stanford medicine



Stealth healthTapping into the healing power of social movements

Thomas Robinson isn’t a prophet, but he might be more successful if people thought of him that way.

The gospel that Robinson, MD, MPH, preaches is a familiar one: Exercise and eat healthy food. But, like most of the researchers in his field, Robinson knows that he’s frequently crying in the wilderness.

For decades, physicians and health professionals have urged people to do what’s good for them, but their efforts meet with limited success. After all, we know that broccoli is better for us than french fries, but few of us are likely to order veggies with our next meal.

Leif Parsons
William Kuo

As a professor of pediatrics and of medicine at the School of Medicine, Robinson has given a lot of thought over the last 20 years to the reasons people do — and don’t — change their behaviors. If they won’t eat better to improve their own health, he wondered, what other reason might inspire them?

One example stood out: religion.

“Religious conversion is something that prompts dramatic changes that are sustained over time,” Robinson says. “I’ve always joked that, if it were ethical, I’d propose that we start a religion.”

So what’s another force that inspires change? Social movements. Robinson observed that many people will make large, sustained changes in their lives if they believe it serves a greater good. “A commitment to a larger belief system seems to be more compelling than personal health reasons for changing behavior,” he says.

And so he began exploring social movements that also could prompt healthy behavior changes. One good example he found was environmentalism: You can reduce your carbon footprint by eating more locally grown fruits and vegetables and cutting back on meat and processed foods. While your primary motivation in making these changes may be to help the environment, you’ll end up with a more nutritious diet.

That’s how he came to the idea he dubbed “stealth interventions” because they address the deeper needs and desires of the participants, their intrinsic motivators, while improving health as a side effect.

He put the stealth strategy to the test by evaluating the eating behaviors of Stanford undergraduates who enrolled last year in the Food and Society course he helped develop. The course focused on food-related social and environmental issues, but not on the health aspects of food and eating. Students viewed documentaries, read sections from books such as the The Omnivore’s Dilemma and created brief videos on relevant topics. For comparison, Robinson’s team tracked undergrads enrolled in three health-related courses the same quarter.

At the beginning and end of the quarter, students in all four classes were surveyed about their eating habits. The results showed that students in the Food and Society course were eating more vegetables and fewer high-fat dairy products, high-fat meats and sweets than they were at the beginning. The comparison students reported no improvement in dietary habits. The findings were published in the May issue of the American Journal of Preventive Medicine.

Robinson is employing similar stealth approaches to boost exercise among children and adolescents, such as encouraging them to help the environment by walking and biking to school rather than being driven in a car.

“This approach looks very promising,” he says.

Can he get an amen?

— Susan Ipaktchian






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