I’ve often heard Europeans express shock over the gargantuan portions American restaurants dish out.

Which is why, on a recent holiday with my boyfriend, I was surprised to find the waiters at everything from small, family-run pizzerias to gourmet restaurants in Puglia (the heel of Italy’s boot) piling our table with plates and servings exceeding American proportions.

Breakfast for two at our modest seaside beach apartment featured a basket of croissants and bread, plates of salami and cheese, yogurts, and platters of fruits, jams, butter, and nuts — enough to hold us over for an entire day!

One night in a wood-paneled trattoria near Ostuni, a gleaming white city that rises out of Puglia’s olive groves, we ordered the house appetizer. Seventeen small dishes arrived filled with battered and fried vegetables, raw and fried cheeses, oily frittatas, salamis, crackers, and breads. There were so many plates, in fact, that the servers brought a side table to accommodate them.

Then came the primi (first course, often pasta) and secondi (second course, usually fish or meat), followed by dolci (dessert, often gelato). In the gelaterias, I noticed something new: Servers were now offering to dip the cones in chocolate, in addition to the usual offering of whipped cream topping (gelato con panna).





"The Italians are eating a lot, all the time!" my boyfriend, who’s from Germany, would exclaim as we watched many courses fly by the tables around us in what became a mini study of contemporary Italian eating habits.

We love food, and went to Italy this summer with dreams of handmade pastas, juicy produce, and fresh fish. Instead, we were surprised to find scant vegetables and too many fried, meat- and sugar-filled dishes.



We've both lived in Italy in the past, and traveled through most of the country before, but something seemed to be different this time. This recent immersion in the mythical Mediterranean diet in Southern Italy got us wondering about the country’s changing eating habits and their impacts on public health. And then I started poking around. Here are three things I learned.

1) Italy’s childhood overweight and obesity rates are among the highest in the world

While there’s no one Mediterranean diet, the typical dietary pattern in Southern Italy has long been celebrated as one of the healthiest in the world, with high consumption of fruits, vegetables, legumes, lean protein (particularly fish), and olive oil, and low consumption of red meat and sugar.

But after eating so many voluminous meals and watching Italians gobble up ice cream at the gelaterias in every town we visited, it was harder and harder to comprehend how they could maintain their slim physiques.

It turns out they’re not: Obesity has increased dramatically in recent years among young Italians. According to the European Association for the Study of Obesity, the adult obesity rate is among the lowest in Europe (about 10 percent of the population), but childhood overweight and obesity rates are among the highest in the world.

You can see how Italy stands out on this 2014 chart from the OECD, showing the overweight prevalence (including obesity) in boys under age 18. Italy is second in the world only to Greece:

Italian girls are in about the same situation: 34 percent are overweight or obese.

Take note — the United States is actually behind Italy when it comes to overweight children. And the reason for Italy’s rise in childhood obesity, researchers say, has to do with food.

2) There are growing concerns about the quality of the Italian diet

Most Italians today don’t actually follow a "Mediterranean diet." In a 2015 study of more than 5,000 Italians’ eating habits, fewer than half (43 percent) said they ate Mediterranean-style. The rest were following either a diet that was low in fruit and vegetables or a "Western-like" diet, which included more red meat and dairy products like butter instead of olive oil.

Zachary Nowak, a PhD candidate at Harvard University and associate director for the Food & Sustainability Studies Program at the Umbra Institute in Central Italy, says he’s seen some unhealthy changes in recent years. In his 14 years shuttling back and forth between Perugia and the United States to do research, he said he’s observed a trend toward larger portions and more refined carbs like bread, pasta, and sugar, instead of more fruits and vegetables or lean meats and fish.

"Italy has been in a deep recession for way longer than 2009," Nowak said. Pasta and sugar are cheaper than fish and vegetables, so he thinks Italians are relying more on the former for their calories.

A report by the UN’s Food and Agriculture Organization came to a similar conclusion, finding Mediterranean people "have shunned the Med Diet." Between the 1960s and early 2000s, the daily calorie intake in Italy increased by 30 percent. And many of those calories, according to the report, are coming from foods that are "too fat, too salty and too sweet."

Angelo Pietrobelli, a professor of pediatric nutrition at the Verona University Medical School, also lamented that Italy is grappling with the incursion of the Western diet: more sugary, refined foods, especially soda. Sounding very much like an American health official, he explained in an email that public health in Italy is working to introduce more produce in schools, and remove vending machines.

Other outsiders have noticed the changes. In an excerpt in Slate from her book The Lost Art of Feeding Kids, author Jeannie Marshall points out that junk food companies like Coca-Cola have been heavily marketing soft drinks to Italians — and making headway. Italians now drink more than 8 gallons (per capita) of soft drinks per year. That’s small compared with the US, which has the highest consumption rate in the world at about 30 gallons, but it’s still a big change. (As Marshall writes of a dinner in Rome, "I was surprised when the waiter asked my 6-year-old son, Nico, if he wanted a Coca-Cola with his pizza.")

3) There’s no good data on changing portion sizes — but there are clear signs of a problem

I could not find any good data on how portion sizes in particular have changed in Italy over the years beyond anecdotes and research that suggests calorie consumption has gone up.

But I did find other evidence that Italians’ plates may be overflowing with food.

Italian legislators recently passed a law to reduce food waste, which included money for rebranding and destigmatizing the doggy bag in restaurants. The goal: to get people to bring food home in order to eat it later instead of throwing it away (or perhaps overeating). Meanwhile, the Italian celebrity chef Massimo Bottura is leading another food waste initiative to educate and feed refugees, the homeless, and the working poor.

All this suggests there’s a lot of extra food being prepared. Sometimes it’s going to waste. Sometimes people are eating too much. Either way, at least Italians are starting to address the problem.

In a global context, Italy is still in okay shape. As this chart shows, the country’s obesity rate looks favorable compared with that of countries like Australia, Canada, and the US.

But if Italians want to prevent that red line from going up, they’ll need to do something about what — and how much — they feed their bambini (children).

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