Seventeen-year-old Salvatore weighs 170kg (26st 10lb) and can't tie his own shoelaces. His Vespa scooter's wheels have broken seven times in a single week from the strain. His mother Anna says simply, "He eats constantly." Salvatore is among a growing number of Italian children and teenagers living with obesity, a crisis so acute that in parts of the Campania region, over 40% of eight- and nine-year-olds are overweight. Ponticelli, near Naples, has earned the dubious honor of being one of the world's child obesity capitals.

This is a striking development for a country long considered 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). Dr. Sonja Chiappetta, who has spent 15 years treating severe obesity at Betania Hospital in Ponticelli, notes that her patients used to be 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." She performs surgery that removes up to 90% of the stomach, but Salvatore's weight is so excessive that the operation is too dangerous. Instead, he's been prescribed a GLP-1 weight-loss injection to reduce his appetite enough to qualify for surgery.

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 habits to remarkably low rates of heart disease. But as Dr. Valter Longo, director of the Longevity Institute at the University of Southern California, puts it, "The traditional Mediterranean diet has been lost. Only 10% of Italians really follow it." He now sums up the modern Italian diet with what he calls the "five Ps": pizza, pasta, potatoes, protein, and pane (bread). The transformation is visible from supermarket shelves stocked with ultra-processed foods to pizzerias selling slices piled high with chips, sausages, and fried snacks.

Dr. Roberto Berni Canani, a paediatrician and obesity specialist at the Federico II University in Naples, sees the consequences daily. "I've treated children who are just two or three years old and already weigh 25kg," he says. Most parents don't recognize their children are overweight. "They come to see me because of other problems - a cough, stomach pain, diarrhoea. They don't realise their child's weight is what's causing it." Ten-year-old Francesca weighs 60kg (9st 6lb) and has a persistent cough and trouble swallowing; her parents sought help for a suspected inflammatory condition, not her weight. She eats bread with Nutella for breakfast, a chocolate-filled sponge cake as a snack, pasta with lentils for lunch, and usually chicken for dinner. Her mother Carmen says, "But she doesn't eat vegetables. I put them in front of her, but she won't touch them." Dr. Berni Canani explains the problem is the overall pattern: small, calorie-dense foods throughout the day, sugary drinks, too few fruit and vegetables, and little understanding of how these habits accumulate.

Encouraging children to be more active is surprisingly difficult. Many schools are housed in beautiful old palazzi never designed for modern physical education. At the Ugo Foscolo primary school, the gym has barely enough space for a class to move around. Teacher Francesca Pecce says she has a 10-year-old pupil weighing around 60kg, but his mother isn't worried. "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.

A nutrition workshop run by the Valter Longo Foundation at a secondary school in Naples 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, with families receiving support to change eating habits at home. But 18-year-old Ciro doubts information alone will change behavior: "My classmates already know what's healthy. They just don't care." Another student notes that even traditional foods have changed: "When we go out for pizza, people don't just order a Margherita. They put chips, sausages and fried food on top."

In 2025, Italy became the first country to pass a national law recognizing obesity as a chronic, progressive, and relapsing disease - not merely the result of poor choices. The Campania region is testing this philosophy with 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 the following four days, so restrictive it resembles a fast. Dr. Longo says the goal is to trigger a "metabolic reset," but paediatrician Berni Canani worries the evidence is too limited and that restrictive diets could increase the risk of eating disorders, anorexia, and body dysmorphia in adolescents.

Meanwhile, Salvatore hopes to have surgery in the summer so he can wear a swimming costume without feeling self-conscious for the first time in years. But across Italy, a generation of children is growing up increasingly removed from the Mediterranean diet that once made the country famous - trading the four food groups for the five Ps.