No matter where, when, how, or with whom you intervene, successfully preventing or controlling obesity requires changing individual-level behaviors. That is true for environmental and policy interventions as much as it is for interventions targeting individual patients. Even fluoridating 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 targeting eating and activity behaviors have shown variable success. In most cases, successful interventions have produced relatively modest magnitude effects lasting for limited periods of time. This has been the case regardless of whether interventions have focused on individuals, groups, institutions, environments 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 challenge 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 obvious model, with many compelling illustrations of substantial and sustained behavior change; ranging from an extreme of religious martyrdom, to many different specific dietary prescriptions (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 universally followed, adherents who do comply often do so in the face of formidable pressures to abandon them, from the surrounding 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. This characteristic also seems common to other successful 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 difficult for the general population, or even high-risk subgroups, to resist analogous pressures from the toxic environment promoting obesity through excessive energy intake and insufficient activity. Should we conclude that religious 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 individuals comply with behavioral prescriptions despite countervailing pressures? The 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 harnessed for the purposes of obesity prevention.
One strategy is to develop new social movements to combat 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. The 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 participation in a movement has been limited. To date, therefore, obesity and appeals to improve health have not proven sufficiently 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 benefits 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. Thus, 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 efforts to control obesity with participation in social movements that are already proving to be highly motivating to different segments of the population. As it turns out, there are a number of potential candidate movements to choose from. In these cases, participants are motivated to alter their diets, increase physical activity, or reduce screen time by the objectives of the movement or cause, not for purposes of improving their health or controlling their weights. Any personal, social, or environmental change that results in eating less energy dense, low nutrition foods (e.g., fast foods, convenience snack foods, etc.) in favor of lower energy, higher nutrition foods (e.g., fruits and vegetables), reducing sedentary behavior, or increasing physical activity, has the potential to prevent obesity, regardless of the primary reason for that change. From participants' perspectives, and those of the movement leadership, the potential benefits to health and weight can be considered a beneficial side effect. This approach has been systematically used to design screen time reduction interventions (3,4,5), after school ethnic dance programs (5,6), and team sports (7) interventions to prevent and control childhood obesity. As a result, we have termed these, stealth interventions (8). Piggybacking onto existing social and ideological movements is the next logical step in applying this approach.
Examples of existing social and ideological movements that may also produce obesity prevention as side effects are listed in Table 1. Table 1 includes a description of the goals of different social and ideological movements and/or causes, individual-level behaviors that are consistent with those goals and also with obesity prevention, and supporting community/society-level social, cultural, and environmental changes that may arise to facilitate broader population-wide changes in obesity-related behaviors. The examples illustrate that these movements and causes are not limited to a single ideological viewpoint, but may represent a surprisingly wide spectrum of political, cultural, and socioeconomic perspectives and values. However, they all share behavioral goals consistent with obesity prevention and control.
A review of the movements and causes in Table 1 should ring true to many readers who have witnessed family members, peers, patients, etc. making significant changes in their eating and activity-related behaviors. Think about the vegetarians you know. What motivated their change in diet, was it their risk of heart disease and cancer or something else? Think about the addition of a stop sign, traffic light, or new street lighting in your neighborhood. What led to the change, was it an enlightened attempt to prevent obesity or something else? Although some individuals may be successfully motivated by health concerns, including obesity, these changes are too frequently short-lived, if successful at all. In contrast, it is not unusual to witness transformational changes in behavior attributed to influences unrelated to health. For example, the vegetarian motivated by not wanting to harm animals, the bicycle commuter who is trying to reduce his or her greenhouse gas footprint or reduce dependence on foreign oil, the family that starts growing their own vegetables to help the environment, the sedentary family that trains for a 10K run to raise money for cancer research, the teen who leaves behind his video games to attend an after school sports program daily to play with other kids where there are no other safe places to play, the neighbors that insist on a new stop sign and speed bumps to protect playing kids from passing traffic, etc. Where behavior changes appear very difficult when made to improve one's own health, the very same behavior changes may be more readily achieved when they are linked to a social cause or social good.
It may appear that some of the movements listed will engender less participation from lower-income, less-educated populations, those at higher risk of obesity. Most successful social and ideological movements begin among higher socioeconomic status and more highly educated groups. As these movements develop, they evolve to include more diverse segments of the population. This is a natural progression as many of the causes represented by these movements disproportionately impact the populations in lower-income, less-educated communities (e.g., environmental degradation, human and workers' rights abuses, globalization of jobs, youth violence, etc.) However, there also are many social movements noted in Table 1 in which low-income, less-educated populations are already actively participating or leading (e.g., urban and community agriculture, food justice, and food sovereignty, improving community air quality, workers' rights, labor movements, antigang/antiviolence, military service, etc.) In addition, many of the community and social changes listed in Table 1 1 will have their greatest potential benefits in lower-income communities and populations.
Why might it be easier to alter behaviors when participating in a social and ideological movement than when trying to improve one's own health? First, attempts to improve health are frequently motivated by rational arguments—maximizing utilities in the language of rational choice theories of behavior. This may be one of the most important ways that piggybacking on social and ideological movements differs from the status quo. Almost all existing approaches to changing behavior start with the assumption that humans will act rationally in their own best interest—they will make explicit calculations of anticipated costs and benefits and make a rational choice among alternatives. In addition, the promised potential benefits to health (or avoidance of poor health) often are in the future, further discounting their values as motivators. This has led to countless interventions that focus on persuading persons to adopt and maintain new eating and physical activity behaviors for their own good. Unfortunately, this rational choice assumption has persisted despite several decades of contradictory findings from social psychology, cognitive psychology, behavioral economics, neuroscience, and related fields. This research has clearly indicated that human decision making and behavior are far from rational, but influenced by contextual factors and cognitive biases and limitations (9,10,11).
Social and ideological movement participation may be motivated by rational choices to some extent, such as goals to reduce discrimination or disparities, materially help others or oneself, gain membership in a social group, etc., but a number of other characteristics with contemporaneous incentive value may explain the substantially greater commitments to behavior change. For example, a large body of research has focused on identity formation as an important factor in social movement recruitment and participation (12,13). This may take the forms of self-identity (self-schemata, one's own perception of oneself), collective identity (group-schemata, perception of group identity), and/or public identity (perceptions of how one is identified by others), and may involve a search for a new identity or validation of existing identity and values. At an extreme, identity, values, and symbolic beliefs have been found to be strong motivations for suicide bombers (14), and members of social movements will generally reject material incentives in favor of symbolic, value-laden gestures (15). Participation allows individuals to express their deeper values and demonstrate them to themselves and others. Often, membership in a social movement serves the purposes of both differentiating oneself from others, particularly the perceived mainstream, while also fitting in with the other members of the movement. As such, individuals are frequently defined by their memberships/affiliations with different social and ideological movements (e.g., environmentalists, liberals, and conservatives, members of social or charitable causes).
Identity formation may be particularly relevant to triggering and sustaining behavior change. First, one feels internal pressure to behave in a way that is consistent with one's own perceived self-identity, deeper values, and morals. Similarly, there is pressure to behave consistently with how one has portrayed oneself to other members of the movement (group identity), and to others in the public (public identity). The behaviors may even be the key factors that define membership in a movement, both to oneself and/or to others. Deviance from the idealized behaviors, those consistent with these perceived identities, creates a tension or dissonance that motivates behavior change. Reducing the discrepancies between actual behaviors and goal behaviors is a key element of motivation (16).
Another feature of social and ideological movements is the opportunity for social interaction and membership in a social group. This, in itself, becomes a motivating feature of participation. Opportunities to expand one's social network via social interaction with peers may be highly motivating, and a strong incentive for joining a social movement and continuing participation. Strong social networks also have been identified as important predictors of participation, through socialization, structural connections, and decision making processes (17). This is particularly relevant in light of recent evidence of the “transmission” of obesity and other health behaviors through social networks (18). Opportunities to observe influential models who successfully change and maintain their behaviors, and social support during the change process, enhance perceived self-efficacy for behavior change (16). Perceived individual and collective efficacy in producing desired outcomes through their actions is a potent determinant of participation.
We have also hypothesized another potential efficacy-related motivation that helps explain greater participation in social movements rather than individual-level behavior changes; an exchange of personal responsibility for collective responsibility, to avoid possible personal failure. If the ultimate goal of the movement is not immediately achieved (e.g., climate change is not reversed), each individual can still feel efficacious about their own efforts, and their continued behavior in support of the cause. The collective efficacy created by the smaller successes achieved in the process of working as a group also reinforces persistent effort (16). In contrast, focusing only on individually defined goals (e.g., weight loss, daily physical activity, calorie restriction) without the larger context of collective goals, leaves individuals unprotected from failure and accompanying drops in perceived self-efficacy for their behavior change and maintenance. This may explain why participation in social and ideological movements, where successes can be more broadly defined (e.g., protesting international human rights abuses), may be more appealing than individual attempts to make social changes where successes and failures are more concretely defined (e.g., tutoring an underserved child).
Most social and ideological movements also tend to elicit emotional responses. The emotional aspects of social causes may additionally promote greater participation and increased motivation for behavior change. In contrast, health-related motivations for behavior change tend to lack the altruistic, societal, and/or value-laden emotional appeal characteristic of most social movements.
Finally, as illustrated in Table 1, social movements also have the potential to influence public policy to promote further change through the simultaneous actions of multiple societal sectors—family, government, markets and civil society. To the extent that social movements are successful, they can trigger community- and society-level changes that shift social and environmental norms and barriers to facilitate and reinforce additional individual-level behavior changes. This feedback loop can potentially sustain and magnify behavior change effects among participants. In addition, community- and society-level structural and policy changes can potentially influence the behaviors of wider populations, including those not participating in the movements.
The appeal of social and ideological movements to school children, college students, and young adults is another feature that may have particular usefulness for prevention. Participation may be even more motivating to young people because they are actively forming their own self-identity, collective-identity, and social-identity, and also perceive they will be impacted greater personally by problems such as climate change, globalization, energy insecurity, and most other social causes. This is beneficial because their behaviors at an earlier age are likely to produce a greater impact over their lifetimes and, as early adopters, young people are an appropriate group to trigger broader diffusion of new attitudes, norms, and participation throughout their communities (e.g., families, peer groups, community organizations, workplaces). For example, in our research we have found that it is often more effective to target children rather than parents when trying to influence the entire family's/household's behaviors (4).
In sum, social and ideological movements can produce dramatic and sustained changes in behavior, among individuals and across population subgroups. Almost by definition, existing social movement are highly motivating to their participants. Perhaps surprising, already there are many existing social movements, from across the ideological spectrum, with behavioral goals that overlap with the goals for obesity prevention and control. Piggybacking on these movements is a potential new strategy to prevent obesity. Emphasizing the eating and physical activity-related behaviors that are consistent with these movements and causes has the potential to produce widespread obesity prevention among participants. Appealing to additional populations, including those at risk of obesity, to engage in these social movements may help magnify the effects to include the broader public. In fact, promoting participation in these social movements may be a more effective way to prevent and control obesity, as a side effect, than targeting diet and physical activity changes directly. Because of the reasons noted above, individuals participating in social and ideological movements will likely make greater magnitude and more sustained changes than are typical in health-related interventions. This approach creates a large new set of allies, resources, and strategies for efforts to prevent obesity. It offers the possibility to prevent obesity, while saving the World.