{"title":"Early obesity risk prediction via non-dietary lifestyle factors using machine learning approaches.","authors":"Ker Ming Seaw, Melvin Khee Shing Leow, Xinyan Bi","doi":"10.1111/cob.70011","DOIUrl":"https://doi.org/10.1111/cob.70011","url":null,"abstract":"<p><p>Obesity poses a significant health threat, contributing to the development of noncommunicable diseases (NCDs). Early identification of individuals at higher risk for obesity is crucial for implementing effective prevention strategies. This study explores the viability of non-dietary factors such as lifestyle, family history, and demographics as predictors of obesity risk. The dataset comprised 1068 males and 1043 females, aged between 14 and 61 years. Only non-dietary factors were used to build the machine learning models, including decision tree, random forest, support vector classification (SVC), k-nearest neighbour (KNN), and Gaussian Naïve Bayes (GNB). Random forest emerged as the optimal model, demonstrating 66.9% test accuracy, 66.4% precision, 66.9% recall, 66.4% F1-score, 94.5% specificity and 92.3% area under the receiver operating characteristic curve (AUC-ROC). Variability of the models' performance was also evaluated through bootstrapping. Lifestyle factors, while less impactful than family history and demographics, also contributed to predictive power. This indicates the potential for predicting obesity while relying less on dietary data, paving the way for future studies to refine predictive models. This could play a crucial role in identifying lifestyle factors as predictors of obesity, thereby preventing and intervening early to address obesity-related complications.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70011"},"PeriodicalIF":2.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Considerations in the treatment of individuals with obesity and periodontitis.","authors":"Abigail S Q Cheong, Jean E Suvan","doi":"10.1111/cob.70002","DOIUrl":"https://doi.org/10.1111/cob.70002","url":null,"abstract":"<p><p>Two common non-communicable diseases, obesity and periodontitis, are responsible for and affected by systemic inflammation, sharing common risk factors and mechanistic pathways. Periodontitis is an irreversible immune-mediated inflammatory disease of hard and soft tissue supporting teeth. If left untreated, periodontitis can lead to tooth loss, affecting food choices and healthy eating, therefore affecting overall health. Obesity is an independent predictive factor for worsened periodontal inflammation, increased onset, progression, severity, and recurrence of infection, as well as delayed wound healing. Thus, managing obesity and associated metabolic dysfunctions may improve periodontal therapy outcomes. The chronic inflammatory state of obesity impairs immune regulation exacerbating the inflammatory gingival tissue destruction of periodontitis, which can also systemically contribute to inflammatory mediators. Furthermore, bariatric surgeons and dietitians should educate patients with obesity regarding the risk of elevated caries, xerostomia, and periodontitis risk from acid reflux and frequent food intake. Non-dental healthcare professionals should recognise periodontal disease signs to prompt dental referral when warranted. Asking patients about recent dental visits promotes patient involvement in cross-discipline dialogue to enhance patient care coordination between medicine and dentistry. This article discusses the association between these two diseases, the challenges of achieving optimal periodontal treatment outcomes, and the clinical strategies to enhance holistic care. It also explores oral health considerations in dietary and surgical interventions in the treatment of obesity.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70002"},"PeriodicalIF":2.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Jaensson, Karuna Dahlberg, Yang Cao, Anders Thorell, Johanna Österberg, Ulrica Nilsson, Erik Stenberg
{"title":"Impact of health literacy and general self-efficacy on surgical outcomes 2 years after bariatric surgery.","authors":"Maria Jaensson, Karuna Dahlberg, Yang Cao, Anders Thorell, Johanna Österberg, Ulrica Nilsson, Erik Stenberg","doi":"10.1111/cob.70009","DOIUrl":"https://doi.org/10.1111/cob.70009","url":null,"abstract":"<p><p>After bariatric surgery, adherence to lifestyle recommendations is crucial. Health literacy and self-efficacy may impact recovery after surgery. In this multicentre study performed in three hospitals in Sweden, we evaluated any relation between preoperative health literacy and general self-efficacy on the one side and weight loss, health-related quality of life, length of stay, and complications up to 2 years after bariatric surgery on the other. Of 686 included patients, 56% (n = 382) had limited functional health literacy, 42% (n = 278) had limited communicative and critical health literacy, and 40% (n = 266) reported low general self-efficacy. Preoperative functional, communicative and critical health literacy, and general self-efficacy were not associated with the degree of weight loss at 1 or 2 years after surgery. However, limited health literacy and low general self-efficacy scores were associated with both reduced quality of life and obesity-related problems postoperatively. Further, a higher proportion of those with inadequate health literacy had a prolonged length of stay. Although patients with limited health literacy and self-efficacy may experience similar maximum weight loss after bariatric surgery as other patients, they still might have reduced health-related quality of life in terms of obesity-related problems. Increased awareness of this association as well as patient-centered support before and after bariatric surgery may be of benefit.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70009"},"PeriodicalIF":2.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A B M Kamrul-Hasan, Joseph M Pappachan, Lakshmi Nagendra, Hamid Ashraf, Deep Dutta, Saptarshi Bhattacharya, Nitin Kapoor
{"title":"Metabolic outcomes of bariatric surgery versus lifestyle intervention in adolescents with severe obesity: A systematic review and meta-analysis.","authors":"A B M Kamrul-Hasan, Joseph M Pappachan, Lakshmi Nagendra, Hamid Ashraf, Deep Dutta, Saptarshi Bhattacharya, Nitin Kapoor","doi":"10.1111/cob.70008","DOIUrl":"https://doi.org/10.1111/cob.70008","url":null,"abstract":"<p><p>Data from clinical trials evaluating the effectiveness and safety of metabolic and bariatric surgery (MBS) compared to lifestyle modifications (LSM) in children and adolescents with obesity are scarce. This systematic review and meta-analysis (SRM) sought to fill this knowledge gap. Randomised or non-randomised trials spanning at least one-year involving children and adolescents with severe obesity receiving any form of MBS in the intervention group and LSM for weight loss in the control group were systematically searched through electronic databases. This SRM adhered to the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA checklists. The primary outcome of interest was the change in body weight from the baseline. Five trials (three randomised, open-label and two non-randomised) with 1-2 years follow-up durations were analysed, including 367 participants aged 10-19 years. MBS resulted in greater reductions in body weight (mean difference [MD] -25.83 kg, 95% confidence interval [CI] [-36.91, -14.75], p < .00001) and per cent body weight (MD -24.54%, 95% CI [-33.19, -15.89], p < .00001) compared to LSM. Furthermore, MBS outperformed LSM in reducing body mass index (BMI), BMI z-score, waist circumference, glycated haemoglobin, fasting plasma glucose, insulin resistance, triglycerides, alanine aminotransferase, high sensitivity C-reactive protein and an overall improvement of physical functioning and quality of life. The safety profile was comparable between the two groups; however, data was scarce. Larger, longer-term trials that include multinational and multiethnic representation are essential for making solid clinical practice recommendations regarding MBS for children with obesity.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70008"},"PeriodicalIF":2.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maya E Joseph, Nisha Mathews, Lydia H Albuquerque, Peter Chen
{"title":"An exploration of self-perception of weight status, weight-related variables, and preferences for weight management strategies among South Asians in the US.","authors":"Maya E Joseph, Nisha Mathews, Lydia H Albuquerque, Peter Chen","doi":"10.1111/cob.70007","DOIUrl":"https://doi.org/10.1111/cob.70007","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the relationships between self-perception of weight status, weight-related variables, and weight management preferences of South Asians (SA) to assist in building culturally tailored interventions for obesity management.</p><p><strong>Methods: </strong>This was a cross-sectional, descriptive, and correlational study. The sample consisted of 272 South Asians over 18 years of age. Data analyses included descriptive and inferential statistics.</p><p><strong>Results: </strong>Based on ethnic-specific BMI criteria, 88.6% of participants were overweight/obese, and 53.5% had abdominal obesity. Among participants, 37% misperceived their weight status. Older individuals had lower chances of accepting weight loss medications (OR = 0.96, 95%CI: 0.94-0.99), while overweight/obese participants had lower odds of accepting weight management surgery (OR = 0.34, 95%CI: 0.13-0.85). The odds of accepting medication therapy were higher if the healthcare provider discussed weight status with them (OR = 1.84, 95% CI:1.06-3.21). Finally, compared to their counterparts, men, those with overweight/obesity, and those with abdominal obesity had 66%, 65%, and 49% lower odds of accurately perceiving their weight status, respectively.</p><p><strong>Conclusion: </strong>This study highlights the high prevalence of overweight and obesity, the misperceptions of weight status, the need for provider involvement in care, and the specific subgroups of SAs with more misperceptions of weight status.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70007"},"PeriodicalIF":2.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca L Pearl, Laurie C Groshon, Marian Hernandez, Caroline Bach, Erica M LaFata, Hannah F Fitterman-Harris, Dakota L Leget, Miriam Sheynblyum, Thomas A Wadden
{"title":"Characterising first, recent and worst experiences of weight stigma in a clinical sample of adults with high body weight and high internalised stigma.","authors":"Rebecca L Pearl, Laurie C Groshon, Marian Hernandez, Caroline Bach, Erica M LaFata, Hannah F Fitterman-Harris, Dakota L Leget, Miriam Sheynblyum, Thomas A Wadden","doi":"10.1111/cob.70005","DOIUrl":"https://doi.org/10.1111/cob.70005","url":null,"abstract":"<p><p>This research aimed to systematically characterise experiences of weight stigma and their impacts among weight-loss treatment-seeking adults with high body weight and high levels of internalised weight stigma. Participants recruited for two clinical trials completed a semi-structured interview about weight stigma (Study 1 n = 84, M<sub>age</sub> = 47.8 ± 11.2 years, 83.3% women, 67.9% Black; Study 2 n = 129, M<sub>age</sub> = 50.0 ± 12.2 years, 88.4% women, 65.1% White). Study 1 focused on first and most recent experiences of weight-based teasing, bullying, discrimination and unfair treatment, and Study 2 focused on the worst examples of these experiences; participants in both studies also identified their overall worst experiences. Participants reported the age at which the experiences occurred and rated (1-5) how upsetting they were. Interview responses were coded for interpersonal sources of weight stigma and impacts of these experiences. Across studies, weight teasing was the most commonly reported experience of weight stigma and the most frequently identified worst experience. Family members were the most commonly identified interpersonal source of weight stigma. Weight stigma experiences were reported across the lifespan and were predominantly described as having negative emotional impacts. Findings provide insights into the types and characteristics of weight stigma experiences that may contribute to the internalisation of this stigma and other adverse consequences.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70005"},"PeriodicalIF":2.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Patient and professional perceptions for long-term success: Developing a framework for bariatric surgery care in Portugal.","authors":"Cláudia Mendes, Manuel Carvalho, João Gregório","doi":"10.1111/cob.70004","DOIUrl":"https://doi.org/10.1111/cob.70004","url":null,"abstract":"<p><p>A multidisciplinary health team for perioperative care of the bariatric patient, sustained in a viable framework, may provide a comprehensive bariatric surgery process analysis. This study aimed to analyse patients' and professionals' experiences with the perioperative care process and identify their perceptions of the bariatric surgery process to support the long-term management of obesity surgical treatment. This study also wants to develop a framework to sustain a long-term follow-up. This qualitative study was conducted in July 2022 at a bariatric surgery centre in southern Portugal, comprising four focus group sessions. Participants included seven health professionals in one focus group and 16 patients divided across three focus groups. Patients were selected based on specific criteria, including those awaiting bariatric surgery and those who had undergone surgery within the past 1 to 5 years. The patient focus group script consisted of 11 open-ended main questions with follow-up prompts to explore motivations, experiences with the presurgery and postsurgery processes and perceptions of lifestyle changes. Sessions lasted between 40 and 70 min. Participants reported the need for a reference professional in the hospital to contact, the importance of psychological support to help patients deal with the 'ups and downs' of postsurgery life and the financial support for physical activity programmes. This research helped identify a need for a framework for long-term follow-up and showed priorities to tailor health services for managing bariatric surgery patients. This team should be led by a dedicated case manager and include physical activity specialists.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70004"},"PeriodicalIF":2.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stuart W Flint, Ezra Goldberg, Mohammad Kaykanloo, Stuart Sherman, Duncan Radley, Sarah R Kingsbury, Louisa Ells
{"title":"Is personality associated with the lived experience of the NHS England low calorie diet programme: A pilot study.","authors":"Stuart W Flint, Ezra Goldberg, Mohammad Kaykanloo, Stuart Sherman, Duncan Radley, Sarah R Kingsbury, Louisa Ells","doi":"10.1111/cob.70003","DOIUrl":"https://doi.org/10.1111/cob.70003","url":null,"abstract":"<p><p>This pilot study explored the use of a novel behavioural artificial intelligence (AI) tool to examine whether personality is associated with the lived experience of the NHS England launched a low calorie diet (LCD). A cross-sectional survey was disseminated to service users to gather data on emotional wellbeing, physical activity, pain, motivation to manage diabetes, motivation to lose weight, rating of total diet replacement (TDR) products and frequency of using fibre supplements. The scaled insights behavioural AI tool was used to infer personality traits from service users' language construction, and in doing so, examine associations with the outcomes indicated above. Findings show that service users can be profiled by personality, and this can provide a method of understanding programme outcomes. Three clusters of personality traits were identified. Despite this, there was no association between personality features and emotional wellbeing, physical activity, pain, motivation to manage diabetes, motivation to lose weight, rating of TDR products and frequency of using fibre supplements. As the self-selected sample size was limited, future research should examine the use of behavioural AI tools and personality using larger and longitudinal samples.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70003"},"PeriodicalIF":2.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Firas Bahdi, Sagar Shah, Fadi Dahoud, Maryam Farooq, Philip Kozan, Stephen Kim, Alireza Sedarat, Na Shen, Adarsh Thaker, Jennifer M Kolb, Erik Dutson, V Raman Muthusamy, Danny Issa
{"title":"Revisional endoscopic sleeve gastroplasty versus semaglutide and tirzepatide for weight recidivism after sleeve gastrectomy.","authors":"Firas Bahdi, Sagar Shah, Fadi Dahoud, Maryam Farooq, Philip Kozan, Stephen Kim, Alireza Sedarat, Na Shen, Adarsh Thaker, Jennifer M Kolb, Erik Dutson, V Raman Muthusamy, Danny Issa","doi":"10.1111/cob.70001","DOIUrl":"https://doi.org/10.1111/cob.70001","url":null,"abstract":"<p><strong>Background and aims: </strong>Weight recidivism following sleeve gastrectomy (SG) is common. Adjuvant treatments include new glucagon-like peptide 1 and glucose-dependent insulinotropic peptide receptor agonists (GLP1/GIP-RA) or revisional endoscopic sleeve gastroplasty (R-ESG). We here compare the outcomes of these treatments.</p><p><strong>Methods: </strong>A retrospective study of patients ≥18 years with prior SG treated with semaglutide, tirzepatide or R-ESG for weight recidivism between January 2019 and 2023 at large academic centre. Primary outcomes were total body weight loss (TBWL) and adverse events (AEs). Secondary outcomes were changes in metabolic parameters. Tertiary outcome was to compare GLP1/GIP-RA outcomes in SG patients to matched patients with intact stomach.</p><p><strong>Results: </strong>Our study included 68 (prior SG + GLP1/GIP-RA) and 22 (prior SG + R-ESG). R-ESG offered higher TBWL% than GLP1/GIP-RA at 3 (11.2% vs. 4.3%, p < .001), 6 (13.5% vs. 6.8%, p < .001) and 12 months (13.4% vs. 9.2%, p = .07) with no significant difference in AEs or change in metabolic parameters. On subgroup analysis, tirzepatide achieved similar 12-months TBWL% as R-ESG (13.2% vs. 13.4%, p = .9) and significantly more than semaglutide (13.2% vs. 8.1%, p = .04). Compared to patients with intact stomach (n = 87), GLP1/GIP-RA achieved significantly lower TBWL% in patients with prior SG at 3 (4.3% vs. 5.7%, p = .02), 6 (6.8% vs. 9.2%, p = .02) and 12 months (9.2% vs. 12.7%, p = .03). Medication refills were difficult in 41.3% of patients.</p><p><strong>Conclusions: </strong>In a single-centre real-world experience study, R-ESG and tirzepatide appear to offer more weight loss than semaglutide in SG patients with weight recidivism although GLP1/GIP-RA were underdosed. GLP1/GIP-RA achieved higher weight loss in patients with intact stomach than those with prior SG.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70001"},"PeriodicalIF":2.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Change in glucose, insulin and serum lipids due to ultra-processed food consumption in children with obesity.","authors":"Caroline Cortes, Joana Maia Brandão, Diana Barbosa Cunha, Vitor Barreto Paravidino, Rosely Sichieri","doi":"10.1111/cob.70000","DOIUrl":"https://doi.org/10.1111/cob.70000","url":null,"abstract":"<p><p>While the association between ultra-processed food (UPF) consumption and chronic non-communicable diseases in adults is well-established, its relationship with serum markers of chronic diseases in children remains underexplored. This research investigates changes in serum markers in children with obesity during a trial aimed at reducing UPF consumption. The study is a prospective cohort, based on a parallel randomized controlled trial conducted between August 2018 and February 2020, with children aged 7-12 years. Over 6 months, children and their guardians attended monthly consultations and educational activities aimed at reducing UPF consumption. Body weight, height, and 24-h dietary recall were measured at all visits. Serum markers were collected at baseline and at the 2- and 5-month visit (during the intervention). Data from 95 children were analysed. Body mass index (BMI), UPF consumption in grams and energy, and percentage of UPF in grams showed a quadratic trend, initially decreasing, followed by an increase in the following months. Glucose, insulin, and HOMA-IR decreased throughout the study, but after adjustment for BMI, the associations no longer persisted, except for glucose levels, which decreased linearly by 2.25 mg/dL. Reducing UPF consumption may lower blood glucose levels in children with obesity, independent of BMI changes.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":" ","pages":"e70000"},"PeriodicalIF":2.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}