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Old 08-22-2017, 09:59 AM
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Originally Posted by hamchan View Post
Steve, the problem is that outside of gastric bypass surgery there is not a proven method of losing a significant amount of weight and keeping it off permanently.
You're ignoring the fact that morbidly obese people weren't born morbidly obese. We did it to ourselves.
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Old 08-22-2017, 02:01 PM
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what about consuming the recommended calorie intake for your sex/age/height and exercising. If your body burns say 200 calories more than it intakes per day, you'll lose weight and keep it off. I don't think crash diets work because it tricks your body into thinking it's starving, afterwards your body then does everything possible to store calories as fat. But eating properly + exercise will do it without the need for a magic pill.

I worked with 2 obese ladies at my old job. they constantly complained about how hard it was to lose weight and diet and such, but every day for lunch they'd consume enormous amounts of food. I'm a relatively young guy, relatively athletic, but there's no ways I could consume as much food in a single meal as they were putting down regularly. They'd be doing a big mac meal, supersized (diet coke of course), and a second big mac on the side. And to top it off, they'd eat something for dessert. This is just an example, but their eating habits for non fast food was equally as bad. I'd have to guess that their meals were maybe 1500-2000 calories, which is obscene. Even 1000 calories per meal is already a lot unless you're extremely active.

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Old 08-22-2017, 02:13 PM
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Originally Posted by rennigade View Post
Doctors now have to be politically correct and not give obese patients sound medical advise because it may hurt their feelings.
not surprised. The rest of western society follows that model, so why not medicine? Today, obese people are glorified in ads for "plus sized models", criticizing weight (even constructively) is berated as "fat shaming", and they come up with cute words like "curvy" to ensure that overweight people feels good about themselves and is as narcissistic as some of their "less endowed" counterparts.
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Old 08-22-2017, 03:58 PM
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You're ignoring the fact that morbidly obese people weren't born morbidly obese. We did it to ourselves.
Did you read the rest of what I wrote? Statistically dieting leads to long term weight gain, not loss. The average female starts their first diet in elementary school, and as a nation we keep getting bigger. There's most definitely a connection.
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Old 08-22-2017, 04:05 PM
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what about consuming the recommended calorie intake for your sex/age/height and exercising. If your body burns say 200 calories more than it intakes per day, you'll lose weight and keep it off. I don't think crash diets work because it tricks your body into thinking it's starving, afterwards your body then does everything possible to store calories as fat. But eating properly + exercise will do it without the need for a magic pill.

I worked with 2 obese ladies at my old job. they constantly complained about how hard it was to lose weight and diet and such, but every day for lunch they'd consume enormous amounts of food. I'm a relatively young guy, relatively athletic, but there's no ways I could consume as much food in a single meal as they were putting down regularly. They'd be doing a big mac meal, supersized (diet coke of course), and a second big mac on the side. And to top it off, they'd eat something for dessert. This is just an example, but their eating habits for non fast food was equally as bad. I'd have to guess that their meals were maybe 1500-2000 calories, which is obscene. Even 1000 calories per meal is already a lot unless you're extremely active.
Physiologically speaking, it doesn't matter if you lose weight by crash dieting or a more modest deficit. Once you go a certain amount below your starting weight your body starts fighting tooth and nail to get you to gain it back. Crash diets have been studied as well as moderate reductions in caloric intake plus a modest increase in activity. The results are the same with the vast majority of participants regaining most or all of the weight within a years' time, and a good number winding up heavier.

Gina Kolata who is a science writer for the NYT wrote a book called Rethinking Thin which goes into a lot of depth on the studies that have been done on this. That's not the only book out there, but it's a good start.
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Old 08-22-2017, 04:25 PM
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Here's a recent article from the CDC explaining the reasoning behind this recommendation more.

https://www.cdc.gov/pcd/issues/2017/17_0006.htm#

It's so weird to me how rabidly antiscience people get when you tell them long term weight loss is all but impossible and that other measures should be taken to improve health.

For the record, I'm not obese, morbidly or otherwise. I'm a size 6 to 8, vegan, I work out six days a week, and my biometrics are perfect. Would I like to be a size 2? Sure, I guess. It gets you a lot of privilege in society. But I know I wouldn't be able to sustain it if I got there.
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Old 08-22-2017, 05:57 PM
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Originally Posted by hamchan View Post
Physiologically speaking, it doesn't matter if you lose weight by crash dieting or a more modest deficit. Once you go a certain amount below your starting weight your body starts fighting tooth and nail to get you to gain it back. Crash diets have been studied as well as moderate reductions in caloric intake plus a modest increase in activity. The results are the same with the vast majority of participants regaining most or all of the weight within a years' time, and a good number winding up heavier.

Gina Kolata who is a science writer for the NYT wrote a book called Rethinking Thin which goes into a lot of depth on the studies that have been done on this. That's not the only book out there, but it's a good start.
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The perception of the general public is that no one ever succeeds at long-term weight loss. This belief stems from Stunkard and McLaren-Hume's 1959 study of 100 obese individuals, which indicated that, 2 y after treatment, only 2% maintained a weight loss of 9.1 kg (20 lb) or more (1). More recently, a New England Journal of Medicine editorial titled Losing Weight: An Ill-Fated New Year's Resolution (2) echoed the same pessimistic message.
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The single best predictor of risk of regain was how long participants had successfully maintained their weight loss (Table 1⇓). Individuals who had kept their weight off for 2 y or more had markedly increased odds of continuing to maintain their weight over the following year. This finding is encouraging because it suggests that, if individuals can succeed at maintaining their weight loss for 2 y, they can reduce their risk of subsequent regain by nearly 50%.
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Not surprisingly, those who regained weight reported significant decreases in their physical activity, increases in their percentage of calories from fat, and decreases in their dietary restraint. Thus, a large part of weight regain may be attributable to an inability to maintain healthy eating and exercise behaviors over time. The findings also underscore the importance of maintaining behavior changes in the long-term maintenance of weight loss.
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Findings from the registry suggest six key strategies for long-term success at weight loss: 1) engaging in high levels of physical activity; 2) eating a diet that is low in calories and fat; 3) eating breakfast; 4) self-monitoring weight on a regular basis; 5) maintaining a consistent eating pattern; and 6) catching “slips” before they turn into larger regains. Initiating weight loss after a medical event may also help facilitate long-term weight control.
http://ajcn.nutrition.org/content/82/1/222S.long


TLDR version: people regain the weight because they regress to a state of eating too much and exercising too little.

Logically, it makes sense. If you go back to consuming 4k calories a day and getting almost no exercise, of course you'll gain the weight back. The greater issue is more that the person isn't used to maintaining a healthy lifestyle, so has trouble sticking to it for the long term. If you look at my 2 big mac a lunch example, these ladies go on fad diets/exercise every year. They lose weight, then gain it all back once they're back on the no-exercise, 2 big mac a lunch meals. No surprise.

your body isn't a machine, it takes time for your body to adjust to something new. Say you haven't ran in years, but all of a sudden you decide to run 5 miles, you'll send your body into shock after 1 day! Similarly, for someone who doesn't do it, dieting and exercise does the same. Consider if you make it a routine to run regularly. Your body starts to adjust to the new "normal" over the period of a month, 6 months, year, years, and before you know it, your body is more than in condition to do the regular runs. Same process for eating healthy and getting enough physical activity.

Last edited by ~bs; 08-22-2017 at 06:15 PM.
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Old 08-22-2017, 06:05 PM
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Originally Posted by hamchan View Post
Here's a recent article from the CDC explaining the reasoning behind this recommendation more.

https://www.cdc.gov/pcd/issues/2017/17_0006.htm#

It's so weird to me how rabidly antiscience people get when you tell them long term weight loss is all but impossible and that other measures should be taken to improve health.

For the record, I'm not obese, morbidly or otherwise. I'm a size 6 to 8, vegan, I work out six days a week, and my biometrics are perfect. Would I like to be a size 2? Sure, I guess. It gets you a lot of privilege in society. But I know I wouldn't be able to sustain it if I got there.
You are used to eating a healthy diet (I assume) and exercise. Therefore, you are used to maintaining a body size of 6 to 8. An individual currently a size 2 may be comfortable there (possibly not) because their body allows it, they're used to eating and exercising in the proportions to maintain that size. You would have to make significant, permanent lifestyle adjustments to go to size 2 and stay there.

On the flip side, what if you were used to eating extremely unhealthy and not exercising? Of course after you lose interest in your eating healthy and exercising regimen, you'll revert to form and gain all the weight back. This is why I think things like weight loss shouldn't be approached as temporary yearly diets, but as a permanent lifestyle change.

Last edited by ~bs; 08-22-2017 at 06:19 PM.
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Old 08-22-2017, 06:58 PM
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You are used to eating a healthy diet (I assume) and exercise. Therefore, you are used to maintaining a body size of 6 to 8. An individual currently a size 2 may be comfortable there (possibly not) because their body allows it, they're used to eating and exercising in the proportions to maintain that size. You would have to make significant, permanent lifestyle adjustments to go to size 2 and stay there.

On the flip side, what if you were used to eating extremely unhealthy and not exercising? Of course after you lose interest in your eating healthy and exercising regimen, you'll revert to form and gain all the weight back. This is why I think things like weight loss shouldn't be approached as temporary yearly diets, but as a permanent lifestyle change.
The National Weight Control Registry (which has strong direct ties to the diet and weight loss industry) is a master manipulator of data. You have to lose at least 30 lbs and keep it off for a year in order to join the registryin the first place (they have no requirements that your BMI be under a certain amount either, so you could go from 330 lbs to 300 and still join). So these are people, a very small percentage, who manage to beat the odds, and not regain within a year. Even so, according to NWCR's own data, in a given year they lose over 40% of their participants because they regain some or all of the weight.

There is one thing you said I can agree with, and that is that people regain because they revert to their prior habits. But what you're not understanding is WHY. It's not out of laziness or not caring. It's because biology is forcing their hand. Read this article for a good explanation as to why this happens. https://mobile.nytimes.com/2012/01/0...-fat-trap.html

As for me, my weight stays fairly stable regardless of what I do. The only thing that really changes much is my body fat and lean mass percentage.
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Old 08-22-2017, 07:31 PM
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hamchan, I worked 12 hours today so haven't been online. I haven't had a chance to look at the links you posted so I'm not sure if they address this question.

If, as you say, obesity is all biology based and losing weight is impossible, what explains the dramatic increase in obesity over the past couple of decades? Nothing has changed in our biology to my knowledge. Humans are pretty much the same as they were 20 or 30 years ago. So if it can't be explained by increased calorie intake and decreased physical activity, why are so many people so much heavier today?
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Old 08-22-2017, 08:21 PM
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Did you read the rest of what I wrote? Statistically dieting leads to long term weight gain, not loss. The average female starts their first diet in elementary school, and as a nation we keep getting bigger. There's most definitely a connection.
How in the world do you get "Nutria thinks we must all crash diet" from "we did it to ourselves"??
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Old 08-22-2017, 09:46 PM
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How in the world do you get "Nutria thinks we must all crash diet" from "we did it to ourselves"??
I didn't? I'm saying it doesn't matter whose fault it is, dieting is part of the problem.
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Old 08-22-2017, 09:55 PM
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hamchan, I worked 12 hours today so haven't been online. I haven't had a chance to look at the links you posted so I'm not sure if they address this question.

If, as you say, obesity is all biology based and losing weight is impossible, what explains the dramatic increase in obesity over the past couple of decades? Nothing has changed in our biology to my knowledge. Humans are pretty much the same as they were 20 or 30 years ago. So if it can't be explained by increased calorie intake and decreased physical activity, why are so many people so much heavier today?
Just to clarify, losing weight isn't impossible, keeping weight off long term after losing it is more than the vast majority of people are capable of doing.

I'd encourage you to read the links and check out the book I recommended, as the book addresses the question you had. The bottom line is that "we don't really know" but we have found that even labratory animals, whose diets are tightly controlled, weigh more than they used to. There are a variety of other factors being looked at and studied as well. It's not a simple answer, and it's not really known.

Given that people are dieting more than ever before, and starting earlier than ever before, and dieting is associated with weight gain and increased risk of obesity in the long term, I'd be taking a hard look at that as well. We'd probably weigh a whole lot less on average if we stopped trying to lose weight in the first place, especially kids and teens.
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Old 08-22-2017, 10:22 PM
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Did you read the rest of what I wrote? Statistically dieting leads to long term weight gain, not loss. The average female starts their first diet in elementary school, and as a nation we keep getting bigger. There's most definitely a connection.
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I didn't? I'm saying it doesn't matter whose fault it is, dieting is part of the problem.
I never asserted "dieting is good and necessary". Thus, your confrontational "Did you read the rest of what I wrote?" is a non sequiter to "we do it to ourselves".

EDIT: the title of this thread is not "Physicians should recommend dieting". Your whole string of comments on how bad dieting is is completely OT from whether or not people should lose weight.

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Old 08-23-2017, 05:29 AM
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keeping weight off long term after losing it is more than the vast majority of people are capable of doing.
"capable" or "willing"? Those are two entirely different things.

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Given that people are dieting more than ever before, and starting earlier than ever before, and dieting is associated with weight gain and increased risk of obesity in the long term, I'd be taking a hard look at that as well. We'd probably weigh a whole lot less on average if we stopped trying to lose weight in the first place, especially kids and teens.
This is pure nonsense. People are "dieting more than ever". What constitutes "dieting"? I have patients tell me all the time that they are "dieting". When I actually dig into what they mean by that and what changes they've made, most of what they're doing isn't any better, and sometimes is even worse, than what they were already doing.

Example: Speaking to one patient I learned that she drinks beer regularly. She's not an alcoholic. I don't believe she has any addiction issue. She just happens to like beer, so whenever she goes out to eat, which she does a lot, she gets a beer with her meal. I showed her how many calories are in that beer and how beneficial it would be to drink water instead. She comes back a couple of months later excited to tell me that she "followed my advice" and stopped drinking beer when she went out. I congratulated her for that, despite noting that she had gained about 5 pounds. She then proceeded to tell me that in place of a beer, she was getting a margarita. In her mind, she was "dieting". Had a research company called her, she would have said, "Yes, I am currently on a diet." That would have totally ignored the fact that her idea of a diet was substituting a 350 calorie margarita for a 150 calorie beer.

To say that we don't know why more people are obese is inane. Numerous studies have shown that average daily calorie intake has increased by something like 300 calories. That's an extra 110,000 calories/year. Of course people are heavier than they used to be. People no longer cook from scratch. They eat a diet primarily composed of processed foods. And they are more sedentary than ever.

Serving sizes have grown dramatically as well. In the 1960s, McDonald's sold one size of french fries that was about 200 calories. Today, a large has 510 calories. A regular burger, small fries, and small Coke is about 620 calories which isn't terrible, but nobody actually does that. Instead, they get a BBQ bacon burger, large fries, and large coke of 1,220 calories. And to top it off, they get dessert to go, a McCafe shake, which adds another 510 calories bringing the meal to a whopping 1,730 calories. And then they come and tell me, "I don't know why I'm gaining weight."

When CocaCola was first introduced, it came in one size, a 6-ounce bottle. When I was in high school, I worked at a snack bar. We had 3 sizes of soda. The large was 12 ounces and we didn't sell that many larges. Today, a "small" at most places is at least 16 ounces and often more than that.

Another study found that Americans get about 8% of their daily calories from sugary drinks and about 16% from added sugar.

Yet another study found that the average adult weight worldwide (in developed countries) was 137 pounds. The average in the US was 180 pounds. Clearly, Americans are doing something differently that is making them the fattest on the planet. It's not a secret.
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Old 08-23-2017, 05:50 AM
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We went to Canada a number of years ago. Early in the trip, we went to a local amusement park. At lunch, my plan was to do what we normally do and get one drink that the 3 of us share. So I ordered one Coke only to be handed a cup that couldn't have been more than 8 or maybe 10 ounces. They didn't have small, medium, and large. They had one size.

A day or two later, we were in Niagara Falls. It was hot and we needed to cool off. We saw an Icee stand and decided to get those. We were deciding what size we each wanted only to walk up to the counter to find that they also had just one size, what Americans would probably call a "kid's", not even a small.

Throughout the trip, we encountered the same thing over and over. Serving sizes were very reasonable and, as a result, obesity in Canada isn't nearly the problem that it is in the US. One time we even stopped at a vending machine on the street to get a drink, expecting a 12-oz can to pop out. Nope. It was one of the short 8-oz cans.

Anybody who says they don't know why 70% of Americans are overweight or obese is simply not paying attention.
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Old 08-23-2017, 06:51 AM
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She comes back a couple of months later excited to tell me that she "followed my advice" and stopped drinking beer when she went out. I congratulated her for that, despite noting that she had gained about 5 pounds. She then proceeded to tell me that in place of a beer, she was getting a margarita. In her mind, she was "dieting". Had a research company called her, she would have said, "Yes, I am currently on a diet." That would have totally ignored the fact that her idea of a diet was substituting a 350 calorie margarita for a 150 calorie beer.


She votes and breeds, too, huh?
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Old 08-23-2017, 07:26 AM
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hamchan, I worked 12 hours today so haven't been online. I haven't had a chance to look at the links you posted so I'm not sure if they address this question.

If, as you say, obesity is all biology based and losing weight is impossible, what explains the dramatic increase in obesity over the past couple of decades? Nothing has changed in our biology to my knowledge. Humans are pretty much the same as they were 20 or 30 years ago. So if it can't be explained by increased calorie intake and decreased physical activity, why are so many people so much heavier today?
One of my hobbies is collecting cookbooks and reading them. Yes, seriously I read them and look at many or the recipes. Over the years of reading cookbooks from the early 1900's to current time shows some interesting facts that most people are missing in wondering why Americans get so fat.

1. The big ones is so few people cook from scratch anymore and they then eat high calorie, high sodium fast food.

2. Cookbooks have gotten on the band wagon of trying to lower fats, salt and sugar in the diet, so many cookbooks are taking old recipes and remaking them into 'healthy' recipes.

3. Way back when, people put out so much more energy to earn the cost of grocery or work hard in their gardens to grow their food. Many, if not most folks are certified couch potatoes.

4. Eating a low-fat meal with severe portion control, means a person wants more to eat within an hour and so then they open a bag of chips and a soda as well as other goodies.

5. I really think that if people would one learn to cook and throw out those low fat, low sugar, low salt, low taste cookbooks and start using a Betty Crocker or Better Homes and Gardens cookbook main cookbook from the 1950's, people might eat and get more fat/salt in their diet during a meal, BUT they wouldn't have that need to pull out snacks in no time after a meal. By doing so, they would actually reduce the amount of sale, sugar, fat in their diet significantly over the course of time.

@Steve, when I have visited Canada, I have noticed the same thing. Much skinnier people.
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Old 08-23-2017, 07:41 AM
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The big ones is so few people cook from scratch anymore and they then eat high calorie, high sodium fast food.

I really think that if people would one learn to cook and throw out those low fat, low sugar, low salt, low taste cookbooks and start using a Betty Crocker or Better Homes and Gardens cookbook main cookbook from the 1950's, people might eat and get more fat/salt in their diet during a meal, BUT they wouldn't have that need to pull out snacks in no time after a meal.
The #1 cookbook in our house is Better Homes and Gardens and our edition is probably from the 70s.

I agree that all of the "diet" foods are part of the problem.

Even cookbooks depend heavily on processed foods. Most things sold as cookbooks are little more than assembly manuals today, putting together a bunch of prepared foods to make a meal.
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Old 08-23-2017, 09:49 AM
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RE cooking

Agreed totally. I cook mostly from scratch (WAY cheaper than eating out), and it's only after cooking do you realize how insane restaurants are when it comes to sodium and fat used in preparation. I CAN season the food to taste like how theirs tastes, but CHOOSE not to because I'm conscious of the absurd amounts they use.

---------------

i've been to japan and multiple other countries in asia. The populations are largely slender. The difference is smaller meals and more exercise. In fact, in Japan, despite eating "like an american" the entire trip, I actually came back leaner and lighter than when I left on the trip. In fact, several of my friends I traveled with commented something similar.

The amount of walking one does in Japan is quite impressive. After we finished our meal, we'd be off walking to the next destination. Maybe it's kinda bad, but Japan isn't the best on handicap accesibility either. It's up/down stairs and hills. You want to visit that 500 year old temple? It's up and down the 1000 steps you go! The constant low grade exercise meant that even with high food intake, I'd burn the calories off easily, even without resorting to "real workouts". If I actually lived in japan, I have no doubt I'd be a lot leaner LONG TERM, as I'd adjust to the cultural norms of smaller portions and more exercising (walking/mass transit vs car)

Last edited by ~bs; 08-23-2017 at 09:55 AM.
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