**8. An expanded role for corporations**

obesity and its correlates. Specifically, a child's "inflammatory profile" may indicate varying

Whereas certain individuals become obese on limited food intake, their experiences are rarely creditable, because ideas of individual accountability suggest that they must be consuming more energy than they report. Research articles with revealing titles such as "Do unsuccessful dieters intentionally underreport food intake?" [55] conclude that shame in a culture that

Well‐studied human populations provide illustrative examples of genetic and molecular mechanisms that couple energy intake and expenditure to obesity in ways that are not strongly associated with individual‐level behaviors. The Pima aboriginal population of the states of southern Arizona in the United States and northern Sonora in Mexico are highly genetically similar and share evolutionary origins. The Sonora cohort subsists on a more traditional Mexican diet, whereas the Arizona cohort consumes a calorie‐dense US diet. The Arizona cohort experiences some of the highest rates of obesity and diabetes in the world, whereas the Sonora cohort is less obese and much healthier. Consensus medical opinion holds that these differences are related to genetics and metabolic pathways, not primarily to differences in

New studies are being proposed, to learn more from these populations about the mechanisms linking obesity and health outcomes. With chronic inflammation as a central explanatory mechanism, new types of data become relevant. For example, the nationally representative US National Social Life, Health, and Aging Project, 2005–2006, was used to investigate why older black men have worse metabolic outcomes than older white men, ages 57–85 years. Research at the intersection of social science and medicine finds that health behaviors do not explain the

"Instead, these outcomes seem to derive more consistently from a factor almost unexamined in the literature—chronic inflammation, arguably a biological "weathering" mechanism induced by these men's cumulative and multi‐dimen‐ sional stress. These findings highlight the necessity of focusing attention not simply on proximal behavioral interventions, but on broader stress‐inducing

The insight that obese individuals who are relatively metabolically healthy (*e.g*., no Type 2 diabetes despite obesity) lack many local (in adipose tissue) and systemic (in blood) biomarkers of chronic inflammation was important [57]. The impact of such insight into medical screening and treatment protocols is surprisingly low inasmuch as many clinicians, whose training is a journey through avowedly meritocratic institutions, do not readily see beyond individual accountability for health outcomes. There is still strong medical opinion that avers that obese individuals must be both in charge of their own obesity and at risk of their somewhat deserved if unfortunate outcomes. Indeed, obesity was only recognized as a disease by the American

What is interesting from a translational medicine approach is that these findings meet resistance in promulgation into care management and public policy. One reason appears to be

social inequalities, to reduce men's race disparities in health."

Medical Association in 2013, over considerable opposition among professionals.

levels of severity of obesity and likelihood of developing Type 2 diabetes [8].

blames obesity on the obese prompts underreporting.

202 Adiposity - Omics and Molecular Understanding

individual willpower on either side of the border.

difference [56]:

Many players across sectors have been called to action to address the pediatric obesity epidemic. The CDC [3] lists these:

"The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society, including families, communities, schools, child care settings, medical care providers, faith‐based institutions, government agencies, the media, and the food and beverage industries and entertainment industries."

*Notably absent from this list is the for‐profit sector and corporations beyond the industries proximally related to food and exercise*.

Corporations have been drawn into obesity debates in their roles as producers and distributors of sugary, fatty, and salty foods. Some corporations have voluntarily withdrawn their foods from vending machines located in schools. Companies that rely on foods regarded as too sugary are seeking new strategies, as described for the Kellogg corporation in the business press [60]. Business schools have been teaching for a decade about the food industry and its response to public pressures to address the obesity problem [61].

Corporations play another role in health care in the United States, as the provider of health benefits to employees. In addition, they increasingly offer wellness programs, which some‐ times focus on obesity; one review found some fun work‐based contests like "the biggest loser," which is modeled in a popular television program [62]. These wellness programs are more likely to support adults and do not typically extend to the children of working parents. Such programs are also rare in low‐wage workplaces.

We propose that the most important role of corporations for stemming pediatric obesity is their structural role as employers. As employers, corporations create working conditions for the parents of young children, which in turn affect parental time and financial resources for supporting their children's diet and exercise [63, 64]. Work practices can be a good place to look for sources of inequalities [65]. Long and nonstandard hours of work affect parenting, such that pediatric obesity might be regarded as an externality of current work arrangements. An externality is a factor that causes harm, that a corporation exports, that no corporation is rationally motivated to curb on its own, but that later impinges negatively on all corporations and societies collectively; pollution is an example. Considering pediatric obesity as a negative externality of corporations might reframe policy debates, particularly toward supporting more remunerative and stable work conditions.

We emphasize the importance of looking at the corporate role in creating obesogenic employ‐ ment conditions. Indeed, employment and consumption patterns may be linked, when taking a broader view of food systems [66]:

"[I]nstead of paying workers well enough to allow them to buy things like cars, as Henry Ford proposed to do, companies like Wal‐Mart and McDonald's pay their workers so poorly that they can afford only the cheap, low‐quality food these companies sell, creating a kind of nonvirtuous circle driving down both wages and the quality of food. The advent of fast food (and cheap food in general) has in effect, subsidized the decline of family incomes in America."

The pediatric obesity epidemic will, in turn, affect corporations. The future workforce will be less healthy and robust, and the children of workers in low‐wage jobs, who are statistically most likely to end up themselves in low‐wage jobs, may not be fit to undertake the heavy lifting or long hours expected. In addition, public opinion is shifting, such that there is greater awareness of food issues and their sources. Corporations should be welcomed into the varied alliances of stakeholders working on the pediatric obesity crisis.

Why might corporations be reluctant partners in this project? The answer requires looking at power. Status quo employment arrangements favor top executives and shareholders. Merito‐ cratic ideals and the ethos of individualism can be invoked to legitimate inequalities from which corporate leaders benefit. Shifting toward structural explanations for outcomes, whether income or obesity, is a radical move. It will require some radical redistribution of employment opportunities, incomes, and resources, and thereby, it is likely to be met with resistance.
