Italy, long celebrated as the birthplace of the Mediterranean diet, is facing a growing childhood obesity crisis that health experts say reflects major changes in eating habits, lifestyles and public awareness.
In parts of southern Italy, particularly the Campania region, more than 40% of children aged eight and nine are overweight, according to health authorities. The Naples suburb of Ponticelli has become one of the country's most visible examples of the problem.
Among those affected is Salvatore, a teenager living with severe obesity. His mother, Anna, says he struggles with everyday activities and eats almost constantly. He is being treated at Betania Hospital in Ponticelli, where doctors specialise in treating severe obesity.
Salvatore had hoped to undergo bariatric surgery, a procedure that significantly reduces stomach size to help patients lose weight. However, doctors determined that his current weight makes the operation too risky. Instead, he has begun treatment with a GLP-1 weight-loss medication designed to reduce appetite and help him lose enough weight to become eligible for surgery.
Patients Are Getting Younger
Dr Sonja Chiappetta, who has treated obesity patients for 15 years, says the profile of those seeking treatment has changed dramatically.
Years ago, most patients requiring bariatric surgery were middle-aged adults. Today, she says, teenagers as young as 16 are presenting with similar levels of severe obesity.
The trend reflects broader changes in Italy's food culture.
From Mediterranean Diet to Processed Foods
For decades, Italy's traditional Mediterranean diet—rich in vegetables, legumes, olive oil, whole grains and fish—was considered one of the healthiest dietary patterns in the world. Research conducted in southern Italy during the 1950s helped establish its reputation for reducing cardiovascular disease risk.
Health experts say that dietary patterns have gradually changed.
Dr Valter Longo, director of the Longevity Institute at the University of Southern California, estimates that only a small share of Italians still consistently follow the traditional Mediterranean diet.
He describes today's eating habits with what he calls the "five Ps": pizza, pasta, potatoes, protein and pane (bread).
Supermarkets now stock more ultra-processed foods, while restaurants increasingly offer calorie-dense versions of traditional dishes topped with fried ingredients and processed meats.
Parents Often Miss the Warning Signs
Dr Roberto Berni Canani, a paediatric obesity specialist at Federico II University in Naples, says many parents seek medical care for unrelated symptoms without realising excess weight may be contributing to their children's health problems.
He regularly treats very young children with obesity and says families often underestimate the long-term health risks.
One of his patients, 10-year-old Francesca, weighs about 60 kilograms (132 pounds). Although she participates in gymnastics and Latin dance, her daily diet includes frequent refined carbohydrates and sugary foods while lacking vegetables.
According to Dr Berni Canani, the issue is not necessarily a single meal but an overall pattern of calorie-dense foods, sugary drinks and insufficient fruit and vegetable intake.
He emphasises that most parents care deeply about their children, but they often lack awareness of nutrition and healthy body weight.
Schools Face Cultural and Structural Challenges
Schools are increasingly being asked to support healthier lifestyles, but many face practical limitations.
Some older school buildings have limited indoor space for physical education, making regular exercise difficult.
Teachers also describe cultural attitudes that can delay intervention. Francesca Pecce, a primary school teacher in Naples, says some families still associate a heavier child with good health rather than recognising obesity as a medical concern.
She believes schools can play an important role by educating children, who may then encourage healthier habits at home.
Education and New Treatment Strategies
Campania has launched several initiatives aimed at reducing childhood obesity, including nutrition education programmes that are expected to reach more than 17,000 students across 25 schools.
Student reactions are mixed. Some believe young people already understand healthy eating but struggle to change their habits, while others say nutrition education can encourage better decisions.
Italy has also introduced broader policy changes.
In 2025, the country became the first to legally recognise obesity as a chronic, progressive and relapsing disease. The legislation acknowledges that personal behaviour, biological, environmental and social factors all influence obesity.
Debate Over Fasting-Based Treatments
Researchers in Campania are also studying a fasting-mimicking diet for overweight adolescents.
The clinical trial will enrol 300 participants who will follow a highly calorie-restricted diet for five days every three months. Researchers hope the approach will improve metabolic health.
However, the strategy remains controversial.
Dr Longo argues that controlled fasting may offer long-term health benefits, but Dr Berni Canani says evidence supporting fasting-mimicking diets in children remains limited.
He also warns that restrictive eating plans during adolescence could increase the risk of eating disorders and body image problems.
A Growing Public Health Challenge
The World Health Organization describes obesity as one of the world's fastest-growing public health challenges, with more than one billion people living with obesity worldwide and childhood obesity increasing sharply over recent decades.
For families like Salvatore's, treatment represents hope for a healthier future. More broadly, Italy's experience illustrates how changing diets, cultural attitudes and modern lifestyles have reshaped childhood health in a country once synonymous with healthy eating.
