Pizza, pasta, potatoes, protein - how Italian children became so overweight

Daily life is not easy for Salvatore. At 17, he weighs 170kg (26st 10lb) and struggles to walk.He can't tie his own shoelaces and his Vespa scooter strains to bear his weight - in one week, its wheels broke seven times. "He eats constantly," 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 earned the unenviable reputation as one of the world's child obesity capitals. It is a striking development in a country long regarded as the spiritual home of the Mediterranean diet. Yet today, Italian children are among the most overweight in Europe, according to the World Health Organization (WHO).Salvatore is waiting for life-changing surgery at the Betania Hospital in Ponticelli, where Dr Sonja Chiappetta has spent 15 years treating patients with severe obesity.Until recently, she says, most of her patients were in their fifties. "Now I see those same patients when they're teenagers, as young as 16. They are getting younger, and it's frightening." The surgery she carries out removes up to 90% of the stomach - meaning people are unable to eat large quantities of food. Demand has risen sharply in this part of Italy. But Salvatore has been told he cannot get the operation. His weight is so excessive it makes the surgery too dangerous.Instead, Dr Chiappetta has prescribed him a GLP-1 weight-loss injection to reduce his appetite and help him lose enough weight for the operation.The Ugo Foscolo primary school is no exception. Its gym has barely enough space for a class of children to move around."I have one pupil I'm particularly concerned about," says Francesca Pecce, who teaches at the school. "He's 10 years old and weighs around 60 kilograms."She has tried raising the issue with his mother."But she is not worried," Pecce says. "In Neapolitan culture, if a child is a little chubby with rosy cheeks, people often think they're healthy."Schools, she believes, can help change that, especially if children "take home" lessons about healthy eating."Sometimes it's easier to educate the parents through their children than the other way round."At a secondary school in Naples, students file into a classroom for a nutrition workshop run by the Valter Longo Foundation.The programme is part of a regional initiative to tackle childhood obesity. Over the coming months, more than 17,000 students across 25 schools will take part. Families will receive support to help change eating habits at home.But not all of the students are convinced.Obesity is an "escalating global epidemic", says the WHO. More than one billion people worldwide are now obese, and childhood obesity has quadrupled since 1990.In 2025, Italy became the first country to pass a national law recognising obesity as a chronic, progressive and relapsing disease.Rather than treating obesity simply as the result of poor choices, the country's new law recognises it as a chronic disease influenced by biology, environment and social circumstances.The Campania region has become a testing ground for putting that philosophy into practice, implementing a series of ambitious interventions - including a controversial trial of a "fast-mimicking diet".Researchers are recruiting 300 overweight adolescents who will spend five days every three months on a controlled diet of 1,100 calories on day one and 770 calories on following four days - so restrictive it resembles a fast.The goal is to trigger a "metabolic reset"."Fasting, or controlled deprivation of food, is linked to a longer and healthier lifespan," says Dr Longo, who has spent three decades studying the effects of fasting. But not all obesity specialists are persuaded that fasting is the right approach for children.Paediatrician 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 restrictive diets could carry psychological risks for adolescents, whose relationship with food is still developing."I fear that imposing food restrictions on teenagers could increase the risk of eating disorders, anorexia and body dysmorphia," he says.Meanwhile, Salvatore hopes to have surgery in the summer, so that, for the first time in years, he can wear a swimming costume without feeling self-conscious.But he is not alone. Across Italy, a generation of children is growing up increasingly removed from the Mediterranean diet that once made the country famous.Additional reporting by Bob Howard.