Written By: Jackie Ballou Erdos, MS, RD, CSSD, Registered Dietitian & Owner, Balancing Act Nutrition, New York, NY
Reviewed by William A. Neal, MD, professor emeritus, pediatrics (cardiology), West Virginia University, Morgantown, WV
It’s been close to a decade since The Endocrine Society’s guidelines on pediatric obesity1 have been updated. For many clinicians, the latest revisions—from the European Society of Endocrinology and the Pediatric Endocrine Society, and funded by the Endocrine Society—are long overdue.
“Childhood obesity is not something that can be prevented in the doctor’s office, it’s prevented in the community in which the child lives,” says Dennis M. Styne, MD, Yocha Dehe Chair of Pediatric Endocrinology and a professor of pediatrics at the University of California, Davis. As chair of the task force that established the new guidelines, Dr. Styne has emphasized the need to form alliances among government officials, the education sector, urban development groups, and healthcare professionals.
What are the new recommendations?
In addition to strategic partnerships, the new guidelines encourage breastfeeding, given its many well-established benefits, yet with the caveat that the relationship between breastfeeding and obesity prevention is less clear than was once thought. As Dr. Styne explains, “We absolutely recommend breastfeeding. But unfortunately, several studies have suggested that maybe it isn’t the one unequivocal way to prevent obesity.”
Not surprisingly, Dr. Styne and his guidelines co-authors also continue to recommend decreasing or eliminating intake of sugar-sweetened beverages, and limiting juice intake to 4 to 6 ounces a day for children 6 months to 6 years old, and 8 to 12 ounces daily for kids 6 years and older. Whole fruit is preferred over juice, and 5 to 7 servings of fruits and vegetables per day are encouraged.2
Further, the guidelines recommend increasing the number of opportunities for children to be active. The authors acknowledge that technology, and with it, screen time, has increasingly become a part of everyday life. They endorse the practice of offsetting time spent being sedentary with physical activity, and prescribe a more moderate recommendation, given that the condition of obesity itself makes it more difficult to be active.2 While 60 minutes of vigorous physical activity 5 days per week is ideal, an initial goal of 20 minutes 3 to 5 days per week may be more realistic as a starting point, and has been shown to yield metabolic benefits.2
Rest is critical, too. Obtaining adequate sleep (8 to 11 hours a day) of good quality is a new prevention strategy recommended in the 2017 guidelines. As Dr. Styne explains, “If you don’t sleep enough, you’re more insulin-resistant and it affects your carbohydrate metabolism in an adverse manner.”2
Reducing stress and addressing dysfunctional family dynamics are also emphasized in the guidelines as important obesity-prevention tactics.2 Add to that school- and community-based interventions that employ specific behavior change strategies as part of childhood obesity-prevention measures.
Guidelines for screening young patientsThe guidelines recommend using body mass index (BMI) to diagnose childhood obesity. Although imperfect and limited in the information it provides, BMI is easily calculated and is still a useful tool, Dr. Styne believes.
Styne says diagnosing pediatric obesity and assessing the child for comorbidities early on are paramount. The 2017 guidelines recommend evaluating children and adolescents as young as 2 years old with a BMI greater than or equal to the 85th percentile (defined as overweight) for obesity-related comorbidities.2
The updated guidelines also include new benchmarks for alanine aminotransferase (ALT) levels, which are used to monitor the risk of non-alcoholic fatty liver disease (NAFLD). “We’re worried about a boy having a value over 25 and a girl having a value over 22,” Dr. Styne says.
What about evaluating young patients for diabetes?
“The hemoglobin A1c in a teenager isn’t necessarily as accurate as in the adult in diagnosing diabetes,” Dr. Styne says. The authors of the 2017 guidelines acknowledge that an international expert committee recommended in 2009 that the same diagnostic criteria for diabetes using HbA1c levels be applied to adolescents, but caution clinicians that this recommendation is based on adult studies only. Other pediatric studies, the authors go on to say, have shown that HbA1c isn’t a good indicator of prediabetes or diabetes (underestimating the incidence of both), and note that in high-risk youths, there’s good support for using other tests in combination with HbA1c when making a diagnosis (such as a fasting, random, or oral glucose tolerance test).2 The guidelines also steer clinicians away from testing insulin levels, given that there are no clear diagnostic criteria for insulin resistance, and that temporary insulin resistance commonly accompanies the conclusion of puberty.
In addition to diabetes and NAFLD, the authors encourage screening patients with a BMI greater than or equal to the 85th percentile for dyslipidemia, hypertension, polycystic ovary syndrome, obstructive sleep apnea, and psychosocial problems.2
Assessment of endocrine and genetic disorders is also covered in the guidelines. “An endocrine evaluation isn’t so important unless you have clear evidence of an endocrine problem, or the child’s growth is attenuated,” Dr. Styne says. “However, there are genetic causes of obesity which can be diagnosed. At present it’s about 7% of the most extreme obesity [cases].” Specifically, the guidelines recommend a genetic evaluation for patients younger than 5 years of age with extreme obesity (BMI >120% of the 95th percentile) accompanied by genetic obesity syndrome characteristics (such as food-seeking behaviors or hyperphagia), with or without a history of family members with extreme obesity.2
Treatment options can vary widely
“Lifestyle [modification] is most important for prevention, and it’s the most important method of treating obesity,” Dr. Styne stresses. Dietary changes endorsed by the guidelines are in agreement with recommendations set forth by the American Academy of Pediatrics and the U.S. Department of Agriculture, such as reducing intake of fast food, salty or fatty processed foods, added sugars, and high-fructose corn syrup, while increasing intake of fruits and vegetables. The guidelines also encourage educating families about portion control and strategies to address common eating cues, such as boredom and stress.2
Dr. Styne’s team recommends resources published by dietitian and family therapist, Ellyn Satter, to help clinicians and families navigate struggles at the dinner table. “Dietitians are an incredibly important resource,” Dr. Styne says.
Treatment guidelines for physical activity mirror prevention recommendations,2 and Dr. Styne says working with communities and schools to increase safe opportunities for children to be active is key to helping families meet physical activity goals. Additionally, the authors recommend limiting nonschool-related screen time to 1 to 2 hours per day.2
Screening for psychosocial comorbidities and making appropriate referrals to mental health professionals—as well as working with the entire family to support effective parenting styles and communication methods—is at the foundation of treating this chronic condition, per the guidelines.2 Notably, children with obesity have reported quality of life scores similar to those of patients with diabetes and cancer, and are at higher risk for anxiety, depression, eating disorders, substance abuse, and low self-esteem, underscoring the need for a sensitive approach.2
When is surgery warranted?
The new guidelines also discuss pharmacotherapy and bariatric surgery as treatment options. “We caution against the use of medications approved for adults in children under 16, and we recommend that no one do it [prescribe anti-obesity agents] unless they have experience in the area, as children are not the same as adults,” Dr. Styne says.
Regarding weight loss surgery, the authors of the new guidelines state bariatric surgery may be indicated in patients who meet certain criteria, including: Tanner stage 4 or 5 in puberty; BMI >40 kg/m2, or BMI >35 kg/m2 with major comorbidities; patients whose weight and comorbidities have failed to improve with intensive lifestyle intervention; those who have undergone psychological assessment and have been deemed appropriate for surgery; and patients who are prepared to undertake necessary long-term lifestyle changes post-surgery.2 These recommendations align with best practices put forth by the American Society for Metabolic and Bariatric Surgery.3
Though clinicians play an important role in preventing, diagnosing, and treating pediatric obesity, Dr. Styne stresses that health professionals can’t succeed alone. “There’s a lot of work to be done,” he says. “Everyone has to play a role, including policy makers, politicians, and education professionals.”
Originally Published on 03/27/2017: http://www.medpagetoday.com/resource-center/Advances-in-Weight-Management/Pediatric-Obesity-Guidelines/a/64156?xid=NL_MPT_weight_management_2017-04-01&eun=g1143694d0r
Originally Posted on: http://www.eatright.org/resource/food/planning-and-prep/recipes/shaped-tuna-cakes-recipe
By Romina Barritta de Defranchi, DTR
10 ounces chunk light tuna in water, drained and flaked
3 tablespoons mayonnaise
1 green onion, finely chopped
1 teaspoon paprika
¼ teaspoon garlic powder
½ teaspoon kosher salt
Freshly ground pepper
⅔ cup plain breadcrumbs, divided
3 tablespoon olive oil
Lemon wedges, optional
- In a medium bowl, mix tuna, mayonnaise, eggs, chopped green onions, paprika, garlic powder, salt, a few grinds of pepper and ⅓ cup breadcrumbs.
- Over a non-stick sheet pan, shape each tuna cake by filling a 2-inches cookie cutter (use fun shapes such as hearts, diamonds, stars) with the tuna mixture. Repeat with different shapes until all the mixture is used. Depending on the size of your cookie cutters, you should have 10 to 12 cakes.
- Cover and refrigerate cakes for at least 15 minutes.
- Remove cakes from refrigerator. Place the remaining ⅓ cup breadcrumbs on a plate. Carefully coat each tuna cake on all sides in breadcrumbs.
- Heat the olive oil in a non-stick large skillet over medium-high heat. Add the cakes and cook 2 minutes per side or until golden brown.
- If desired, serve with lemon wedges.
Serving size: 3 tuna cakes (125 grams)
Calories: 330; Total fat: 22g; Saturated fat: 4g; Cholesterol: 123mg; Sodium: 648mg; Carbohydrates: 14g; Fibers: 1g; Sugars: 1g; Protein: 20g; Potassium: 224mg; Phosphorus: 184mg
Written By: Toby Amidor February 24th, 2017
I admit: I’m late to the meal delivery kit game. Even my own brother has tried the services, which promise to deliver ingredients and recipes for quick, tasty meals to your door. But while I’m happy to see that cooking meals at home is becoming mainstream, I didn’t know whether the kits lived up to the hype. So I contacted six meal delivery kit services and tried them out with feedback from the pickiest of judges: my three kids. Here’s a summary of our experiences:
1. Blue Apron
This meal kit delivery service promotes meat with no added hormones, sustainably-sourced seafood and farm-fresh, seasonal produce. The three meals I made included spiced chicken chili with chickpeas and currants, Cajun catfish and spiced rice with collard greens and mushrooms, and baked ricotta cannelloni with romaine salad and Meyer lemon dressing.
[See: 13 Best Fish: High in Omega 3s and Environmentally-Friendly.]
I loved rolling the cannelloni using the fresh pasta dough. My kids and I also devoured the chili, although they wanted more bread to dip into it. The portions were very large – the chili lasted an entire week! From a nutrition standpoint, one of my main concerns was that the meals each packed between 620 and 750 calories per serving, which is too much for me as a 5-foot-7-inch woman. So, I cut back on the portions.
Plated is tailored to omnivores, seafood lovers, vegetarians and even those with a sweet tooth. I tried tomato-poached fish with crispy potatoes, cheesy baked potatoes with mushroom Marsala sauce and arugula salad, leek and mushroom ramen with bok choy and soft-boiled egg, and chili-dusted frozen hot chocolate.
My kids loved the baked potatoes with cheese, but weren’t so keen on the Marsala sauce. That wasn’t a problem; I kept the extra sauce for myself, and used it on scrambled eggs the next morning. The tomato-poached fish was probably one of the best meals I tried from all of the meal delivery kits – and it was really easy to make. My meals were between 460 to 550 calories, which is appropriate for my older kid and me. (Plated does offer meals in the 800-calorie range, but I didn’t order them.)
This service touts the fact that it works with a registered dietitian to create healthy meals. I tried “Do the Dukkah” chicken with sweet potatoes and snap peas, “the Great Caper” cod piccata with couscous and baby spinach, and Tunisian freekeh stew. Surprisingly, the vegetarian stew was the highest in calories, with 757 per serving. But, it was so “freeken” good and very satiating! To lower the calories, I made the portions smaller than what the recipe card called for. The cod piccata was also one of the tastiest dishes, and my 9-year-old daughter definitely agreed. After she had the cod for dinner, I found her sneaking bites of the fish from the refrigerator the next day. She also now requests to have fish for dinner at least twice a week. Score!
4. Sun Basket
Advertised as healthy cooking made easy, Sun Basket provides organic and non-GMO ingredients with options like gluten-free, paleo, and vegetarian. I tried the Sicilian chicken breasts with salmoriglio sauce, pan-seared salmon with orange-jicama salad and lemongrass steak stir-fry with bok choy and basil. All meals were simple and quick to make, and they ranged from 560 to 650 calories.
[See: 10 Healthy Meals You Can Make In 10 Minutes.]
The chicken breasts were tasty, and I had leftovers with the orange-jicama salad. My older two children (ages 11 and 14) loved the salmon, but weren’t too keen on the citrus salad on the side, which was a favorite of mine. The beef in the stir-fry was a bit chewy, which was probably the worst issue I had with all the meals in any kit.
Like the name implies, the meals from Chef’d are created by popular chefs and websites. I loved the fact that I could order American Diabetes Association- and Weight Watchers-based meals, which all had the most reasonable calories per serving of all the kits (between 250 and 350 per serving). I tried the American Diabetes Association’s chicken lovers balsamic chicken with cherry tomatoes and green beans, The New York Times’ roasted glazed salmon with sauteed kale and herbed orzo, and Hershey’s s’mores cookies (I just couldn’t resist!).
The balsamic chicken was extremely easy to make, and the veggies complimented the flavors and texture of the chicken nicely. The glazed salmon was another favorite in my house, thanks to the simple glaze. And no surprise, the dessert – which my kids helped bake – was quickly devoured.
6. Purple Carrot
These plant-based meals were the most creative of any of the meal delivery kits. I made kimchi quesadillas, pumpkin fettuccine alfredo and buffalo tempeh tacos. Everything was crazy good and reheated fabulously, but the calories really shocked me. The quesadillas, for example, which were made with kimchi and black beans, were 840 calories per serving. Fortunately, halving the portions was no problem since there was so much food in one serving. The fettuccine, on the other hand, was so good it was really hard to stop myself from eating the entire (650 calories-per-serving) potful! The tacos called for a simple buffalo sauce to marinate the tempeh, which was baked. Still, they would have packed 840 calories per serving had I not cut back on the fillings. (The extra baked tempeh worked well on salad for lunch the next day.)
[See: 11 Healthy Veggie Recipes That Prove Slow Cookers Are for More Than Meat.]
Bottom line? I’d absolutely order from any of these services again – particularly Chef’d since the meals were lower in calories. Purple Carrot was another favorite, thanks to the extremely creative vegan dishes, but required halving the portion sizes. I’d recommend any of these services to anyone who just doesn’t have the time to shop and organize recipes for the week.
Originally Posted on: http://health.usnews.com/health-news/blogs/eat-run/articles/2017-02-24/heres-what-happened-when-a-dietitian-tried-6-meal-delivery-kits
If you think losing a meaningful amount of weight is so monumentally difficult that hardly anyone succeeds, think again.
The counseling piece is crucial — and should include at least 14 sessions over six months with a trained professional such as a dietitian or exercise specialist. That kind of hand-holding is readily available, the review said, not only at medical centers but through YMCA diabetes-prevention programs, commercial weight-loss plans such as Weight Watchers or Jenny Craig, and even through call centers that provide tailored guidance.
“With intensive counseling, patients get a lot of instruction, but, equally important, they get a lot of support,” said psychologist Thomas Wadden, director of the Center for Weight and Eating Disorders at the University of Pennsylvania. “Partly, it’s the accountability that makes the difference. If you’re reviewing your progress every week with a counselor, you’re going to try harder than if you’re just recording your weight on a phone app.”
For the paper, Wadden teamed with Steven B. Heymsfield, an obesity researcher at Louisiana State University, to sum up what is known about the causes of the obesity epidemic and how to battle it.
Some parts of their scholarly review come as no surprise. Two-thirds of the U.S. adult population is overweight (a Body Mass Index of 25 to 29.9) or obese (a BMI of 30 or more), a result of increasingly sedentary lifestyles and eating too much high-calorie food in super-size portions. The girth of the nation has led to soaring rates of diabetes, heart disease, and other chronic illnesses.
But less well-known is the fact that research has uncovered 11 uncommon genetic forms of obesity, including a type that is found in about 5 percent of severely obese children. Moreover, studies suggest that when fat people slim down, they continue to suffer metabolic and psychological effects such as increased appetite and a preoccupation with food.
“The implication is that persons who are no longer obese may not be physiologically identical to their counterparts who were never obese,” the authors wrote.
If obesity permanently changes how the body functions, then that helps explain why so many who lose weight regain it. The authors say it also supports “the concept of obesity as a chronic disease that requires long-term vigilance and management.”
Because of the chronic nature of the problem, professional guidelines recommend that anti-obesity medications be considered to supplement intensive counseling and lifestyle changes. Six drugs have been approved for short- or long-term use, and research by Wadden and others has shown that adding a medication leads to greater weight loss and better maintenance.
Nonetheless, studies suggest the medications are underused, given the scale of the obesity epidemic.
Wadden and his co-author cite the reasons: Diet drugs have a history of being barely effective or unsafe; insurance usually doesn’t cover them; and patients are often disappointed that pills are no panacea — their losses are modest.
“It’s clear that these medications are beneficial,” said Wadden, who has been a paid consultant to pharmaceutical companies as well as Weight Watchers. “Unfortunately, there’s a sense that they must not work if you have to take them indefinitely. But I think obesity medications should be used on a long-term basis for chronic weight management, just as I take a [cholesterol-lowering] statin and a blood-pressure medication for the long term.”
Originally Published by The Philadelphia Inquirer on January 17, 2017.
Recipe By: Sara Haas, RDN, LDNEatingWell Recipe Contributor
In this healthy bowl-dinner recipe, hummus may seem like an unconventional dressing ingredient, but here we thin it with some hot water to make a rich, creamy drizzle.
Ingredients | 4
- Preheat oven to 400 °F.
- Bring 2 1/2 cups water to a boil in a medium saucepan. Remove from heat and stir in bulgur and 1/4 teaspoon salt. Cover and let stand until tender, about 20 minutes.
- Meanwhile, sprinkle pork with marjoram, pepper and 1/4 teaspoon salt. Heat 1 tablespoon oil in a large cast-iron or other ovenproof skillet over medium-high heat. Add the pork; cook, turning several times, until browned on all sides, 4 to 6 minutes.
- Toss asparagus and onion with the remaining 1 tablespoon oil and 1/4 teaspoon salt in a medium bowl. When the pork is browned, scatter the asparagus and onion around it. Transfer the pan to the oven and roast until an instant-read thermometer inserted in the center of the pork registers 145 °F, 12 to 16 minutes. About 5 minutes before the pork is done, scatter the tomatoes over the vegetables in the pan.
- Transfer the pork to a clean cutting board and let rest for 5 minutes before slicing. Toss the vegetables with the pan juices.
- Drain any remaining liquid from the bulgur, then stir in parsley, lemon zest and lemon juice. Combine hummus and 2 tablespoons hot -water in a small bowl. Divide the bulgur among 4 bowls and top with the pork and vegetables; drizzle with the hummus sauce.
- Serving size: 1 cup bulgur, 3 oz. pork, 3/4 cup vegetables & 1 1/2 Tbsp. sauce
- Per serving: 400 calories; 12 g fat(2 g sat); 9 g fiber; 44 g carbohydrates; 33 g protein; 129 mcg folate; 74 mg cholesterol; 4 g sugars; 0 g added sugars; 1492 IU vitamin A; 26 mg vitamin C; 72 mg calcium; 4 mg iron; 583 mg sodium; 985 mg potassium
- Nutrition Bonus: Vitamin C 44%, Folate 32%, Vitamin A 30%, Iron 21%
- Carbohydrate Servings: 3
- Exchanges: 2 starch, 1 1/2 vegetable, 3 1/2 lean meat, 1 1/2 fat
Originally Posted: http://www.eatingwell.com/recipe/251352/roast-pork-asparagus-cherry-tomato-bowl
Article by Sandy Bauers, For The Inquirer
If your child has weight problems, it won’t help to focus on the numbers on the scale. Reminding kids about weight can lead to dangerous dieting tactics and unhealthy eating.
Family meals help develop balanced eating habits and foster communication. Slideshow icon SLIDESHOW
5 questions: How to talk to kids about weight
That’s the main message in a recent report by the American Academy of Pediatrics (AAP). The researchers found that adolescents whose parents focus instead on healthy eating and physical activity are less likely to have eating disorders or turn to unhealthy weight control methods.
This information is more important now than ever. The rate of teen obesity has quadrupled in the last 30 years, according to the academy.
For perspective, we recently spoke with two experts at the Renfrew Center, established in 1985 in Philadelphia as the nation’s first residential eating disorder facility, treating girls and women age 12 and over. Its 17 locations nationwide also include Mount Laurel and Radnor. Corrine Kopp, who has degrees in psychology and social work, is site director of the Renfrew Center of Southern New Jersey. Lauren Rooney is that center’s regional nutrition manager.
When the AAP said parents should focus on healthy eating, not weight, what did they mean? Why is this important?
Kopp: The report is really broadening the conversation with children and adolescents for both parents and providers. It’s incredibly important. Children’s and teens’ minds are very impressionable. They’re already inundated with unhealthy messages around weight. Broadening the picture takes the fixation off the number. When the focus is on weight alone, people begin to define themselves based on that number. When they see their worth as just that number, they’re minimizing their value.
If the only thing that’s important is the weight, then all that would matter to the patients we treat – or, really, anyone – might be whatever they are doing to manipulate their weight. We see patients who are bingeing on large amounts of food. We see patients who are undereating. They might not be eating starches or fats. We also see patients that are purging or using laxatives or diuretics.
We’ve definitely seen an increase in preteens, teens and adolescents who are not only overweight, but also obese and underweight. These issues are very much interrelated.
Rooney: Diets just don’t work. Although a multitude of factors contribute to eating disorder development, dieting is the most common. Diets can lead to the abuse of diet pills or laxatives or binge-eating behavior. Those that diet are also labeling food as good or bad. If they are consuming foods labeled bad, they would think of themselves as a bad person. It can lead to this very unhealthy relationship with food and with their bodies.
The academy’s report suggested that families have more meals together as a way to combat eating problems.
Rooney: Family meals are essential. They are a place where we can develop balanced eating habits and create communication within our families. They are an opportunity for parents to model healthy eating behavior – how important it is to have variety, balance and moderation in our diets. Our children are picking up on that.
Any opportunity to share a meal is an important one. It gives parents an opportunity to check in with their children about their day, to ask about their friends.
Kopp: If a child is struggling with overeating or undereating or harmful dieting behavior, the parents are more likely to miss it if they’re not sharing family meals. If they are sharing, they might, for instance, notice changes in mood or behavior or eating patterns that might be a red flag. Then they could talk about it with their child or with a health-care provider. Early identification is better.
Another recommendation was to promote a positive body image for your child. How does a parent do it?
Kopp: It comes back to teens being so inundated with all these negative messages. If they have a positive body image, a positive view of themselves and their bodies, they are going to have a healthier outlook on everything and not be so likely to diet or develop an eating disorder.
One thing that’s important is that the parent or other role model not be commenting on their own weight. If a parent is standing in front of a mirror, really scrutinizing their body, the child is probably going to do the same thing. If they are talking about needing to lose weight or this not being right or that not being right, the child may not be able to understand that the assessment is just of the parent. The child might think, “They must be talking about me, too. I must also need to lose weight.” They’re taking this as a lesson rather than just a comment that Mom or Dad made. It seems innocent, but the impact can be significant.
Instead, parents should talk about the good things their bodies can do. Maybe Dad goes to yoga and he’s been working on this one pose, a headstand. He can talk about his body’s abilities – how his muscles are able to support him doing a headstand – as opposed to proportions or height or weight.
Or, the parents could focus on a discussion about how their daughter went out with her friends and they went for a walk. Was that fun? Or, hey, you like new foods, how about trying some tomatoes?
But those numbers on the scale are important, right?
Kopp: Yes. A health-care provider will have an eye on that. But that number is not the discussion with the child. That will go something like, what do you do for fun? What are your hobbies? It would be a collaborative conversation – what the child is interested in, what activities the family can provide support for, what they can do together – rather than a blanket statement, such as “Why don’t you go for more walks?”
What should a worried parent do?
Kopp: Definitely the first place to start is getting in touch with a provider that knows eating disorders. They need to find someone who can give them an appropriate assessment and, if needed, intervene early. One of the things we know is that the earlier the intervention, the easier the recovery.
I would emphasize that recovery is possible. People can change, and they can lead a healthy lifestyle that isn’t based on weight.
Originally Posted on: http://www.philly.com/philly/health/kidshealth/20161009_5_questions__How_to_talk_to_kids_about_weight.html
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As quoted in Main Line Today January 2016: http://www.mainlinetoday.com/Main-Line-Today/January-2016/2016-Faces-of-the-Main-Line/MD-Weight-Loss-Beyond/
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