A Social–Ecological Model of Influences on pediatric obesity. Levels of environmental influence begin with the family environment and extend to larger spheres of influence and include peers, neighborhoods, schools, community, and national factors. Examples of influences within each of these spheres are also given. For example, neighborhood environment may influence children’s activity if there are no sidewalks or if safe areas for play are not available. (Figure courtesy of Denise E Wilfley, PhD, St. Louis, MO; adapted with permission.)