Italy’s child obesity time-bomb

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1:26This whole area is suffering from an obesity crisis, with children here amongst the most overweight in Europe. What's gone wrong and can it be fixed?

1:41This is the Betania Hospital, a busy health facility in a suburb of Naples, the largest city in southern Italy. It's at the forefront of dealing with an obesity epidemic for Italian children.

1:59Salvatore is 16 and is here at the hospital with his mum, Anna. He's morbidly obese. That means, without change, his weight poses a significant risk to his health and life expectancy. I can't even sign him up for the gym because he's so obese. They don't want to take on the responsibility. Your son is not allowed to go to the gym. Why? He can't go to the gym because he weighs too much. Because they rightly say that he gets out of breath. Something could happen to him. Salvatore doesn't currently go to school or work. And as you just heard, he's effectively barred from his local gym. When he gets on his Vespa scooter, he's so heavy he breaks it time and again.

2:53How many times did the wheels break in a week? Seven times. Seven. He broke the motorcycle wheel in a week because he weighs so much. That's dangerous. Yes, it is. Those who are not living through it cannot understand it.

3:21Salvatore is under the care of Dr Sonia Chiappetta, an expert in the surgical treatment of obesity. She has been working with and operating on obese patients for 15 years. Salvatore and Ana are from Torre Annunziata, a suburb very close to the world-famous archaeological remains of Pompeii. Other patients come from Ponticelli, where the Betania Hospital is situated. Both places have many people on low incomes. Ponticelli itself has one of the highest child obesity rates in Europe. The surgery Dr Chiapetta carries out generally means removing up to 90 % of their stomachs if their health is at serious risk.

4:10And demand is increasing. World Health Organization figures show Italian children are the second most overweight in the EU and the joint third most obese. The patients are getting younger and normally the patient with obesity, with type 2 diabetes, hypertension, sleep apnea, This was a patient I saw around age of 50. Now I see these patients around age of 16, 17, 18, 20. This is the documentary from the BBC World Service. I'm Sophia Bettizer. In this edition of Assignment, I'm finding out why the children growing up in a country many associate with the legendary Mediterranean diet are becoming overweight and clinically obese in record numbers.

5:11And if anything is being done about it...

5:19His weight has always been excessive. When he was 12, he weighed 100 kilos. Overeating is normal for him. Salvatore is not this boy's real name. He didn't want to be recognised. His mother, Ana, who is a supermarket manager, was happy for us to use hers. Salvatore is waiting for an operation to reduce the size of his stomach. The problem is he's too obese to currently have it. He's here today so that Dr Chiapetta can give him a weight loss injection that will, hopefully, reduce his hunger and bring down his body mass to a level where it's safe for her to operate on him. Anna has two other children, and she says neither are overweight, let alone obese.

6:12Still, she says people blame her for Salvatore's condition, even though she says she's done her best for all three children. Do you ever feel judged as a parent? Sempre. Parents always point the finger, but I think that if you're not in this situation, you can't judge. You can't point the finger because it's easy to say it's your fault. But it's not like that.

6:45Being overweight or obese is generally classified around the world according to agreed criteria. Doctors calculate your BMI, or body mass index, by looking at your weight and height. For children, they also take into account your age and sex. It's not a perfect system. For example, BMI doesn't differentiate between muscle and fat, but it does give a broad indication of whether you are a healthy weight or not. But the reality is that the reasons people become obese is often more complicated. Dr. Chiappetta says those causes can sometimes be traced back to early childhood. In Italy, love is also connected to food.

7:34So when a child is crying, the first idea is to give something good to the child, is to give some sugar, you know, some chocolate or some food. They don't think about that there have to be a no or that there have to be a stop where too much love can also hurt. It's been like this for generations. My mother, her mother. So if this has been the case for decades, why is the problem getting worse now? Food has changed. And obviously, it's not that one year causes this. I think it's really the last 30, 40 years that changed. And now we see at the end the results. Dr. Chiapeta is very clear that blaming parents or their children for this obesity explosion is unfair and misunderstands the nature of obesity.

8:38It's not about that the children don't have discipline or the parents don't transmit discipline. It's about the disease obesity. When you have hunger, you can fight one time, the second time, but it's survival to eat. You can't control your body when you feel hunger. One of the biggest changes has been Italians eating processed and ultra-processed food. While traditional Italian foods like salami or certain cheeses have always fallen into this category, the food industry has come up with a host of others, especially as people are spending less time preparing meals, particularly in households where both parents work.

9:29It's a striking shift in the country that many associate with the so-called Mediterranean diet. A diet which seems to mean something slightly different to almost everyone I spoke to. And then there are the five P's. Food words which, in Italian at least, all begin with the letter P and are blamed for people gaining weight. The five Ps are pasta, pizza, pane, which is bread, potatoes and meat proteins. A lot of us will eat at least some, if not all of the five Ps every day. Health experts say it's not about abandoning them altogether, just trying to moderate your intake. But that's sometimes easier said than done.

10:27When it comes to food, even though I'm from Rome, I have not seen anywhere in the world quite like Naples. Temptations are everywhere. Every cafe has a little window opening onto the street filled with fresh pastries and pizza slices, often topped with chips and hot dogs. It's all the classics of Naples. Pasta omelettes, sugary coffee, rum cakes. What's new is imported fast food. Burgers from America, kebabs from Turkey. And it's cheap, really cheap. I'm holding the city's most popular street snack, pizza fritta. It's an entire pizza, deep fried in oil, and it cost me just a couple of euros. All of it is delicious, but probably not something you should eat every day if you want to stay healthy.

11:23This is the documentary from the BBC World Service.

11:51It's an account co-owned by you and your teen, so you can monitor and engage with the account while your teen learns how to invest and manage money. Learn more at schwab.com. I'm Sofia Bettizza on assignment in southern Italy. If there's a child obesity crisis in Italy, especially in the south, at what age are children starting to get seriously overweight? have come to a primary school in the old part of Naples, which is working hard to keep its children healthy. The Ugo Foscolop Primary School is located just off the main square of a beautiful piazza in old Naples. Today, the pupils are getting a little extra help from various members of the Walter Longo Foundation.

12:42Based in Los Angeles, it's involved in health campaigns in many different countries. and is working with schools across Naples and the surrounding Campania region.

13:00We've arrived just in time to hear the Viva la Pappa col Pomodoro song, a famous tune celebrating tomato and bread soup. It makes fun of poor school meals and suggests that hungry people eventually rebel.

13:22So we are in a classroom. The kids are about seven, eight-year-olds. They're all standing up and they're about to do some physical activity. They're wearing white t-shirts and blue jeans. So the kids are now doing jumping jacks. And you can hear the floor rumbling. There's a lot of enthusiasm here.

13:47Now the children are playing again. If something is true, they have to jump, and if something is false, they have to crouch to the floor.

13:58Eating well and exercising helps us grow up in a stronger, healthier way. Everyone's jumped. That was an easy one, wasn't it?

14:14So the children are being asked, yes or no answers. A chip's good for you, a fizz of drinks good for you. They all say the right thing, but what they do when they go home is a different question.

14:33The children seem to really enjoy this session. Leonardo, Nicolò, Sofia and Shainulia are going to give me their impressions. What did you think of the session today? It was interesting. Give me an example of something you've learned. There are so many plants I didn't know were there. Okay, so a lot of them are saying they didn't know that grains were a thing to eat, like orzo, so that's something new they learned. And at home, what do your parents feed you? Healthy stuff? A hamburger. How often do you eat pizza?

15:21We eat pizza every two months or every two weeks. It's a long time since I had pizza. I eat more pasta. I eat pizza only when I leave the house for dinner. and then I hardly ever eat pizza at home. And when you come to school, what do you bring for a snack? Bread and oil.

15:52Bread, oil and some apple. Breadsticks. Do you think kids your age eat healthily?

16:05Yes. Yes. That sounded to me like a rather qualified yes. Francesca Pizce teaches the students several subjects here, including English. I'm interested to hear about her experiences as a mum and how attitudes to food and healthy eating differ across Neapolitan generations. This is very important to be an example for the students because we have many, many children who like muffins and every kind of cakes and sweets and also teachers. In the morning, we have a break at 10. And what do the parents give them? It's a piece of cake which is called brioche and it's big, it's very big. Can children here do physical activities?

16:55In the centre of Naples, We have schools that are in old buildings without any gym, so we can't do a proper lesson of physical education. So all of your students at this school don't get any sports as part of their curriculum? We have only the fourth and fifth grade. They have two hours a week. Are you worried about your students? Yes, I have one student that I'm really worried about because I think he weighs maybe 60 kilos. He's 60 kilos. How old is he? He's 10. So I think it's really too much. And if I speak to his mother and I say, maybe you have to do something about it, she's not worried at all.

17:46Because in Neapolitan culture, if you're a little fat, if you're chubby, you're healthy.

17:55So that's younger children, but what about teenagers? Now I'm leaving Piazza del Gesù and I'm walking through the bustling streets of the old town to high school where the students are 13 to 19. It's schools like this that are particularly targeted by the Walter Longo project. They're going to be working with 25 schools over an extended period to help educate students about living a healthy lifestyle.

18:34So all the students have been asked whether they're ready for a little bit of light physical activity, and they all answered with a big, loud no. And they've just been asked to do some jumping checks. Most of them are kind of refusing to do them, but I think some of them are starting to get involved. Most of the time laughing. There's a round of applause for that one person that managed to get the jumping jacks correctly. As well as preventative education, in the coming months, the Valter Longo project and its partners will identify around 300 children aged 14 to 18 whom they believe would benefit from support to lose weight.

19:19They'll be invited to take part in a clinical trial in conjunction with doctors from the Britannia Hospital in Ponticelli which we heard from earlier One group will carry on eating and exercising as they were before A second group will follow a version of the Mediterranean diet one rich in vegetables, fruit and fish And the third group will periodically undertake a type of fasting for five consecutive days. It's called a fast-mimicking diet because it simulates or mimics some aspects of not eating at all. But I need to stress they will be allowed to eat. It's just not very much. On some days, they'll be limited to around 800 calories.

20:10I'm Romina Cervigni, I'm a nutritionist and chief scientific officer in Fondazione Valter Longo in Italy. During the first day there are around 1 ,100 kilocalories and from day 2 to 5 around 800, so it's a calorie restriction. I mean 800 calories for teenagers is very little. Yes, it is. We are speaking about people with obesity or overweight, but it is also important to point out that actually it's low calorie but it has the same level of micronutrients, so vitamins and minerals. They can choose whether follow it or not every month. So in those five days, what can you eat, for example? The composition of this fasting-mimicking diet is made, such as nuts, nut bars and olive oil, for example, but also vegetables in the form of soups and olives.

21:10Sounds like very little food to me. Chocolate also. No meat or fish. No, no, no. It's a vegan diet for these five days. But this composition has already been tested in a lot of people. There were also safety and feasibility studies. So we involve pediatricians, doctors, hospitals, other than nutritionists, of course, and also psychologists. We will include in the study only the adolescents who are overweight or obese and who don't have other clinical problems. So we will supervise them all the time. And of course, if they should have any problem, we will stop. The idea behind fasting is not just to lose weight over those five days, but to put your body in a much better condition when you resume your normal diet.

22:06So you're cleaning up your body during those five days, and not only the fasting is important, but also when you start to refeed again. When you start eating again, you are rebuilding. What do you think the parents would say? Yeah, we know that this is a challenge. So, of course, to participate to the study, the parents should agree. If they don't agree, the son or the daughter will not participate. Other medical experts in Naples are also working hard to combat obesity. I've travelled up into the hills of the city to a university founded 800 years ago and still going strong. I'm Roberto Bernicanane, I'm a full professor in pediatrics here at the University Federico II in Nepal, this is the oldest public university at the worldwide level.

22:58What kind of patients do you treat? The vast majority of these patients are affected by obesity or overweight. And how young are your patients? Two, three years. So you're seeing children who are two or three who are obese. Already affected by overweight or obesity. How much do these children weigh? A normal child, two, three years of age, the body weight would be around 10 kilos, but you can find that a child within, I don't know, 20 kilos, 25 kilos. Many children are unable to drink regular water. They are going to consume a Coca-Cola can, a Fanta can or a Gatorade. Obesity is under-recognized by the families and by the doctors.

23:39These parents who bring their children who are maybe 20 kilos and they are three years old, do they see it? They are unable to recognize. Why? I don't know. We need to explain the importance of the sleep, the time that you are spending with your device, the sport activity, the quality of your food. We cannot solve the problem limiting the caloric intake. Could there be psychological risks around food restriction at that age. I feel that limiting, proposing food restriction in teenagers or pre-adolescents and adolescents could be not super safe. So childhood obesity is a crisis in Italy. Do experts agree on how to solve it?

24:30We are interacting with the mother in the first trimester of pregnancy to better explain the importance of nutrition, the importance of the quality of the diet at the beginning of the first 1 ,000 days that are of fundamental importance in driving the health outcome of the children. Professor Roberto Benicanani tells me that parents are bringing their children to his clinic not because they recognise they're obese, but because they have other health conditions linked to obesity.

25:10Effectively, they're often in denial when their child is seriously overweight. A good example of this is this family who the professor's colleagues are assessing today. Mum, Carmen, dad, Massimo, and their daughter, Francesca, who's 10.