Salvatore, 17, cannot tie his own shoelaces. He weighs 170kg (26st 10lb) and his Vespa scooter strains under his weight – in one week, its wheels broke seven times. "He eats constantly," his mother Anna says.
He is among a growing number of Italian children and teenagers living with obesity, a crisis that has turned the town of Ponticelli near Naples into one of the world's child obesity capitals. In parts of the Campania region, more than 40% of eight and nine-year-olds are overweight, according to the World Health Organization (WHO).
“Italian children among most overweight in Europe as 17-year-old weighing 170kg waits for surgery in Ponticelli”
It is a striking development in a country long regarded as the spiritual home of the Mediterranean diet – the diet based on vegetables, legumes, olive oil, whole grains and fish that US physiologist Ancel Keys and his wife biochemist Margaret Keys linked to low heart disease rates in 1950s southern Italy. But that Italy 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 as the "five Ps": pizza, pasta, potatoes, protein and pane (bread).
Salvatore is waiting for life-changing surgery at the Betania Hospital in Ponticelli, where Dr Sonja Chiappetta has spent 15 years treating severe obesity. She removes up to 90% of the stomach, but Salvatore is too heavy for the operation. Instead, Dr Chiappetta has prescribed him a GLP-1 weight-loss injection to reduce his appetite and help him lose enough weight. "Now I see those same patients when they're teenagers, as young as 16," she says. "They are getting younger, and it's frightening."
The demand for such surgery has risen sharply in this part of Italy, but for Salvatore, the operation remains out of reach until he can lose enough weight.