to ensure that their products approach our "bliss point," by loading them with—you guessed it—salt, sugar, and fat.

It does appear that the main cause of our expanded girths is that we have been consuming more calories. Most of the increase in obesity has occurred since the mid-1980s (rates rose to around 13 percent in the 1960s but stayed more or less constant until the early 1980s), which coincides with a sustained binge on the part of a significant portion of the American public. The amount of calories consumed per day by an average American man rose from about 2,080 calories per day in the late-1970s to 2,400 in the mid-1990s to 2,600 in the early 2000s. Equivalent figures for women are 1,500, 1,650, and 1,850, respectively. Meanwhile, we seem to be expending about the same amount of energy as we did in the 1970s: In a 2003 paper, Harvard economists David Cutler, Edward Glaeser, and Jesse Shapiro concluded that "The available evidence suggests that calories expended have not changed significantly since 1980."

OK—so we've been eating too much. But are those food and drink companies to blame? Well, most of the increase in calories does seem to have come from pre-prepared snacks. Cutler et al. explain that the increase in availability of pre-prepared food and drink made it easier for us to eat more by lowering the "time costs" of preparation. That makes sense. In 1913, we certainly could have eaten lots of chips and cake and drunk lots of juice but it would have taken considerably more time to prepare them than it takes to open a few packages, so most of us would not have had the time to snack in the way that we do today.

But there is a twist. Cutler et al. calculated that even taking into account the consequences of our increasing girth, we have benefitted on net from the wider availability of pre-prepared foods and drink because they have reduced the amount of time we have to spend in the process of preparation. In that light, all the efforts made by food and drink companies to identify our "bliss point" seem benign, not malign as in the Moss account.

Moreover, it turns out that obesity is not quite the health disaster the tort lawyers would like it to be. In a 2005 paper published in the Journal of the American Medical Association (JAMA), Katherine Flegal and her coauthors showed that people who are "overweight" but not obese are less likely to die of any cause than people of "normal" weight. Meanwhile, people who are "grade 1" obese are as likely to die as "normal" people. Only people who are underweight or have grade 2 or 3 obesity are more likely to die. In other words, obesity can lead to health problems but does not necessarily do so—and is only a serious concern for people who are very obese. These results were confirmed in a follow-up study by Flegal published in JAMA in January, which analyzed 97 studies giving a sample size of more than 2.88 million individuals.

Now, the proportion of people with grade 2 or 3 obesity did increase significantly in the 1980s and 1990s, rising from about 5 percent of the population in 1980 to about 15 percent in 2000. But over the same period, the proportion of those with grade 2 or 3 obesity who died from all causes fell. The most likely explanation for this is some combination of the following: First, improvements in medical interventions addressing a range of obesity-related problems, from diabetes to cardiovascular disease, mean that people suffering these obesity-related ailments fare better today than they would have done 30 years ago. Second, whereas previously obese people tended not to get much exercise, many more are now both physically fit and obese. Most likely, the group that really do suffer substantial increases in health problems are those who are "grade 3" obese; and this may in part be because above a certain weight there seems to be a vicious circle of declining exercise and increasing weight—even though those who are most obese are likely to benefit most from exercise.

And so to "solutions." In an influential study published in Science in 2003, James Hill of the University of Colorado and three coauthors estimated that a reduction in calorie consumption—or increase in energy use—of 100 calories per day would be enough to keep most of us trim. Many health advocates argue that taxes or even regulation are the simplest way to achieve that objective. But would those policies work?

Soda taxes have been extensively studied. Initially, it looked like they would work. Several studies found that a tax would reduce consumption of the beverage in question. However, these studies failed to factor in offsetting behavior by consumers. In particular, when faced with a tax many consumers either buy a cheaper (own-brand) variety, or switch to other drinks that are equally calorific, such as juice or milk. In a 2010 paper in Contemporary Economic Policy, Jason Fletcher of Yale, and colleagues David Frisvold of Emory University and Nathan Teft of of Bates College, found that increases in taxes on sugary beverages do reduce the number of calories adults consume but, because of these offsetting behaviors, the effect is very small. In a subsequent paper published in the Journal of Pubic Economics, Fletcher and co. looked at purchasing habits of schoolchildren and found that "the decrease in calories from soft drinks in response to an increase in the soft drink tax rate is completely offset by the increase in calories from whole milk."

If taxes don't work, what about regulation? The main regulation promoted by health advocates is calorific labeling at restaurants. This might work if people paid attention to such labels—but most don't. In a detailed study of the impact of NYC's food labeling law published in the American Journal of Public Health in 2010, Tamara Dumanovsky and co. found that only about 20 percent of consumers used the calorie information. This probably explains why such labeling has little impact on calorie consumption at restaurants. Moreover, since most of the extra energy people consume (now about one third of all calories) is in the form of snacks rather than meals at restaurants, such a regulation is unlikely to have a significant effect on most people's waistlines. The same goes for regulations limiting the size of soda beverages sold in restaurants.

At this point, you may be throwing up your hands in despair. And maybe you should. But not at me. You should throw up your hands in despair at the false bill of goods you have been sold by the public health researchers who, as Helen Lee observes in a fascinating study recently published by the Breakthrough Institute, "set about defining the causes of obesity in ways that they believed would predispose the public to support societal action to bring the industry to account." Lee observes that this involved, first, redefining obesity as an "epidemic" (it isn't—because it is not a disease) and, second, defining obesity as an "involuntary risk" (it isn't—otherwise we'd all be obese, given that the alleged risk factors are so ubiquitous).

Unfortunately, this distortion of the nature of "obesity" has led us down a blind alley from which we must now retreat. The government is incompetent to decide what and how much each of us should eat and drink. Its attempts to influence our decisions have mostly been futile and sometimes counterproductive: for example, at least one study found that college-age men increased their energy intake when purchasing food at restaurants where the energy content was displayed. At the same time, government regulations and taxes distort our consumption decisions in ways that may reduce our level of satisfaction: for example, soda taxes encourage us to consume lower quality unbranded sodas—or reduce the amount of money we have to spend on other items.

What we eat and drink is, first and foremost, a matter of individual responsibility. Fortunately, some researchers have been investigating the real reasons some of us consume too many calories—and this research is yielding practical advice. Brian Wansink and his colleagues at Cornell University's Food and Brand Laboratory have been investigating practical measures that can be taken by individuals and organizations to encourage us to eat fewer calories. Many of Wansink's findings, detailed in his book, Mindless Eating, focus on addressing various cognitive biases that lead us to consume more calories than we intend. So, for example, when we eat off a large plate, we tend to underestimate the amount of food we're eating. Solution: eat off smaller plates. Likewise, when we drink out of shallow glasses. Solution: drink from tall glasses. When we eat chips straight from a giant container, we consume more than if we portion out chips into small bowls. And so on.

Meanwhile, contrary to the dire assessments of people like David Kessler and Michael Moss, companies are beginning to realize that they can provide nutritious food and beverages in ways that enable people to maintain a healthy weight. A group of CEOs of food and beverage companies has created the Healthy Weight Commitment Foundation, which seeks to encourage the public to manage their weight better by "balancing calories in with calories out." Because of the significant presence of member companies in the supply of food and beverages, the Foundation has great potential to communicate important messages about how most effectively to maintain this healthy balance. Beyond that the Foundation is reaching out directly to teachers, who have the potential to influence how kids think about diet and exercise. According to its website, the Foundation has so far reached over half of all U.S. elementary schools; that's pretty impressive.  

Unfortunately, Coca Cola's decision to "market responsibly" might not help and could even be counterproductive. While the small-print qualifies the company's apparent blanket prohibition on marketing to children, saying that it will "not buy advertising directly targeted at audiences that are more than 35% children under 12," that still means it will have difficulty marketing healthy products and healthful messages to kids.

But there are also things the government can do. Or, rather, there are things the government can stop doing, such as distorting our consumption decisions. Among other things, the federal government could end its subsidies to food production, distribution, and consumption. That includes food stamps, which may only be used to purchase foods and beverages and has been linked to increased obesity; if instead people simply received a cash transfer, they could then make decisions themselves about how to spend their money. And governments at all levels could stop imposing arbitrary, discriminatory taxes on food and beverages. To the extent that these taxes incentivize consumers to avoid brand products, they may actually reduce access to the kinds of information that the brand companies seek to provide about maintaining a healthy weight.

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  1. I fucking hate our Government.

    1. Just looked at your name; I guess you do!

      1. I think it suits me quite well.

        1. Hopefully you’ve never been in a Spanish prison.

    2. If the current trend continues it’s only going to get worse.

  2. Last week, in an attempt to pre-empt this barrage of legislation, tax, and litigation, the Coca Cola Company announced that it would from now on “market responsibly, including no advertising to children under 12 anywhere in the world.”

    Pussies. I’d have new ad campaigns promoting coke in baby bottles, using the original formula. “Discover the classic, refreshing taste that put the Coca in Coca-Cola!”

    1. no advertising to children under 12 anywhere in the world

      What does that even mean?

      Are they going to have a leader segment warning that children are not to view the ad?

      1. Surest way to get children to watch “Hey kids, look away!”

        1. Forbidden fruit always tastes the sweetest.

      2. Probably means they’ll pull advertising from Nickelodeon and Disney.

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  3. when we eat off a large plate, we tend to underestimate the amount of food we’re eating. Solution: eat off smaller plates. Likewise, when we drink out of shallow glasses. Solution: drink from tall glasses.

    But Big Gulp cups are *banned*! I’m so confused!

    1. I would love to see them explain the big increase in obese six-month-olds. They drink breast milk or formula (gluttony!), and they lie in their cribs all day (sloth!). Maybe they can drink from tall baby bottles?

      1. Epigenetics

        1. Yep! An “A” for the day to Mr. G!

          1. We’ve read the same books my friend…

            1. My niece got Why We Get Fat from her endocrinologist. She’s lost 50 pounds since the summer.

    2. When I drink from a big gulp I wonder why anyone would ever want to drink that much sugar water in one sitting.

      1. Hormones. No kidding.

  4. What we eat and drink is, first and foremost, a matter of individual responsibility

    True, except the government has been giving us bad dietary advice since the McGovern Commission.

    In an influential study published in Science in 2003, James Hill of the University of Colorado and three coauthors estimated that a reduction in calorie consumption?or increase in energy use?of 100 calories per day would be enough to keep most of us trim.

    This won’t work because calorie intake and expenditure are not independent variables. IOW working out makes you hungry.

    “the decrease in calories from soft drinks in response to an increase in the soft drink tax rate is completely offset by the increase in calories from whole milk.”

    The sugar in plain whole milk contains no fructose. The HFCS or sucrose in the soda does. Fructose is processed as a hepatic poison, increasing insulin resistance in the liver.

    Cutler et al. explain that the increase in availability of pre-prepared food and drink made it easier for us to eat more by lowering the “time costs” of preparation. That makes sense.

    People are obese in places where there is no pre-prepared food and no restaurants. People in abject poverty who live on fewer calories than the WHO say is even minimal can even be obese.

    1. I assume you’re a follower of Lustig’s work?

      1. More like Gary Taubes. I read Lustig, but what he says does not agree as well with my personal experience. I lost 125 pounds in 8 months and have kept it off for 9 years doing Atkins, except I still drink milk with breakfast, and I give myself one “cheat meal” each weekend.

        A friend started off at nearly 500 pounds, was able to drop and keep off about 100, but was stuck until he went to my endocrinologist who got him a “ketometer.” Turned out he was eating too much protein and not enough fat. Now, after losing around 80 pound a year, he’s down to 235 pounds.

    2. Live Free, I was thinking about your diet/weight posts while making my coffee this morning (I know, get a life, right?). You always post really interesting info, that often contradicts conventional wisdom. And then you post another epic. Thanks! 😉

      Now, if only Tony or Shreek would post something stupid…

      1. Geez EDG, I’m so used to getting back criticism and silence about this. I frankly have no idea what to say beyond thank you!

        1. FWIW, I don’t respond to your diet comments precisely because I agree with you. I think a lot of commenters here are fans of Gary Taubes.

          1. Cool. I get ravaged by people on other forums. A lot of times they act like people shouldn’t be able to lose weight without suffering.

        2. Live Free or Diet: I want to add my support. Your comments about Taubes are right on the money. I eat a modified LCHF diet.

          Our government via farm subsidies and crappy nutritional advice has been a leading cause of the obesity problem.

          At this point, I’d like all government stooges like Bloomberg to STFU. Individuals getting good information from sources like Gary Taubes, Eric Westman and even Lustig (I find his anti-corporatist position annoying) will figure out the solution without their statist bull.

          1. Thank you, ma’am,for your kind words. I initially used the Atkins Essentials and had not bought a more recent Atkins book, so I had to look up Dr. Westman.

            Lustig’s politics put me off as well. Also, he goes well out of his way to avoid saying things directly that might make him agree with people who are openly LCHF or Paleo advocates, but then the diet recommendations in Fat Chance turn out to be quite similar.

            1. I don’t want to sound like smart-alec or anything but I’m 41, 5’10 and weigh 145 lbs. No hint of a belly and eat just about anything.

              People say it’s because I’m “nervous” and always moving but I don’t know. Maybe it’s just genetics. I don’t think it’s sports either because I know plenty of guys who despite working out or playing a sport still sport some fat.

              I’ve never had to go through a diet and I’m thoroughly impressed with people who do and stick to it. It takes discipline and they deserve a high five.

              All these laws are just bull shit. In the end, take control of your life and educate yourself like LFOD did.

              I rarely read labels on foods because they’re mostly meaningless. I’ll check for salt and high fructose and hydrogenated crap but that’s about it.

              1. High fructose corn syrup that is.

              2. I don’t want to sound like smart-alec or anything but I’m 41, 5’10 and weigh 145 lbs. No hint of a belly and eat just about anything.

                What I would give to have your efficient fat metabolism!

    3. “The sugar in plain whole milk contains no fructose. The HFCS or sucrose in the soda does. Fructose is processed as a hepatic poison, increasing insulin resistance in the liver.”

      And yet the sugar in fruit contains (wait for it) FRUCTOSE! But I guess its the special fructose that is totally different than the exact identical fructose you get from corn syrup, eh?

      1. Of course not. Fructose in fruit (but not juice, of course) comes with both soluble and insoluble fiber, which slows down the pulse coming to the liver, and extends satiation.
        Heard the old adage the poison is in the dose? A pint of fresh strawberries contain 17 grams of sugar, about 8.5 grams of fructose. A small Coca Cola has 41 grams of sugar, about 20.5 grams of fructose. For me, 16 ounces of soda would barely get me started, but 2 1/2 pints is a lot of strawberries.

  5. The premise behind all of this is that people cant figure out how to feed themselves. I say that if they are that dimwitted then we dont need them around anyhow.

    1. The government successfully fed me the low-fat, calorie-is-a-calorie bit until ten years ago. (Remember when rice cakes were diet food?) Now I’m 2/3 the man I used to be, and eating whenever I’m hungry.

      1. So what is it you’re eating whenever you’re hungry?

        1. No soda, no sugar, minimize bread, potatoes, corn and rice. Meat, cheese, high-fiber vegetables and salads (that look more like a sub sandwich without the bread). I treat fruit more or less like most people do dessert or candy.

          If we’re having spaghetti and meatballs with red sauce as the main dish, I get meatballs with red sauce.
          I’ll have my tacos without the tortilla, or I’ll take only one tortilla and slice it up and mix it in with all the fillings that would go with the four I would normally eat.

          1. Thank you.

            1. Read this. It’s short.

              http://www.nytimes.com/2002/07…..all&src=pm

              1. Great article.

          2. If you haven’t already seen this documentary, I’d recommend it…

            http://www.perfecthumandiet.us/

            1. Thanks! I’ll watch it when I get a chance.

              Also, Fat Head: http://www.hulu.com/watch/196879

            2. Torontonian:
              I’m about 30 minutes into it now. You have given me a lot of new reading to do.

      2. I am probably biased as I took biochem and organic etc etc and figure everyone should know that the fat you eat doesnt fall through you and land on your ass and that taking in excess energy gets stored as fat.

        1. and that taking in excess energy gets stored as fat.

          Your biochem should tell you better than that part.
          Pop quiz: Why are Type I diabetics usually skinny, but Type II diabetics usually fat?
          Type I don’t produce enough insulin and cannot store fat unless given insulin.
          Type II have insulin resistance, so their bodies produce too much insulin trying to compensate, so they cannot release fat unless they find a way to lower their background blood insulin levels.

    2. Sweet home Alabama…

    3. If Americans could just finally wake up and realize every last lawyer must go, then we’d have a real paradise.

      And who really gives a damn if someone wants to be fat.

      1. I doubt many people want to be fat.

    4. You would think rational Darwinists would accept that as a kind of natural selection.

  6. What we eat and drink is, first and foremost, a matter of individual responsibility.

    That’s just Randroid, teathuglican crazy talk. Seriously, I didn’t know that I had better than average will power, but I manage to keep the weight off.

  7. The world’s going to suck without jolly fat people.

  8. Coca Cola should sponsor lap band surgery for it’s greatest customers.

    1. When I was very young my mom would break up a couple tiny white pills with X’s on them and put them in her bottle of Coca-Cola. After that she’d really get a lot of housework done really fast.

      We children were never allowed to drink from Mom’s bottle, we had our own Coke bottles.

      Mom never had a weight problem. Makes me wonder why the doctors quit giving mom’s those tiny white pills.

      1. Ah, white crosses! Reminds me of the time…

  9. 16 years of going to my daughter’s events, schools, etc., and I have still yet to see any evidence of this supposed “obesity epidemic.”

    And I still wonder whatever happened to the “no self esteem” epidemic of the 1990s, wherein Male-Dominated Society was destroying young women by falsely causing them to believe they were all overweight and needed to diet…

    1. If Americans didn’t have an “epidemic” to freak out about they’d just invent one.

      1. This lack of an epidemic outlook is growing at epidemic proportions. Surely govt must intervene before everyone thinks there is no epidemic.

        or something like that.

  10. Have you ever drunk a Mexican coke? If you have you know the difference between corn syrup and beet sugar. I don’t really care about the health effects, bring back beet sugar.

    1. HFCS is just a lot cheaper in the USA. There’s no metabolic difference.

  11. If you think Rachel`s story is nice, , 3 weeks ago my aunties neighbour basically broght in $5518 workin twelve hour’s a week from their apartment and the’re co-worker’s sister`s neighbour has been doing this for three months and got a cheque for more than $5518 in their spare time on their mac. apply the guide on this address, http://www.sea12.com

    1. You think Satan’s story is nice, last yetsterday I sucked Obamasama’s Willie and I got paid $3.69 gabillion!!!! See http://www.landoverbaptist.com ?

  12. Full disclosure – I work for Coca-Cola. The marketing policy to kids doesn’t mean that we’re taking the sensible education aspect any less seriously – rather, we’re talking direct to moms (and dads) about energy balance since they’re the ones with the primary responsibility (and better placed) for guiding their children. We can put the exercise programs and nutrition information out there, for sure, but parents can make the choice of how to help their kids enjoy healthy and happy lives.

    1. – rather, we’re talking direct to moms (and dads) about energy balance

      Energy balance doesn’t work as a driver of fat any more than it’s a driver of height. If it did, after 40 years of basketball would mean I would be 7’7″ and 165 pounds.

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  14. If we really want to get serious about reducing and preventing obesity, we need to focus on education instead of government regulation. What you eat, drink and feed your family is your choice and does not need government control, oversight or influence. Taxes, bans, and other restrictions are bad policy because they do nothing to teach people healthy lifestyle habits. They simply increase hardships on hard-working families and invite the government to start looking around for more common, everyday items to tax and regulate.

    -Maureen Beach, American Beverage Association

    1. You’re so right, Maureen. But, we also need to do away with the farm subsidies that artificially lower the price of corn syrup and sugar cane, right? We need to stop subsidizing the production of low nutritional quality food.

      1. Oops, better answer than mine.

    2. If we really want to get serious about reducing and preventing obesity, we need to focus on education instead of government regulation.

      If we really want to get serious about reducing and preventing obesity, we need to focus on research. What passes for research in the dietary sciences would be laughed at in anything this side of Tarot cards.

  15. Great post. Also great caliber of comments in the discussion. Better info then many of the comments I have found elsewhere online when looking at diet. I can see that many here commenting are the type of people that would take a strong responsibility for what they eat and drink. However I don’t think this is representative of every part of today’s society. That everyone would react to food and their daily intake in such measured and calculated fashion. When discussing statistics of the entire population, you have to take into account ALL the factors at play in a group of that size. Which obviously is EVERY factor. I think you missed important factors that are at play in the increase in obesity recorded in modern society. These are psychological. Various psychological reasons and triggers to eat, interplaying against constant food advertising, availability and the insulin inspired hunger surges and the ready availability of packaged snack food you have mentioned. For example when I am stressed at work working for a few hours on a deadline, I break the inner tension with a snack treat. Unneeded for hunger, but a mental relief. Others eat when sad or depressed. i.e. Eatmotion – Eat Emotionally (sorry couldn’t resist). This is getting more prevalent with the added stresses of demanding jobs and higher expected outputs in modern life, and today’s regular economic uncertainty and anxiety. People eat more to quell the anxiety and feel secure.

  16. Then there is eating when your bored to break the tedium. A nice savory snack or sweet snack depending on your palate. Or eating to make an experience perfect i.e. when you go to the cinema to see a really good movie, popcorn or an ice-cream in a darkened theatre is part of the experience. So at home trained over the years by this, we grab something nice to snack on when we watch a great movie on cable etc. Thus Eatainment – Eat Entertainment, another psychological reason to eat. You know that malls brought us Shopertainment, now modern society has brought us Eatainemt. Then there’s the case of school students just grabbing a soda. At lunch through habit. But from vending machine between meals just because “they felt like one” i.e. for a ‘lift’ This is Eatxperience i.e. Eat-experience, i.e. taking in calories not for hunger, or in any way measured way, but for the experience or lift. On the other end of the scale for this is Foodie Gourmet Travelling, Dining, Tasting etc. Eatainment, Eatmotion, Eatxperience, all part of modern societies psychological makeup and approach to eating, which I think you will find differs a lot from the 195O’s, so they must be taken into account as contributing factors in anyone looking at the increase in obesity in modern society.

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  18. By my brother’s own admission he is overweight by about 88 lbs which is equivalent to carrying around an additional 11 gallons of water which he must carry 24/7. He carries this weight as soon as he gets out of bed, or tries to wash his toes in the shower. I choose not to live like that. I walk my dog for 3 miles, run an additional 3 miles and then play basketball for 30 minutes with my son – things that my brother can’t dream of doing. While it may be true that brother may live as long as I do, I doubt he will have the same quality of life that I do, and his medical bills will be far more than mine (I take no statins or other medicines, 100/60 bp). This article does not address the harmful effects that being overweight has on one’s quality of life.

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