**6. Faith in meritocracy**

different amounts [41]. This body of research offers an expanded notion of marketing and context for understanding overeating, but the burden falls back to the consumer. The over‐

We suggest that, instead of treating diet and exercise as lifestyle choices that parents make, energy balance should be understood as shaped within structural constraints created by organizations and environments. In addition, the ability of parents to seek appropriate clinical screening for their children, which can yield early detection of inflammation profiles and medical complications, is often shaped by work hours and wages. Lower SES and working in jobs where compliance is valued over speaking up can affect whether and how much parents

Considerations for how overall environments shape individual options around food and exercise behaviors are just gaining salience. Ideas from organization studies about meritocracy show how hard it is for structural factors to appear above the din of individualistic attributions and recommendations. Despite extensive research on numerous structural factors, the focus remains on individualistic health goals, even for very young children. The Institute of Medi‐ cine [44] issued a comprehensive set of recommendations, which focus on having early child care providers create ample time for exercise and movement, even for infants, and serve healthy foods, with state regulators urged to oversee these practices. Such practices are necessary and useful, but are designed around a fragmentary, incomplete portrait of how parental work conditions relate to childhood obesity. More fundamental questions, such as why long parental work hours necessitate so much child care or how quality and affordability of child care varies across SES, were not probed. Parents who work nonstandard hours may have to resort to more sedentary child care options, such as children staying with older, retired

Childhood obesity typically determines important biological pathways early in life, such that adults who experienced obesity as children commonly show early onset of the comorbidities of obesity, such as diabetes and cardiovascular disease. Our problem of interest becomes relevant here, because while "willpower" has some impact on the margin for adults seeking to control obesity onset later in life, obese children find themselves coping with deeply set biological patterns that will make future control of their obesity difficult. Individualistic prescriptions for diet and exercise will be of limited value; even more extreme surgical remedies, such as bariatric surgery, show mixed evidence of long‐term success [45]. There is mounting evidence that extended exposure to chronic obesity may promote irreversible, "epigenetic reprogramming" events that permanently alter molecular pathways in humans, including nutrient‐sensing pathways in the brain, for which there is currently no practical hope to correct [46]. Sociologists have long examined early path dependencies shaped by children's race and class [43], demonstrating how early determinants of life chances have significant impacts over a long duration. In juxtaposing these cross‐disciplinary literatures, we see that recent medical research is finding remarkable, specific molecular evidence to support this well‐

arching conclusion is that individuals must monitor their "mindless eating" [42].

lobby in the doctor's office for early medical interventions [43].

200 Adiposity - Omics and Molecular Understanding

**5. Path dependencies and future "life chances"**

relatives, or alone.

Meritocracy is an ideal that states that a person's merits determine their outcomes [47]; for example, working hard yields higher income. Meritocracy poses a "logical syllogism" [48] in that it also implies the reverse: People with low incomes must simply not be working hard. The corporation is a setting where faith in meritocracy is emphasized; employees receive performance evaluations and are rewarded with promotions and income accordingly. Em‐ ployees are less likely to contest inequality if they accept that it is meritocratic, so corporations continue to reinforce the idea of meritocracy [47]. There are of course biases and breakdowns in meritocratic processes, such that poor outcomes may not be traceable to individual merit and effort. Nonetheless, the persistent faith in opportunity and meritocracy among Americans creates a belief that hard work can lift families out of poverty. Surveys find that two‐thirds of Americans believe "most people can get ahead if they work hard" [49], consistent with General Social Survey findings over decades [50]. Data show that 9.2 million families constitute the "working poor," who are employed, but whose incomes fall below the poverty level [51]. Nonetheless, Americans continue to view poverty as a "moral failing" and lack of a work ethic. These tenacious beliefs extend now to the realm of obesity, where a person's weight is regarded as a merit‐based achievement—the result of meritorious individual behaviors, such as managing a good diet and exercising vigorously. The cultural overlay around these behaviors —and moral judgments of people who appear not to engage in them—is significant but often underestimated.

Among obesity researchers, people who engage frequent, high‐intensity exercise but find it difficult to lose weight, and people who eat excessively yet gain weight relatively slowly, provoke a similar questioning of a simple link between effort and outcome. Deeper questions of the mechanisms that govern energy balance have been addressed in recent path‐breaking work demonstrating that both humans and animal models that are obese but "metabolically healthy" and lean but "metabolically unhealthy" should be studied [52–54]. The underlying differentiator of metabolic health or abnormal metabolism is, in part, the person's inflammation profile, which is linked to absolute levels as well as ratios of specific cytokines identified in straightforward laboratory analyses.
