We have been living in Bologna for four months now, though Italy is certainly not new to my better half and me. We lived in Rome for three years back in 2010, returned for another year in 2018, and had several six-month stints in both Rome and Bologna in between. All in all, we have spent about five years living in this stunning country.
While we always ended up returning to the U.S. for work, I think this move to Italy will finally stick. I’m becoming more and more convinced of this because I’ve had to return to the States twice since arriving in January—once for work in Baltimore and once for my mother’s memorial in Asheville, NC. More on that later…
I mention all of this to bring you to the heart of this blog: food. Specifically, the regional specificity that makes Italy so interesting. Lately, I’ve been reflecting on America’s obesity epidemic. While GLP-1 drugs may change the landscape, I find myself wondering—particularly here in Bologna where the food is quite pesante (heavy)—why is there so much less obesity in Italy as compared to say, the United States? It is a perplexing question, and while I’m convinced that Italy remains a far healthier population, the reasons behind that are complex and changing.
Italy is not immune to the global obesity crisis. Adult prevalence of overweight and obesity stands at 49% and 17% respectively—notably lower than the United States (72% and 42%), though higher than France (34% and 10%). While Italy occupies a middle ground within the OECD, regional health outcomes vary significantly. A recent Lancet publication indicates that although diet-related non-communicable diseases affect the entire country, Northern regions enjoy higher life expectancy and better health outcomes than the South and the islands. This disparity, often termed the "mezzogiorno effect," suggests that the chronic economic underdevelopment and lower GDP of Southern Italy directly translate into poorer access to healthcare and greater challenges in managing complex chronic health conditions.
Italy sits at 46% overweight. This is quite low compared to the other OECD23 countries (with Japan and Korea being much lower)
Historically, the culinary landscape of Italy was divided by a sharp geographical line. The Southern regions (the Mezzogiorno) became the global blueprint for the Mediterranean Diet—a pattern popularized by American physiologist Ancel Keys after his landmark "Seven Countries Study" in the 1950s. This diet is characterized by a high intake of fresh vegetables, legumes, fruits, and whole grains, with olive oil serving as the primary fat source. It emphasizes seasonal ingredients, moderate fish consumption, and "slow" social dining, while keeping red meat and dairy to a minimum. In contrast, Northern Italy traditionally features a "heavier" continental diet. Influenced by its cooler climate and proximity to Central Europe, Northern cuisine relies more heavily on animal fats like butter and lard, and proteins such as pork and beef. Instead of the South’s dried durum wheat pasta, Northern staples often include rice (risotto), corn (polenta), and egg-based pastas—the latter once serving as a historical signifier of regional wealth and agricultural abundance.
The irony of modern Italy is that while the South "invented" the Mediterranean Diet, it is currently struggling the most to follow it. Fries on pizza are not within the realms of a Mediterranean diet… The decline of the Mediterranean Diet in the South is not a matter of forgotten culture, but of socioeconomic reality. Fresh produce and high-quality olive oil are increasingly expensive, leading lower-income families in the South to rely on cheaper, calorie-dense processed foods. This reinforces the "Mezzogiorno effect" discussed previously: the economic gap between the North and South doesn't just impact GDP—it dictates the very contents of the dinner plate and, consequently, the long-term health of the population.
Daily caloric supply per capita over time comparing the US, Italy and France
Given this context, why has Italy somewhat avoided the obesity surge seen in the United States? I believe a few distinct patterns could be considered. First is quantity. While the gap in daily intake—3,700 calories per capita in Italy versus 4,000 in America—might seem modest, the difference lies in portion sizes and snacking habits. As Tamar Haspel of the Washington Post argues, Italians generally eat smaller portions and snack far less frequently.
The second factor is quality. This is where the most striking differences emerge. Italians consume significantly fewer ultra-processed foods (UPFs) than Americans. According to 2025–2026 data, UPFs account for 20% to 23% of the Italian diet—a figure that has nearly doubled since 2005 but still pales in comparison to the 58% seen in the U.S. While junk food exists—like my personal favorite, cheesy Fonzies—it hasn't replaced the traditional, simple ingredients and dishes that Italians savor. Even after COVID, diet quality improved in Italy compared to the U.S. My experience in North Carolina (NC) recently was a stark contrast: portions were massive, and UPFs were available everywhere, at all hours. While BBQ may be the regional dish in NC, the state doesn’t really have a “cuisine.” The restaurant food felt heavy, laden with sugar, salt, and additives. It was simply too much.
A third factor is standards. In Italy, the "daily shop" is still very normal because fresh produce spoils quickly, suggesting a lack of the heavy preservatives found in American staples. Italy, governed by European Union law, follows the "precautionary principle," which restricts or bans hundreds of additives, synthetic dyes, and pesticides—such as potassium bromate and certain growth hormones—that are commonly used in the US food supply. While the US food system is heavily reliant on ultra-processed foods (UPFs) designed for long shelf-lives, Italian food culture is legally and culturally anchored in DOP (Protected Designation of Origin) standards that prioritize regional, minimally processed ingredients. This results in a stark contrast in ingredient labels; for example, traditional Italian bread typically consists of just four ingredients (flour, water, yeast, salt), while standard US supermarket bread often contains upwards of twenty, including emulsifiers and added sugars.
Kiosks to buy sandwiches in Bologna
Fourth is the ubiquity of food. In the U.S., food is sold everywhere—from hardware stores to bookstores. It is impossible to escape the constant temptation of mindless eating. In contrast, Italy maintains "proper" food environments. I could talk about the idea of slow eating — meals are often seen as a relaxed social experience — but I am not sure the evidence on how that relates to obesity. However, fast-food restaurants are hard to find in most cities, and major global chains (like Pret A Manger, Shake Shack, Chipotle, etc.) have a much smaller footprint, if any. After all, here is where Slow Food was invented. You won’t find a Starbucks on every block selling oversized, sugary caffeinated drinks. Don’t get me wrong, Italians put sugar in their coffee, but it is minuscule in comparison. When "grab-and-go" options do exist, they usually take the form of small, local sandwich shops; in Bologna, for instance, you’ll find piadinerie serving traditional flatbreads.
Fifth is the food environment itself. Italians have the luxury of choice: they can visit a supermarket, but they often prefer the plethora of local farmers' markets, which are frequently as affordable as the big stores. Many still visit the local butcher, cheesemonger, or bakery daily. This reflects a deep cultural respect for the origin of food and a devotion to regional cuisine. When I was in Baltimore recently, I noticed the stark difference: you can’t really find the same connection to fresh, specialized markets, with some neighborhoods suffering from food apartheid.
Sixth, we have to talk about pasta. While it’s often lumped into the "unhealthy refined carb" category alongside white bread and sugary snacks, a recent paper in The Journal of Nutrition argues that pasta is actually the victim of a major nutritional misunderstanding. The researchers highlight that the unique protein-starch matrix of durum wheat semolina—especially when cooked al dente—slows down digestion, giving pasta a surprisingly low Glycemic Index compared to other processed grains. Extensive clinical and population-based evidence shows that pasta consumption isn’t linked to weight gain or heart disease; in fact, when paired with the vegetables and healthy fats of a Mediterranean-style diet, it’s a powerhouse for long-term health. Italians would be pleased because they do eat a lot of pasta!
And last, there is the culture of walking. Italians have a deep-seated love for traversing their cities and towns on foot. Interestingly, while Italians may not engage in as much formal "exercise" as their northern European neighbors, they maintain a consistent level of activity through la passeggiata. This cherished, centuries-old tradition of the nightly post-dinner stroll is more of a vital social ritual than a workout. It allows families and friends to connect, enjoy the fresh air, and socialize with neighbors in the heart of the town center.
In summary, while lifestyle factors like "walking more" are often cited, the data suggest that the single most significant factor in Italy’s lower obesity rates compared to the U.S. is the dramatic difference in ultra-processed food (UPF) consumption. While the average American derives over 50% of their daily calories from industrially manufactured UPFs, Italians average closer to 10–18%, relying instead on the minimally processed staples of a traditional Italian (not Mediterranean) diet. This disparity suggests that the U.S. obesity epidemic is more about a food environment saturated with hyperpalatable, nutritionally void products that systematically override satiety signals—a metabolic hurdle that Italian food culture largely avoids by prioritizing whole ingredients.