Salvatore's Vespa scooter broke seven times in a single week, its wheels unable to bear his 170kg frame. At 17, he cannot tie his own shoelaces and struggles to walk. 'He eats constantly,' says his mother Anna.
Salvatore is among a growing number of Italian children and teenagers living with obesity, a phenomenon that has made Italy — once the spiritual home of the Mediterranean diet — home to some of the most overweight children in Europe, according to the World Health Organization.
“Italian children among most overweight in Europe as Mediterranean diet fades, WHO warns”
The problem is most 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 at the Betania Hospital in Ponticelli that Salvatore is waiting for life-changing surgery. Dr Sonja Chiappetta, who has spent 15 years treating severe obesity there, has seen her patients get dramatically younger. 'Now I see those same patients when they're teenagers, as young as 16. They are getting younger, and it's frightening,' she says.
The operation she performs removes up to 90% of the stomach, making it impossible to eat large quantities. Demand has skyrocketed. But Salvatore has been told he cannot get it: his weight is so excessive that the surgery is too dangerous. Instead, Dr Chiappetta has prescribed him a GLP-1 weight-loss injection to reduce his appetite and help him shed enough weight for the operation.
How did Italy, long held up as a model of healthy eating, reach this point? The Mediterranean diet — rich in vegetables, legumes, olive oil, whole grains and fish — became famous after US physiologist Ancel Keys and his wife, biochemist Margaret Keys, studied communities in southern Italy in the 1950s and linked their eating habits to remarkably low rates of heart disease. That research transformed a regional way of eating into a global blueprint for healthy living.
But the Italy that inspired those studies no longer exists. 'The traditional Mediterranean diet has been lost,' says Dr Valter Longo, director of the Longevity Institute at the University of Southern California. 'Only 10% of Italians really follow it.' He sums up the modern Italian diet with what he calls the 'five Ps': pizza, pasta, potatoes, protein and pane — the Italian word for bread.
For Salvatore, the wait for surgery continues. The injection may offer a path forward, but the deeper problem — the erosion of a diet that once defined Italian health — shows no sign of reversing.