Pizza, pasta, potatoes, protein – how Italian children became so overweight
Daily life is not easy for Salvatore. He is 17 years old, weighs 170 kg (26st 10 lb) and has difficulty walking.
Unable to tie his own shoelaces and unable to support his weight, the wheels of his Vespa scooter broke seven times in a week.
“He’s always eating,” says his mother, Anna.
Salvatore is among a growing number of Italian children and teenagers living with obesity. The problem is particularly acute in the south: in parts of the Campania region, more than 40% of eight- and nine-year-olds are overweight. The town of Ponticelli on the outskirts of Naples has gained an enviable reputation as one of the child obesity capitals of the world.
This is a striking development in a country long considered the spiritual home of the Mediterranean diet. However, according to the World Health Organization (WHO), Italian children today are among the most overweight children in Europe.
Salvatore, Dr. Sonja Chiappetta awaits a life-changing surgery at the Betania Hospital in Ponticelli, where she has treated patients with severe obesity for 15 years.
Until recently, he says, most of his patients were in their fifties. “Now I see the same patients as teenagers, even as young as 16. They’re getting younger, and it’s scary.”
In his surgery, up to 90% of the stomach is removed; This means people cannot eat large amounts of food. Demand has increased sharply in this region of Italy.
However, Salvatore was told that he could not perform the surgery. Its weight is so great that it makes surgery very dangerous.
Instead Dr Chiappetta prescribed him a GLP-1 weight loss injection to reduce his appetite and help him lose enough weight for surgery.
Italy has long been considered the spiritual home of the Mediterranean diet [Getty Images]
For decades, Italy has been held up as a model of healthy eating.
The Mediterranean diet, rich in vegetables, legumes, olive oil, whole grains and fish, became famous when US physiologist Ancel Keys and his wife, biochemist Margaret Keys, studied communities in southern Italy in the 1950s and linked the habits to extremely low rates of heart disease.
His research transformed a regional diet into one of the world’s best-known diets; A plan for healthy living.
However, Italy, which inspired these works, no longer exists.
“The traditional Mediterranean diet has disappeared,” says Valter Longo, MD, director of the Longevity Institute at the University of Southern California. “Only 10% of Italians actually follow it.”
Dr Longo sums up the modern Italian diet with what he calls the “five Ps”: pizza, pasta, potatoes, protein and paneer – the Italian word for bread.
Ultra-processed snacks fill the shelves of a food stall in Naples [BBC]
The transformation is visible everywhere: from supermarket shelves full of ultra-processed foods to pizzerias selling slices filled with chips, sausages and fried snacks.
Roberto Berni Canani, MD, a pediatrician and obesity specialist at the Federico II University in Naples, sees the results every day.
“I have treated children who were only two or three years old and already weighed 25 kg,” he says.
She says most parents don’t realize their child is overweight. “They come to see me for other problems like cough, stomach ache, diarrhea. They don’t understand that their child’s weight is causing it.”
Ten-year-old Francesca has a persistent cough and difficulty swallowing. Doctors suspect an inflammatory condition of the esophagus.
Weighs 60 kg (9.6 lb); But that’s not why their parents sought medical help.
Francesca says she eats Nutella bread for breakfast, chocolate-filled sponge cake as a snack, lentil pasta for lunch, and usually chicken for dinner.
“But he doesn’t eat vegetables,” his mother Carmen interjects. “I put them in front of him, but he won’t touch them.”
Francesca’s family insists she is active. She does artistic gymnastics and Latin dance and does not get tired. They never saw his weight as a problem.
10-year-old Francesca weighs 60 kilos, but her family says they never saw her weight as a problem [BBC]
Dr Berni Canani comes to a different conclusion.
The problem, he explains, is the overall pattern rather than a single meal. Small, calorie-dense foods consumed throughout the day, sugary drinks, too few fruits and vegetables, and little understanding of how these habits accumulate over time.
“That’s a very good mother,” he says. “He’s a very good father. They don’t realize the importance of diet quality and body weight.”
By the time many families come to her clinic, unhealthy habits are already ingrained. They start at home and are reinforced at school.
In Italy, encouraging children to be more active can be surprisingly difficult.
Many schools are located in beautiful old palazzi; these were never designed with modern physical education in mind.
By the time families arrive at his clinic, unhealthy habits are already ingrained, says Dr Roberto Berni Canani [BBC]
Ugo Foscolo primary school is no exception. There isn’t enough space in the gym for a class of kids to move around.
“I have one student in particular that I’m worried about,” says Francesca Pecce, who teaches at the school. “He is 10 years old and weighs about 60 pounds.”
He tried to share the problem with his mother.
“But he’s not worried,” Pecce says. “In Neapolitan culture, if a child is a little chubby and rosy-cheeked, people generally think he is healthy.”
He believes schools can help change this, especially if children “take home” lessons about healthy eating.
“Sometimes it is easier to educate parents through their children than the other way around.”
At a middle school in Naples, students file into the classroom for a nutrition workshop run by the Valter Longo Foundation.
The program is part of a regional initiative to combat childhood obesity. More than 17,000 students from 25 schools will participate in the coming months. Families will receive support to help change eating habits at home.
But not all students are convinced.
More than 17,000 students in 25 schools will participate in the initiative to combat childhood obesity [BBC]
Eighteen-year-old Ciro doubts that knowledge alone will change behavior.
“My classmates already know what’s healthy,” she says. “They just don’t care.”
Carmen, 19, is more optimistic.
“I thought it was really helpful because young people today are really into junk food and they don’t get that much exercise.”
The problem, he says, is that temptation is everywhere. Even foods traditionally associated with Italy have changed.
“When we go out for pizza, people don’t just order Margheritas. They put chips, sausages and fried foods on top.”
Add to that the age-old clichés of Italian mothers and grandmothers showing their love through food, and a perfect storm emerges.
More than 17,000 students in 25 schools will participate in nutrition workshops [BBC]
The World Health Organization says obesity is a “growing global epidemic.” More than a billion people worldwide are now obese, and childhood obesity has quadrupled since 1990.
In 2025, Italy became the first country to pass national legislation recognizing obesity as a chronic, progressive and relapsing disease.
Rather than treating obesity solely as the result of bad choices, the country’s new law recognizes it as a chronic disease influenced by biology, environment and social conditions.
The Campania region became a testing ground for putting this philosophy into practice and implementing a series of ambitious interventions; including a controversial “flash diet” trial.
Researchers recruit 300 overweight adolescents who will spend five days each three months on a controlled diet of 1,100 calories on day one and 770 calories on the next four days; This diet is so restrictive it’s like fasting.
The goal is to trigger a “metabolic reset.”
Dr. has spent thirty years studying the effects of fasting. “Fasting, or controlled food deprivation, is linked to a longer, healthier lifespan,” says Longo.
But not all obesity experts are convinced that fasting is the right approach for children.
Pediatrician Berni Canani believes the evidence for fasting-mimicking diets in children is still too limited to be recommended in Italy’s clinical guidelines.
He also worries that restrictive diets may carry psychological risks for adolescents whose relationships with food are still developing.
“I fear that restricting food to young people could increase the risk of eating disorders, anorexia and body dysmorphia,” she says.
Meanwhile, Salvatore hopes to have surgery in the summer so he can wear a swimsuit without embarrassing himself for the first time in years.
But he is not alone. Across Italy, a generation of children is growing up increasingly alienated from the Mediterranean diet that once made the country famous.
Additional reporting by Bob Howard.
