OBESITY | VOLUME 18 SUPPLEMENT 1 | FEBRUARY 2010 S17 nature publishing group COMMENTARIES CHILDHOOD OBESITY 1 Division of General Pediatrics, Department of Pediatrics and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. Correspondence: Thomas N. Robinson (tom.robinson@stanford.edu) No matter where, when, how, or with whom you intervene, successfully preventing or controlling obesity requires chang- ing individual-level behaviors. Tat is true for environmental and policy interventions as much as it is for interventions tar- geting individual patients. Even fuoridating the water supply or adding bike trails, for example, only work if individuals use them. Population-level obesity will only be overcome when many individual members of the population move toward balancing their energy intakes and expenditures. Current approaches to achieving better energy balance by directly tar- geting eating and activity behaviors have shown variable suc- cess. In most cases, successful interventions have produced relatively modest magnitude efects lasting for limited periods of time. Tis has been the case regardless of whether interven- tions have focused on individuals, groups, institutions, envi- ronments or policy changes. Elusive, however, has been an intervention approach that results in greater magnitude and sustained changes in obesity-related behaviors. Accomplishing this goal may require a whole new way of looking at the chal- lenge of altering behaviors to achieve better energy balance. Looking for examples where individuals adopt and sustain dramatic changes in their behaviors, social and ideological movements stand out. Religious movements provide an obvi- ous model, with many compelling illustrations of substantial and sustained behavior change; ranging from an extreme of religious martyrdom, to many diferent specifc dietary pre- scriptions (e.g., vegetarianism among Seventh Day Adventists, Jews who follow Kosher laws, Hindus who do not eat beef, etc.) Although religious behavioral prescriptions are not uni- versally followed, adherents who do comply ofen do so in the face of formidable pressures to abandon them, from the sur- rounding social environment of mainstream cultural norms and behaviors. But it is not just religious participation that can produce dramatic and lasting behaviors in the face of contrary norms. Tis characteristic also seems common to other suc- cessful social and ideological movements. For example, the civil rights movement, the antiwar movement, the women’s rights movement, unionization movements, the animal rights movement, the antitobacco movement, and many others have been accompanied by substantial changes in attitudes, norms and behaviors in sizable groups of the population. In contrast, it appears more difcult for the general population, or even high-risk subgroups, to resist analogous pressures from the toxic environment promoting obesity through excessive energy intake and insufcient activity. Should we conclude that reli- gious adherents and members of social movements are born more self-disciplined? Or rather, is it something about the social and ideological movements themselves that helps indi- viduals comply with behavioral prescriptions despite counter- vailing pressures? Te latter appears more consistent with the observation that almost everyone displays some individualistic behaviors despite pressures to behave to the contrary. If that is the case, then perhaps those same characteristics can be har- nessed for the purposes of obesity prevention. One strategy is to develop new social movements to com- bat obesity (1). It is possible that a successful antiobesity social movement can be developed de novo using the lessons learned from successful prior social movements. We cannot know, however, whether retrospective explanations of success will be relevant to prospectively building a successful movement. Te understanding of what made a movement successful is only as good as the conceptual models and perspectives used. If the conceptual models are incomplete, a new movement may still lack the necessary ingredients to be successful. Recently a number of local, state, national, and international public health and public policy initiatives to prevent obesity have started to gain traction, although wider public adoption and participa- tion in a movement has been limited. To date, therefore, obes- ity and appeals to improve health have not proven sufciently motivating to stimulate participation with the zeal of a social movement. In the absence of a successful social movement mobilized around obesity prevention, is there still a way to derive the behavior change benefts of social and ideological movements? An alternative solution-oriented approach (2) is to identify existing and emerging social and ideological movements that share behavioral goals with those for obesity prevention. Tus, eliminating the necessity to create new social movements and to predict what motivations will be successful in mobilizing individual and collective action. Instead, it may be possible to integrate eforts to control obesity with participation in social movements that are already proving to be highly motivating to Save the World, Prevent Obesity: Piggybacking on Existing Social and Ideological Movements Thomas N. Robinson 1