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Eating Disorders: What is Anorexia and Bulimia?

Eating disorders are characterized by severely disturbed eating behaviours. The two most common types of eating disorders are Anorexia Nervosa and Bulimia Nervosa. Individuals with these disorders have a disturbed vision of their body shape and weight and have a heightened fear of gaining weight. The causes of these eating disorders are unknown but are influenced by society’s views and portrayal of thinness and attractiveness in media.

Anorexia Nervosa

Anorexia Nervosa is a mental health disorder, which occurs in women in 90% of cases. Individuals with anorexia may start off with light dieting, but the disease often becomes characterized by an extreme obsession with weight and severe fear of weight gain or obesity. Most often, the individuals will starve themselves, count calories and follow strict routines, while exercising excessively. The most significant characteristic is distorted body image, meaning that even if the individual loses an extreme amount of weight, they will still see themselves as “fat”.

Bulimia Nervosa

Individuals who have anorexia will sometimes go through bulimic cycles and vice versa. However, while the main goal of anorexia is to eat as little as possible, bulimia includes cycles of “binging” and “purging”. “Binging” involves the individual eating large amounts of food in one sitting while “Purging” is compensating for the amount of food eaten most often through self-induced vomiting. Approximately 1-3% of young women will develop bulimia in their lifetime.

Eating disorders often occur in early adolescence or early adulthood and tend to affect women ten times more than men according to Stats Canada. Individuals who tend to have a more perfectionist attitude towards aspects in their lives such as school, work, or extracurricular activities, and of course in appearances, are more at risk for eating disorders. This also applies to individuals with already present psychological disorders.

Eating disorders often lead to social isolation due to avoidance of food, making it difficult to go out and eat with friends, extreme secrecy, and often result in extreme health complications and depression. According to the Canadian Mental Health Association, up to 10% of people living with anorexia nervosa die from health problems related to the eating disorder or from suicide.

Seek Help

Eating disorders do not just affect young people or specifically young women. It affects the families and loved ones of those individuals as they are left feeling helpless, unable to make their son, daughter, sister, or friend see that they are not “fat” and are in fact hurting themselves to have the “perfect” body. You may have an eating disorder if:

  1. You constantly think about food, dieting, and your weight
  2. You tend to avoid food even when you are hungry
  3. You feel guilty after eating
  4. You feel completely out of control while eating
  5. You feel better or proud of yourself when you do not eat
  6. You feel you cannot be happy until you reach your goal weight
  7. You try to get rid of the food you ate by purging
  8. You experience physical signs of not receiving proper nutrients such as extreme tiredness, dizziness, dry skin, or hair loss
  9. You feel obsessive about exercise and eating routines
  10. Smoke or chew gum for the purpose of losing weight

Treatment comes in a variety of forms such as counselling, support groups, seeking nutritional help from a nutritionist, and in extreme cases, rehabilitation. It is important to see a health professional as early on as possible if you feel that you or someone you love has an eating disorder, or call the NEDIC (National Eating Disorder Information Centre) Helpline at 1-866-633-4220, or use their online services directory at www.nedic.ca.

Resources:

Types of Eating Disorders

PMC

  • Anderson AE, DiDomenico L. Diet versus shape content of popular male and female magazines: A dose-response relationship to the incidence of eating disorders? International Journal of Eating Disorders. 1992;11:283–287.
  • Arnett JJ. Adolescent’s use of media for self-socialization. Journal of Youth and Adolescence. 1995;24(5):511–518.
  • Becker AE, Burwell RA, Herzog DB, Hamburg P, Gilman S. Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. British Journal of Psychiatry. 2002;180(6):509–514.
  • Champion H, Furnham A. The effect of the media on the body satisfaction in adolescent girls. European Eating Disorders Review. 1999;7:213–228.
  • Durkin S, Paxton S. Predictors of vulnerability to reduced body image satisfaction and psychological wellbeing in response to exposure to idealized female media images in adolescent girls. Journal of Psychosomatic Research. 2002;53:995–1005.
  • Garner DM, Garfinkel P, Schwartz D, Thompson M. Cultural expectations of thinness in women. Psychological Reports. 1980;47:484–491.
  • Groesz LM, Levine MP, Murnen SK. The effect of experimental presentation of thin media images on body satisfaction: A meta-analytic review. International Journal of Eating Disorders. 2002;31:1–16.
  • Hargreaves D, Tiggemann M. Female “Thin Ideal” media images and boys’ attitudes toward girls. Sex Roles. 2003;49(9–10):539–544.
  • Irving LM, DuPen J, Berel S. A media literacy program for high school females. Eating disorders: A Journal of Treatment and Prevention. 1998;6(2):119–131.
  • Kilbourne J. Still killing us softly: Advertising and the obsession with thinness. In: Fallon P, Katzman M, Wooley S, editors. Feminist Perspectives on Eating Disorders. New York: The Guilford Press; 1994. pp. 395–419.
  • Kilbourne J. Can’t Buy My Love: How Advertising Changes The Way We Think and Feel. New York, N.Y: Touchstone; 2000.
  • Levine MP, Piran N, Stoddard C. Mission more probable: Media literacy, activism, and advocacy as primary prevention. In: Piran N, Levine MP, Steiner-Adair C, editors. Preventing Eating Disorders: A Handbook of Inteventions and Special Challenges. Philadelphia, PA: Brunner/Mazel; 1999.
  • Levine MP, Smolak L. Media as a context for the development of disordered eating. In: Smolak L, Levine M, editors. The Developmental Psychopathology of Eating Disorders: Implications for Research, Prevention, and Treatment. Hillsdale, NJ: Lawrence Erlbaum Associates Inc; 1996.
  • Levine MP, Smolak L, Schermer F. Media analysis and resistance by elementary school children in the primary prevention of eating problems. Eating Disorders. 1996;4(4):310–322.
  • Martin MC, Gentry JW. Stuck in the model trap: The effects of beautiful models in ads on female pre-adolescents and adolescents. The Journal of Advertising. 1997;26:19–33.
  • Martin MC, Kennedy PF. Advertising and social comparison: Consequences for female preadolescents and adolescents. Psychology and Marketing. 1993;10:513–530.
  • Murray SH, Touyz SW, Beumont PJV. Awareness and perceived influence of body ideals in the media: A comparison of eating disorder patients and the general community. Eating disorders: A Journal of Treatment and Prevention. 1996;4(1):33–46.
  • Oliver-Pyatt W. Fed Up! New York, N.Y: McGraw-Hill; 2003.
  • Pinhas L, Toner B, Ali A, Garfinkel PE, Stuckless N. The effects of the ideal of female beauty on mood and body satisfaction. International Journal of Eating Disorders. 1999;25(2):223–226.
  • Posovac H, Posovac SS, Weigel RG. Reducing the impact of the media images on women at risk for body image disturbance: Three targeted interventions. Journal of Social and Clinical Psychology. 2001;20(3):324–340.
  • Ricciardelli L, McCabe M, Holt K, Finemore J. A biopsychosocial model for understanding body image and body change strategies among children. Journal of Applied Developmental Psychology. 2003;24(4):475–495.
  • Spitzer B, Henderson K, Zivian M. A comparison of population and media body sizes for American and Canadian Women. Sex Roles. 1999;700(7/8):545–565.
  • Steiner-Adair C, Vorenberg AP. Resisting weightism: Media literacy for elementary-school children. In: Piran N, Levine MP, Steiner-Adair C, editors. Preventing Eating Disorders: A Handbook of Interventions and Special Challenges. Philadelphia, PA: Brunner/Mazel; 1999. pp. 105–121.
  • Stice E. Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin. 2002;128(5):825–848.
  • Stice E, Schupak-Neuberg E, Shaw HE, Stein RI. Relation of media exposure to eating disorder symptomatology: An examination of mediating mechanisms. Journal of Abnormal Psychology. 1994;103(4):836–840.
  • Stice E, Shaw H. Adverse effects of the media portrayed thin-ideal on women and linkages to bulimic symptomatology. Journal of Social and Clinical Psychology. 1994;13(3):288–308.
  • Thomsen SR, McCoy K, Williams M. Internalizing the impossible: Anorexic outpatients’ experiences with women’s beauty and fashion magazines. Eating Disorders. 2001;9:49–64.
  • Tiggeman M. Media exposure and body dissatisfaction. European Eating Disorders Review. 2003;11(5):418–425.
  • Utter J, Neumark-Sztainer D, Wall M, Story M. Reading magazine articles about dieting and associated weight control behaviours among adolescents. Journal of Adolescent Health. 2003;32(1):78–82.
  • van den Berg P, Thompson JK, Obremski-Brandon K, Coovert M. The tripartite influence model of body image and eating disturbance: A covariate structure modeling investigation testing the mediational role of appearance comparison. Journal of Psychosomatic Research. 2002;53:1007–1020.
  • Vaughan K, Fouts G. Changes in television and magazine exposure and eating disorder symptomatology. Sex Roles. 2003;49(7–8):313–320.
  • Williams M, Thomsen SR, McCoy K. Looking for an accurate mirror: A model for the relationship between media use and anorexia. Eating Behaviours. 2003;4(2):127–134.
  • Wiseman CV, Gray JJ, Mosimann JE, Ahrens AH. Cultural expectations of thinnessin women: An update. International Journal of Eating Disorders. 1992;11:85–89.
  • Wolf N. The Beauty Myth. Toronto: Random House; 1990.

Anorexia nervosa takes an enormous toll on the body. But that’s not all. It has the highest death rate of any mental illness. Between 5% and 20% of people who develop the disease eventually die from it. The longer you have it, the more likely you will die from it. Even for those who survive, the disorder can damage almost every body system.

What happens exactly? Here’s a look at what anorexia does to the human body.

The first victim of anorexia is often the bones. The disease usually develops in adolescence — right at the time when young people are supposed to be putting down the critical bone mass that will sustain them through adulthood.

“There’s a narrow window of time to accrue bone mass to last a lifetime,” says Diane Mickley, MD, co-president of the National Eating Disorders Association and the founder and director of the Wilkins Center for Eating Disorders in Greenwich, Conn. “You’re supposed to be pouring in bone, and you’re losing it instead.” Such bone loss can set in as soon as six months after anorexic behavior begins, and is one of the most irreversible complications of the disease.

But the most life-threatening damage is usually the havoc wreaked on the heart. As the body loses muscle mass, it loses heart muscle at a preferential rate — so the heart gets smaller and weaker. “It gets worse at increasing your circulation in response to exercise, and your pulse and your blood pressure get lower,” says Mickley. “The cardiac tolls are acute and significant, and set in quickly.” Heart damage, which ultimately killed singer Karen Carpenter, is the most common reason for hospitalization in most people with anorexia.

Although the heart and the bones often take the brunt of the damage, anorexia is a multisystem disease. Virtually no part of the body escapes its effects. About half of all anorexics have low white-blood-cell counts, and about a third are anemic. Both conditions can lower the immune system’s resistance to disease, leaving a person vulnerable to infections.

Health Consequences

Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health. They are not just a “fad” or a “phase.” People do not just “catch” an eating disorder for a period of time. They are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships.

Eating disorders can affect every organ system in the body, and people struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery.

COMMON HEALTH CONSEQUENCES OF EATING DISORDERS

CARDIOVASCULAR SYSTEM

  • Consuming fewer calories than you need means that the body breaks down its own tissue to use for fuel. Muscles are some of the first organs broken down, and the most important muscle in the body is the heart. Pulse and blood pressure begin to drop as the heart has less fuel to pump blood and fewer cells to pump with. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.
    • Some physicians confuse the slow pulse of an athlete (which is due to a strong, healthy heart) with the slow pulse of an eating disorder (which is due to a malnourished heart). If there is concern about an eating disorder, consider low heart rate to be a symptom.
  • Purging by vomiting or laxatives depletes your body of important chemicals called electrolytes. The electrolyte potassium plays an important role in helping the heart beat and muscles contract, but is often depleted by purging. Other electrolytes, such as sodium and chloride, can also become imbalanced by purging or by drinking excessive amounts of water. Electrolyte imbalances can lead to irregular heartbeats and possibly heart failure and death.
  • Reduced resting metabolic rate, a result of the body’s attempts to conserve energy.

GASTROINTESTINAL SYSTEM

  • Slowed digestion known as gastroparesis. Food restriction and/or purging by vomiting interferes with normal stomach emptying and the digestion of nutrients, which can lead to:
    • Stomach pain and bloating
    • Nausea and vomiting
    • Blood sugar fluctuations
    • Blocked intestines from solid masses of undigested food
    • Bacterial infections
    • Feeling full after eating only small amounts of food
  • Constipation, which can have several causes:
    • Inadequate nutritional intake, which means there’s not enough in the intestines for the body to try and eliminate
    • Long-term inadequate nutrition can weaken the muscles of the intestines and leave them without the strength to propel digested food out of the body
    • Laxative abuse can damage nerve endings and leave the body dependent on them to have a bowel movement
  • Binge eating can cause the stomach to rupture, creating a life-threatening emergency.
  • Vomiting can wear down the esophagus and cause it to rupture, creating a life-threatening emergency.
    • Frequent vomiting can also cause sore throats and a hoarse voice.
  • When someone makes themselves vomit over a long period of time, their salivary (parotid) glands under the jaw and in front of the ears can get swollen. This can also happen when a person stops vomiting.
  • Both malnutrition and purging can cause pancreatitis, an inflammation of the pancreas. Symptoms include pain, nausea, and vomiting.
  • Intestinal obstruction, perforation, or infections, such as:
    • Mechanical bowel problems, like physical obstruction of the intestine, caused by ingested items.
    • Intestinal obstruction or a blockage that prevents food and water from passing through the intestines.
    • Bezoar, a mass of indigestible material found trapped in the gastrointestinal tract (esophagus, stomach, or intestines).
    • Intestinal perforation, caused by the ingestion of a nonfood item that creates a hole in the wall of the stomach, intestines or bowels.
    • Infections such as toxoplasmosis and toxocariasis may occur because of ingesting feces or dirt.
    • Poisoning, such as heavy metal poisoning caused by the ingestion of lead-based paint.

NEUROLOGICAL

  • Although the brain weighs only three pounds, it consumes up to one-fifth of the body’s calories. Dieting, fasting, self-starvation, and/or erratic eating means the brain isn’t getting the energy it needs, which can lead to obsessing about food and difficulties concentrating.
  • Extreme hunger or fullness at bedtime can create difficulties falling or staying asleep.
  • The body’s neurons require an insulating, protective layer of lipids to be able to conduct electricity. Inadequate fat intake can damage this protective layer, causing numbness and tingling in hands, feet, and other extremities.
  • Neurons use electrolytes (potassium, sodium, chloride, and calcium) to send electrical and chemical signals in the brain and body. Severe dehydration and electrolyte imbalances can lead to seizures and muscle cramps.
  • If the brain and blood vessels can’t push enough blood to the brain, it can cause fainting or dizziness, especially upon standing.
  • Individuals of higher body weights are at increased risk of sleep apnea, a disorder in which a person regularly stops breathing while asleep.

ENDOCRINE

  • The body makes many of its needed hormones with the fat and cholesterol we eat. Without enough fat and calories in the diet, levels of hormones can fall, including:
    • Sex hormones estrogen and testosterone
    • Thyroid hormones
  • Lowered sex hormones can cause menstruation to fail to begin, to become irregular, or to stop completely.
  • Lowered sex hormones can significantly increase bone loss (known as osteopenia and osteoporosis) and the risk of broken bones and fractures.
  • Reduced resting metabolic rate, a result of the body’s attempts to conserve energy.
  • Over time, binge eating can potentially increase the chances that a person’s body will become resistant to insulin, a hormone that lets the body get energy from carbohydrates. This can lead to Type 2 Diabetes.
  • Without enough energy to fuel its metabolic fire, core body temperature will drop and hypothermia may develop.
  • Starvation can cause high cholesterol levels, although this is NOT an indication to restrict dietary fats, lipids, and/or cholesterol.

OTHER Health Consequences

  • Low caloric and fat consumption can cause dry skin, and hair to become brittle and fall out.
  • To conserve warmth during periods of starvation, the body will grow fine, downy hair called lanugo.
  • Severe, prolonged dehydration can lead to kidney failure.
  • Inadequate nutrition can decrease the number of certain types of blood cells.
  • Anemia develops when there are too few red blood cells or too little iron in the diet. Symptoms include fatigue, weakness, and shortness of breath.
  • Malnutrition can also decrease infection-fighting white blood cells.

Mortality and Eating Disorders

While it is well known that anorexia nervosa is a deadly disorder, the death rate varies considerably between studies. This variation may be due to length of follow-up, or ability to find people years later, or other reasons. In addition, it has not been certain whether other subtypes of eating disorders also have high mortality. Several recent papers have shed new light on these questions by using large samples followed up over many years. Most importantly, they get around the problem of tracking people over time by using national registries which report when people die. A paper by Papadopoulos studied more than 6000 individuals with AN over 30 years using Swedish registries. Overall people with anorexia nervosa had a six fold increase in mortality compared to the general population. Reasons for death include starvation, substance abuse, and suicide. Importantly the authors also found an increase rate of death from ‘natural’ causes, such as cancer.

It has not been certain whether mortality rates are high for other eating disorders, such as bulimia nervosa and eating disorder not otherwise specified, the latter of which is the most common eating disorder diagnosis. Crow and colleagues studied 1,885 individuals with anorexia nervosa (N=177), bulimia nervosa (N=906), or eating disorder not otherwise specified (N=802) over 8 to 25 years. The investigators used computerized record linkage to the National Death Index, which provides vital status information for the entire United States, including cause of death extracted from death certificates. Crow and colleagues found that crude mortality rates were 4.0% for anorexia nervosa, 3.9% for bulimia nervosa, and 5.2% for eating disorder not otherwise specified. They also found a high suicide rate in bulimia nervosa. The elevated mortality risks for bulimia nervosa and eating disorder not otherwise specified were similar to those for anorexia nervosa.

In summary, these findings underscore the severity and public health significance of all types of eating disorders.

Special thank you to Walter Kaye, MD, Professor of Psychiatry, Director, UCSD Eating Disorder Research and Treatment Program, University of California, San Diego

Learn more about eating disorders >

What Is Anorexia?

Anorexia nervosa, more commonly known as anorexia, is both an eating disorder and a metabolic condition that results in excessive weight-loss and extreme thinness caused by self-starvation. It is estimated that approximately 2 percent of American females and 0.3 percent of males will develop anorexia during their lifetime, based on research collected by the National Eating Disorders Association. Though it most commonly affects adolescent girls and women, anorexia can develop in anyone of any gender, age, race, or cultural background. Athletes, dancers and anyone who works or studies in an industry that emphasizes lean physiques are at particularly high risk.

In addition to extreme thinness and fear of gaining weight, common signs and symptoms of anorexia include skipping meals, refusal to eat in public, frequent references or complaints about weight gain, intense exercise regimens, and covering up in layers of clothing to disguise thinness. If you suffer from anorexia, you are consumed by your own efforts to control your body shape and size.

What Causes Anorexia?

Although eating disorders circle around food, the root of the problem is psychological. With anorexia, you severely restrict food and obsessively control your weight because you equate thinness with self-worth. In your mind, the thinner you are, the more value you have, so you can never be thin enough. Unfortunately, this distorted sense of what your body should look like can make you very sick.

As with other eating disorders, there is no single known cause, but many factors play into the development of anorexia. Your risk increases if you have a close family member, such as a parent or sibling, with an eating disorder. Obsessive-compulsive personality traits, such as perfectionism and sensitivity, are usually associated with anorexia.

Genetics appear to play a major role, though researchers are just beginning to figure out which genes are involved and what type of changes to those genes put people at higher risk of developing anorexia. Genetic scientists have pinpointed genes linking anorexia to depression, anxiety, and obsessive-compulsive disorder. They have also discovered that certain metabolism genes linked to fat burning, physical activity and resistance to type 2 diabetes appear to combine with those genes linked to psychiatric conditions, and that combination appears to increase the risk of developing anorexia. While interesting, these discoveries are really just a drop in the research bucket, since there are likely to be hundreds of thousands of genes involved in the development of anorexia, just as there are in the development of so many other diseases and disorders.

How Anorexia Affects Your Health and Well-Being

Anorexia stems from, and can cause, a variety of physical, psychological, and emotional problems. Ultimately, starving yourself can cause serious physical complications, such as:

  • Abnormally slow heart rate
  • Drop in blood pressure
  • Abnormal blood count
  • Increased risk of heart failure
  • Increased risk of bone loss (osteopenia or osteoporosis)
  • Loss of muscle tone
  • Dehydration which, in extreme cases, can lead to kidney failure
  • Irregular periods in women
  • Lower testosterone in men
  • Feeling weak, fatigued, or dizzy, or experiencing fainting spells
  • Dry skin that may also take on yellowish tint
  • Bluish color on the tips of the fingers
  • Dry hair and hair loss
  • Downy hair that grows over the skin in order to keep warm

You are also likely to experience some or all of the psychological and emotional problems associated with anorexia, including:

  • Lying about your eating habits
  • Irritability
  • Withdrawing from social activities
  • Emotional flat-lining
  • Obsessive thoughts and behavior concerning weight gain
  • Feeling insecure about the way you look
  • Decreased interest in sex
  • Anxiety and depression
  • Suicidal thoughts

Where to Get Help and What to Except

Anorexia nervosa is a serious, and sometimes lethal, physical and mental health condition that requires proper diagnosis and treatment. Once a diagnosis is established, a combination of psychotherapy, medical treatment, and nutrition counseling may be prescribed.

If you’re not already working with a mental health care provider, you can start by speaking to your primary care physician. Describe your symptoms, and the feelings that you associate with your behavior. It may be helpful to make a list of symptoms that you are experiencing before the appointment. Be sure to include all relevant personal information, like any family history of eating disorders, major stress, recent life changes, and a typical day’s eating patterns. In addition to a physical exam, including tests to evaluate whether you are suffering any physical effects from binge eating, your PCP may ask questions about your daily food habits, your thoughts and your thoughts and feelings about your weight and appearance. Don’t hesitate to discuss your emotions, thoughts, or other information that may seem unrelated to binge eating; it is important to give your provider a full picture of your mental and physical health.

If your physician suspects a diagnosis of anorexia, they should be able to refer you to a licensed mental health professional. It is important to seek treatment from someone with the appropriate education, training and experience to treat your specific condition. Be sure you agree with their approach to treating anorexia, and understand their proposed treatment plan and what they see as your primary goal for recovery. If you are not satisfied with their answers or feel comfortable working with this person, consider seeking a second opinion.

Mental health professionals who treat anorexia may draw from different styles of therapy and use various tools to help you move on to a state of recovery. The first line of treatment is usually individual cognitive behavioral therapy (CBT), a one-on-one, relatively short-term form of talk therapy that can help you understand how your negative thoughts and feelings about yourself and about food are connected to your eating disorder. Your therapist can teach you to manage your feelings and help you develop new ways of thinking and behaving around food. At the same time, CBT can help you learn to cope with stress and address any of your broader concerns and conflict, such as your self-esteem, and your relationships with family, friends and coworkers. Finally, CBT can help you learn to recognize and deal with triggers that can lead to relapses. At some point, in addition to individual counseling, your therapist might recommend group therapy or a support group.

In addition to psychological counseling, other treatments and approaches can help alleviate some of the symptoms and improve the behaviors associated with anorexia. Although no drugs have been shown to improve symptoms of anorexia, your physician may prescribe medication for depression or anxiety, if necessary. A registered dietitian or clinical nutritionist can help you achieve or maintain a healthy weight by teaching you more about good nutrition and helping you develop and follow a balanced eating plan. Your health care providers may also suggest adjunctive therapies like movement classes, meditation and mindfulness instruction, yoga, equine therapy, or art therapy. These programs won’t cure anorexia, but they can help lower your stress levels, elevate your mood, improve your body image, and teach you to have a better sense of control over your life.

The level of care for anorexia ranges from simple to intensive outpatient support to part-time and full-time (residential) inpatient programs housed within a hospital, clinic, or eating disorders treatment center. The severity of your symptoms will determine the level and type of care you need.

If you need help and you cannot get it from someone in your immediate support circle, call the National Eating Disorders Association helpline toll-free at 1-800-931-2237.

Article Sources Last Updated: Sep 4, 2019

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