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  #1   ^
Old Mon, Jan-09-23, 18:47
doreen T's Avatar
doreen T doreen T is offline
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Default New US guidance on childhood obesity urges medication and surgery

New guidance on childhood obesity urges medication and surgery

Quote:
Monday, Jan 9, 2023 11:42 AM EST

The longstanding practice of “watchful waiting,” or delaying treatment to see whether children and teens outgrow or overcome obesity on their own only worsens the problem that affects more than 14.4 million young people in the U.S. Left untreated, obesity can lead to lifelong health problems, including high blood pressure, diabetes and depression.

“Waiting doesn’t work,” said Dr. Ihuoma Eneli, co-author of the first guidance on childhood obesity in 15 years from the American Academy of Pediatrics. “What we see is a continuation of weight gain and the likelihood that they’ll have (obesity) in adulthood.”

For the first time, the group’s guidance sets ages at which kids and teens should be offered medical treatments such as drugs and surgery — in addition to intensive diet, exercise and other behavior and lifestyle interventions, said Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital.

In general, doctors should offer adolescents 12 and older who have obesity access to appropriate drugs and teens 13 and older with severe obesity referrals for weight-loss surgery, though situations may vary.

The guidelines aim to reset the inaccurate view of obesity as “a personal problem, maybe a failure of the person’s diligence,” said Dr. Sandra Hassink, medical director for the AAP Institute for Healthy Childhood weight, and a co-author of the guidelines.

“This is not different than you have asthma and now we have an inhaler for you,” Hassink said.

Young people who have a body mass index that meets or exceeds the 95th percentile for kids of the same age and gender are considered obese. Kids who reach or exceed the 120th percentile are considered to have severe obesity. BMI is a measure of body size based on a calculation of height and weight.

Obesity affects nearly 20 percent of kids and teens in the U.S. and about 42 percent of adults, according to the Centers for Disease Control and Prevention.

The group’s guidance takes into consideration that obesity is a biological problem and that the condition is a complex, chronic disease, said Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota.

“Obesity is not a lifestyle problem. It is not a lifestyle disease,” he said. “It predominately emerges from biological factors.”

The guidelines come as new drug treatments for obesity in kids have emerged, including approval late last month of Wegovy, a weekly injection, for use in children ages 12 and older. Different doses of the drug, called semaglutide, are also used under different names to treat diabetes. A recent study published in the New England Journal of Medicine found that Wegovy, made by Novo Nordisk, helped teens reduce their BMI by about 16 percent on average, better than the results in adults.

Within days of the Dec. 23 authorization, pediatrician Dr. Claudia Fox had prescribed the drug for one of her patients, a 12-year-old girl.

“What it offers patients is the possibility of even having an almost normal body mass index,” said Fox, also a weight management specialist at the University of Minnesota. “It’s like a whole different level of improvement.”

The drug affects how the pathways between the brain and the gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago.

“It works on how your brain and stomach communicate with one another and helps you feel more full than you would be,” he said.

Still, specific doses of semaglutide and other anti-obesity drugs have been hard to get because of recent shortages caused by manufacturing problems and high demand, spurred in part by celebrities on TikTok and other social media platforms boasting about enhanced weight loss.

In addition, many insurers won’t pay for the medication, which costs about $1,300 a month. “I sent the prescription yesterday,” Fox said. “I’m not holding my breath that insurance will cover it.”

One expert in pediatric obesity cautioned that while kids with obesity must be treated early and intensively, he worries that some doctors may turn too quickly to drugs or surgery.

“It’s not that I’m against the medications,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I’m against the willy-nilly use of those medications without addressing the cause of the problem.”

Lustig said children must be evaluated individually to understand all of the factors that contribute to obesity. He has long blamed too much sugar for the rise in obesity. He urges a sharp focus on diet, particularly ultraprocessed foods that are high in sugar and low in fiber.

Dr. Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she’d like more research about the drug’s efficacy in a more diverse group of children and about potential long-term effects before she begins prescribing it regularly.

“I would want to see it be used on a little more consistent basis,” she said. “And I would have to have that patient come in pretty frequently to be monitored.”

At the same time, she welcomed the group’s new emphasis on prompt, intensive treatment for obesity in kids.

“I definitely think this is a realization that diet and exercise is not going to do it for a number of teens who are struggling with this – maybe the majority,” she said.


https://www.pbs.org/newshour/health...ion-and-surgery
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  #2   ^
Old Mon, Jan-09-23, 21:40
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wbahn wbahn is offline
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I have conflicted and mixed feelings about this, which I will keep to myself, but one thing that stood out was the statement, "Kids who reach or exceed the 120th percentile are considered to have severe obesity."

That's a physical impossibility. This means that 120% of kids are below them.

I really can't figure out what they meant to say.

I also question the basic validity of basing treatment thresholds on where other people are at. This is basically saying that if Charlie has a certain BMI, that whether or not his health is in sufficient jeopardy as to warrant medical intervention depends on what everyone else's BMI is. That makes no sense. So if everyone else gets fatter, little Charlie is somehow less at risk of obesity-related complications, while if everyone else gets leaner, hit risk level goes up?
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  #3   ^
Old Mon, Jan-09-23, 22:36
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Ms Arielle Ms Arielle is online now
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The number of trim kids is rare now.

I had trouble with school because my kids were thin. It was a rare sight. So teachers thought my kids were malnourished.

When I brought it up with pediatrician, he thought I was the daft one.

Parents are bashed right and left. So happy my kids are legal adults and I am not bashed now.

It's was shocking to see the young children be very fat.....like a thin trim child is a rarity, and not the norm. And this was my experience some ten plus years ago when substituting at the k- 1 and preschool level. The kids ate junk food as snacks and lunch.

No wonder teachers thought my kids sickly and suffering from malnutrition.

At 19 and 20, my kids cannot pinch an inch. They eat better quality food, and work it off. One works 8 hr day installing HVAC systems, physically standing all day. Older one is at college and walks to classes and meal hall then practices fencing. Both are active and eat a better diet than most AND don't nosh all day.

As little ones, I didn't restrict eating but rather pushed real food, like on Atkins food list and real potatoes, real rice, real pasta. Not premade out of can or out of a package. Fruit and cheese for snacks.

Youngest was invited out to eat with girlfriends family. He ordered pan fried pork belly, spinach and white beans. A$30 plate. He couldn't finish it, bringing left overs to his mom. Simply delish. Real food costs.


A friend opens cans of food for her boys. The last time I saw them, the boys were 75# overweight. Mini sumo wrestlers.

I never understood how she couldn't figure out a simple easy meal: microwave a few potatoes, fry a steak, microwave frozen green beans. Or a version of. And she is a well educated woman.


My point is how parents feed their children matters. It sets the pattern for a lifetime.

We need to get ahead of needing meds and surgery......
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  #4   ^
Old Tue, Jan-10-23, 00:11
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wbahn wbahn is offline
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I agree with everything you said, Ms A.

My understanding (and this is perhaps overtaken by newer knowledge) is that the number of fat cells in your body is largely determined by your weight as a child. If you are overweight as a child, you will have more fat cells than you would if you were at a healthy weight. Furthermore, once created, those fat cells don't go away, the merely shrink or grow. So, if you are severely overweight as a child, the odds are really stacked against you as an adult because you have this overabundance of fat cells just waiting for something to store.

A similar situation exists for people the become obese as adults, because that is when they can also create new fat cells that, once again, are there to stay.

But (assuming this is still largely the case), this underscores the importance for taking steps to ensure that your kids are never significantly overweight, from infancy to adulthood. That is how you stack the deck in their favor.

I, too, am amazed at the obesity rates among children. But one thing that I noticed was that the obesity rate among the kids in DD's youth orchestra is surprisingly low, especially by comparison. Her group has about sixty people in and I would guess that perhaps three or four are obese and perhaps another ten would be considered overweight. Most are amazingly trim. While a few of them are involved in sports, the vast majority are not. But I would also venture that these are not normal kids -- they have a level of focus and commitment to achieving a long-term success that also seems pretty rare and I can picture how that personality trait may make it easier for them to put off most kinds of short-term gain (that candy bar) in favor of long-term goals (being at a "good" weight).
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  #5   ^
Old Fri, Jan-13-23, 10:52
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WereBear WereBear is offline
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We've been steeped in nutrition news and we are spoiled. So many people still don't know what to eat, and when margarine is cheaper than butter and their doctor hasn't updated their nutrition education, they are being "good" and getting sick.

It's so frustrating. Especially now, when we've had so much success, and some of these people know us and how we did it...

That's the extra frustrating.

So parents fear meat and everything in the store is plant-based. Even those boxed fresh meal sets are an improvement for beginners. I've started telling people to look into them, especially now the companies are more flexible about what kind to get. I tell people to think of it as a home cooking course and they get to eat the food.
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  #6   ^
Old Fri, Jan-27-23, 06:49
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Default 2019 Weight Watchers App

It reminded me of something called Kurbo. I believe it has been taken down, since I didn't find it on the Apple store, but don't know about Android. But it shows how commercializing health, instead of regarding it as a common good, will lead to nothing but trouble.

I think it took a petition or something. I know there was one.

Quote:
The controversy

After the app’s release, The New York Times featured a registered dietitian who blasted the app as a precursor to eating disorders.

The Atlantic also ran a piece pointing out that putting kids on diets is bound to cause more problems, not less.

The National Association of Anorexia Nervosa and Associated Disorders (ANAD) also took a strong stance against the app.

And GMA highlighted less-than-positive responses from parents who raised concerns about several aspects of the app, such as featuring before and after weight-loss photos of children as young as 8 — what some parents say essentially amounts to “thinspo” for the already vulnerable pre-teen crowd.


Why the New Weight Watchers App for Kids Is Raising Concerns
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  #7   ^
Old Fri, Jan-27-23, 07:33
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GRB5111 GRB5111 is offline
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The most alarming issue for me is the knee-jerk reaction from the medical community to put at risk kids on medications or consider surgery. There was a TV series in the UK where Dr. Chatterjee intervened with families who had kids at risk and helped establish a healthy lifestyle through education. The real issue that is so damaging is due to the rampant disagreement on what exactly constitutes a healthy diet. These wars and debates are a major roadblock to establishing a path to healthy nutrition. Similar to when there was sound science on the dangers of tobacco, this is what must happen to enhance our understanding of healthy foods in our societies today to have a prayer of making progress on this major health issue. If you look at the rampant numbers of diabetes and obesity today, just think how this trend plays out over the next couple of generations without some type of clarity on root cause and how to fix it. For those who have used lifestyle to achieve health, there is confidence that it can be done, for most who are victim to these competing and distorted nutrition claims, it's frightening and seemingly impossible.

The pharmaceuticals will always come up with a drug to sell that addresses the symptoms with toxic side effects, but they are not benevolent and are only in business to make a profit for their shareholders. They are the last group that could remotely be counted on to lead us out of this nutritional wasteland. Same for the medical groups that stand to profit on surgical treatments.
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Old Fri, Jan-27-23, 08:08
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It's a horrifying abuse of authority. And parents accept what doctors tell them. They don't know anything useful.

I agree, nothing will get better unless we break through the wall of corporate noise.
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  #9   ^
Old Fri, Jan-27-23, 09:59
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JLx JLx is offline
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Quote:
Within days of the Dec. 23 authorization, pediatrician Dr. Claudia Fox had prescribed the drug for one of her patients, a 12-year-old girl.


I felt a bit of a chill reading that. We know that these are "for life" drugs for one thing. But we don't know what that means in terms of a long life starting at 12! Not to mention that this girl might not make that choice for herself if an adult, but now the choice is taken from her. (No, parents don't always know best.)

Of course, it's awful to be overfat at any age, but children should have the best chance of everything in their bodies working optimally. Meaning the best chance of losing weight. And it's the time to teach lifelong useful habits, not initiate a lifelong drug. And whatever problem they have that is driving weight gain, will present a lifelong challenge so it's best to figure it out. Imagine this 12-year-old girl who may be able to take this drug while on her parent's insurance but then once on her own, won't have the opportunity. She hasn't developed the knowledge or skills she will need to cope without it.

I recall seeing something on TV, 60 Minutes or some place like that, years back, about the Pima Indians and a nun-taught school. Many children were overweight and diabetic or potentially so and they had success with encouraging a better, more traditional diet and exercise. I have a vivid recollection of a nun greeting the school bus and running with the children across the schoolyard, skirts flying.

Isn't something like that where to start?

That said, I was not a fat child and I have read some awful things about what other kids went through with "Fat Camps" and being put on diets. So I realize it's not easy.

And as a teenager I wasn't really fat when I went on my first diet - commenced because Twiggy was the ideal back then. I was unhelpfully given a 1,000 cal diet by my doctor, despite being only 140 lbs and nearly 5'8", and when I didn't lose weight I cut it down to 500 or didn't eat at all. Naturally, the resulting weight loss was not sustainable and I regained even more - the beginning of a long pattern.

And many kids have it so much worse these days with all the snacking, processed foods, and fast food that is considered the norm. And we can't even have a national dialogue that wouldn't be highjacked by the Big Food lobbyists.

It's a sad situation all around.
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Old Mon, Mar-06-23, 05:09
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WereBear WereBear is offline
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I've been watching the news for reaction on this and there isn't any. Which bothers me even more.

I've never felt comfortable with Weight Loss Surgery as a healing concept. It's like "treating" hyperactive children by tying them to chairs. They LOOK like what we want, now. Done!

Especially when they had to come up with variations since they are essentially performing drastic ulcer surgery because such patients lost weight. The blame should be in our industrialized diet, but it's getting pinned on Individual Choice. Like we have one.

But adults have trouble getting enough nutrition. And how can anyone eat right when they are constantly told the wrong things about food?
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Old Mon, Mar-06-23, 06:33
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Ms Arielle Ms Arielle is online now
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Back on my soapbox.

Doctors are not trained in nutrition. Surprisingly, veterinarians also have little education in that area too.

I learned nutrition when earning a pre-vet degree then focusing more on Animal Science. Meaning: how to feed livestock. Meaning: better equipped to understand nutrition. My vet told me years ago I knew more than her about feeding my horses.

DANDR was a breeze to read. And with internet and google, nutritional information is a swipe away.

My point is ,sadly, few are in a position to change. The government has dragged us down the rabbit hole with the food pyramid which was based on nonsense, no facts at all. And not on the growing junk food industry of profit.

Shop the outer aisles. Make a big U. From produce to meats to dairy to check out.....

Then peek at what others put on the conveyor.......I am surprised to see a shopper who also buys like me. Its a rare thing. Should be the only way.

I wonder with the coming financial crush if buying will change....
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Old Mon, Mar-06-23, 07:49
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WereBear WereBear is offline
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Quote:
Originally Posted by Ms Arielle
I wonder with the coming financial crush if buying will change....


I buy meat on sale and freeze it. I get canned salmon. But I will be on the lookout for better stuff.

Dropping back to rice and beans, or OMG ramen, isn't possible. Every penny we spend on real, nourishing, food is dollars less we'd otherwise would be spending on drugs. Which is one thing if it actually helped, and quite another if it's merely masking symptoms.

Catching up on my nutrition interests with Youtube, which is one of the few places I get exposed to ads. There was a new push for a drug for psoriasis. It doesn't matter what it's called. It's a "biologic."

So I actually don't mind except for worrying about the carnage it will cause the uninformed. What a biologic for psoriasis would cost is far more than a chuck roast.

Then again, I wouldn't take such drugs at gunpoint.

I found two papers about psoriasis treatment with biologics. I'm fortunate that mine stayed "mild" regarding the percentage of my skin involved, but apparently it can affect internal organs as well. Which is why my internal symptoms were dismissed for so long as "not autoimmune" because it didn't fit their various checklists. NOW they have a category for me.

And there are people with more life-threatening situations who are suffering and this relieves it. I understand.

I just don't trust those "discuss with your doctor" outlines I find online, because at the turn of this century Paper One was "be alert to certain neurological conditions so you can treat them right away" to, about a decade later, Paper Two's "Because there WILL be neurological conditions..."

The first paper said "the one that caused all the fuss was taken off the market but new biologics are similar." The second paper said, "these drugs." ALL of them.

I don't see progress here. Especially since these drugs "work" by messing with my nervous system until it's de-myelinated.

ALS, MS, Parkinson's, all the dreaded conditions that I now see as autoimmune, too... how can this be a good treatment?

I have enough problems.
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Old Mon, Mar-06-23, 09:03
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GRB5111 GRB5111 is offline
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Quote:
Originally Posted by WereBear
I've been watching the news for reaction on this and there isn't any. Which bothers me even more.

I've never felt comfortable with Weight Loss Surgery as a healing concept. It's like "treating" hyperactive children by tying them to chairs. They LOOK like what we want, now. Done!

Especially when they had to come up with variations since they are essentially performing drastic ulcer surgery because such patients lost weight. The blame should be in our industrialized diet, but it's getting pinned on Individual Choice. Like we have one.

But adults have trouble getting enough nutrition. And how can anyone eat right when they are constantly told the wrong things about food?

I agree, and I'm not on the fence about treating young people with either drugs or surgery, it's despicable and should be deemed the worst form of child abuse.

I bolded the last sentence in your post, WB, as this is the primary issue confronting humans today before we can address the root cause of the obesity, T2D, Metabolic syndrome, CVD, and cancer epidemics. Using drugs on young people was predictable once they became available; however, I have no confidence that this is a healthy approach due to the adverse events in the drug RCTs that never become public. There is no way to predict long term effects and sustained health in anyone who takes these drugs. In addition, while the human race lives in the era of the most costly, debilitating period in history of self-induced health issues, we fiddle with fixing the problem with drugs and surgery, continue to claim processed foods are healthy because the food manufacturers and "nutritionists" tell us so, and have nothing approaching the societal focus required to solve the problem. We are on our own here.
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Old Mon, Mar-06-23, 17:49
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Bob-a-rama Bob-a-rama is offline
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I play music in an outdoor restaurant/lounge, two afternoons and one morning per week, right on the public beach, here in South Florida.

I am surprised at the number of young people who are severely overweight, and still coming in with bikinis (gals) or just swim trunks (guys). They jiggle all over like a bowl of gelatin desert. I'd guess about 80% are too big for their own good.

When I was young, the fat children were the minority, and they didn't go around flaunting their fat. I know, times change. But obesity is dangerous for one's health, so that can't be a good thing.

Add to that the number of severely overweight adults and from my point of view. the majority of people who visit our beach are either overweight or obese.

IMO this is the cause of a lot of factors but the two main ones are
  • The food that corporate food companies are promoting. Lots of ultra-processed, refined carbs, including corn syrup, sugar, etc., and low fat and animal protein. This obviously isn't working
  • Thanks to Air Conditioning and the Internet, children and adults don't go outdoors much anymore. We sit in our refrigerated boxes and get no exercise, and never work up a sweat. The school kids don't even walk to the bus stop anymore. Mom drives them and they sit in the air conditioned vehicle with the motor running until the bus comes along. IMO that's shameful.

If my child was severely overweight, I'd figure out what was wrong, and put them on a program to fix it (they would probably hate me for that).

I'd put them on different diets until I found out what worked for them. I'd probably start with keto, since that is the only thing that works for me, and they share my genome.

Everybody has their own idea of what is attractive, and I'm not opposed to the extra-large people looking that way, even though I don't prefer that look. I am concerned simply because it is not healthy. I feel for them, sooner or later they will pay the price.

I know, I was fat once, too. But I saw both my parents die too soon due to obesity related diseases. I saw that as my possible future, so I tried a half dozen different diets until I found what works for me. It wasn't easy, but a short life span was a big incentive.

That's how I know that most people can get to a healthier weight. It's for their own good. But I suppose, it's none of my business.

Bob
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Old Mon, Mar-06-23, 18:10
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WereBear WereBear is offline
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Quote:
Originally Posted by GRB5111
... while the human race lives in the era of the most costly, debilitating period in history of self-induced health issues, we fiddle with fixing the problem with drugs and surgery, continue to claim processed foods are healthy because the food manufacturers and "nutritionists" tell us so, and have nothing approaching the societal focus required to solve the problem. We are on our own here.


I have to agree. I think there are two barriers which shore each other up.

Ancel Keys is dead but the careers he started are still never going to admit they were wrong. This covers government, science, disease associations, trade groups, and financial concerns like pension funds, who are literally invested in the medical-industrial complex.

The other problem is the population themselves. How many of them think they can't live without bread? That pint of ice cream might be the only coping strategy they know, or can afford. And not eating holiday feasts with the family!

What people eat is as much a belief system as anything else they've been taught since birth. If we look at the graphs of how people did comply with the did pyramid, it takes time to seep in, and will be fought over in discussion spaces.
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