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As processed snacks and fast food replace traditional diets in Italy and elsewhere in Europe, obesity is soaring. Some say 'Americanization' of eating threatens their culture.ORVIETO, Italy
Every day, rain or shine, Luisa Bornia and her family gather from all corners of this ancient hilltop town for pranzo, the traditional midday Italian meal. Over homemade pasta, vegetables and wine, they hash out the latest issues, then leisurely chat while peeling apples and peaches for dessert.
McDonald's, potato chips, packaged food or da portare via (takeout) is not for them.
''TV dinner? No way. We don't even own a microwave,'' says Bornia's lanky 19-year-old daughter Elisa.
But if the ages-old Mediterranean diet is still the staple in Bornia's household, it is clearly disappearing from plates elsewhere in Italy. Long touted for its health benefits by doctors the world over, the classic regimen of fresh fish, fruits and vegetables, pasta and olive oil is losing out to American-style eating habits. The result: rapidly increasing levels of American-style obesity.
''American fashions always arrive here 10 years later, and now this fashion is arriving,'' says Amleto D'Amicis, a leading government nutritionist who helped write the latest report on obesity in Italy. Among the findings: 25% of Italian children are now overweight or obese, making them the heaviest in Europe.
Of children ages 6 through 10, 36% are overweight, the Italian Ministry of Health reported last month.
And it's not just here. Throughout Europe, the scales are bouncing upward. In many countries, more than half of adults are now overweight and up to 30% obese.
In Britain, 21% of men and nearly 24% of women are now considered obese, a threefold increase in 20 years, according to the International Obesity Task Force, a London-based consumer group that collaborates with the World Health Organization. This month, the task force warned that without urgent action, obesity levels in Britain will soar 40% or more within a single generation. A 2001 study showed over 11% of adults in Finland were obese.
While the extreme obesity so often associated with America is still rare in Europe, experts say it is a factor, too. Among men in Britain, for example, such morbid obesity has tripled in just the past six years.
In the United States, 65% of adults are either overweight or obese, and 31% qualify as obese; 6.3% of women and 3.1% of men are morbidly obese, according to the Centers for Disease Control and Prevention. The problem is not limited to Western countries. There are surprisingly high levels of obesity in the Middle East; 40% of women in Kuwait, for example, are considered obese. Obesity is defined in terms of body mass index, a formula that divides weight by height. A body mass index of 30 or higher qualifies as obese; above 40 a person is considered morbidly obese.
''The way people live now, there's a cornucopia of calories at every turn,'' says Neville Rigby, spokesman for the international task force.
Doctors propose 'fat tax'
Some European countries are so fearful of the medical consequences and long-term costs of obesity that they are suggesting legal or political action. Sweden already has negotiated voluntary restrictions on TV advertising for soft drinks, snacks and junk food aimed at children (although satellite broadcasting still bombards them with ads). Early this month, Debra Shipley, a British member of Parliament, introduced a bill to ban the advertising of foods containing high levels of sugar, fat and salt during preschool TV programs. And just last week, the British medical journal Lancet came out with a tough editorial calling for celebrities to be prohibited from endorsing junk food. The British Medical Association already has called for a 17.5% ''fat tax'' on junk foods.
Doctors in Italy are calling for similar action. Italy's health minister, Girolamo Sirchia, even asked restaurants recently to reduce the size of their portions. (Italians responded by demanding a reduction in prices, too.) Sirchia also has proposed making Friday a day of fasting.
For many of these countries, however, the issue of obesity transcends health and economic concerns. In places such as Italy, where traditions surrounding food trace back hundreds of years, the problem reflects dramatic and often disturbing cultural, social and economic changes.
In Italy, eating is culture
''It all starts with the family,'' says Claudio Colistra, head of the Rome Federation of Pediatricians, whose organization has launched a program to educate parents and schools about healthy eating and the need for physical activity.
''We have lost the habit of sitting down together, the whole family, and eating. We eat outside of the home now, we eat fast food, the mother works, snacks come packaged. Our task is to make parents reflect, and return to the old Italian culture.''
Bornia's family in Orvieto has religiously maintained the tradition of daily family dining, despite the fact that she is a working mother. In much of Italy, stores and businesses still close from 1 to 4 p.m. so people can return home for pranzo, the main meal. But that custom is slowly disappearing: While 72% of workers went home for lunch 10 years ago, now just over half do, according to Lidia Gargiulo of the National Institute of Statistics.
Meanwhile, Italians and other Europeans have become ever more sedentary, their diets more fat-laden and their lifestyles increasingly resembling those of Americans. ''The Americanization of diet and the Americanization of lifestyle, that is how this disease is exported,'' obesity task force spokesman Rigby says.
In Crete, for example, consumption of unhealthy saturated fats -- the main dietary cause of unhealthy cholesterol levels, and mostly derived from animal products -- has doubled in 40 years. They now make up 16% of the diet of young people, according to Anthony Kafatos, professor of Preventive Medicine and Nutrition at the University of Crete. Middle-aged men there now walk less than 1.5 miles a day; in the 1960s, they walked an average 8 miles a day.
Perhaps no eating habit captures the fundamental changes here in Italy better than merendine, or snacks.
Doctors, politicians, health officials and parents alike inevitably fault snacks when talking about the disappearance of the Mediterranean diet and the accompanying rise in obesity.
Plenty of high-fat food
Once hand-packed in children's schoolbags to eat during morning and afternoon break, snacks traditionally consisted of fruit and a hunk of cheese. Today, Italian grocery stores, like many others throughout Europe, have taken on the look of their American counterparts. Their shelves bulge with packaged high-fat snack foods.
Meanwhile, advertisements for the snacks saturate children's television shows.
''All the children eat these chips and cakes and cookies at snack time, and at lunch no one is hungry,'' Luisa Bornia says. ''Then they get hungry in the afternoon and eat them again.''
As she speaks, Francesco, 9 and stick-thin, hunts down his soccer ball and heads out to a nearby piazza to kick it around with friends. It's something he does every day until nearly supper time. But his playtime apparently is an anomaly in Europe these days.
As in the United States, children here now spend most of their free time watching television or playing computer games. Children in Crete spend an average of four to five hours a day in front of a TV or computer, according to Kafatos.
Nutritionist D'Amicis believes such lifestyles are the primary cause of the new epidemic of obesity.
''No one sends their children out to play anymore. There is only one hour a week of physical activity in primary schools, two in secondary schools,'' D'Amicis says.
A particular beef is the ban many apartment complexes in Rome have on children playing in their courtyards, as a noise deterrent. In a recent proposal to the Rome city council, D'Amicis suggested reducing taxes on buildings that let kids play outside. But even in the countryside, he says, studies show most children stay inside.
''We are static. We don't move anymore,'' agrees Luca Biagi, 28, who lives in Rome. Like most Italians, he holds the United States largely responsible for his country's increasingly sedentary and overweight population. Eating at McDonald's, he points out, is ''fashionable'' among young Romans, even though it costs more than a pizza and is not as healthy.
''It makes no sense, of course,'' Biagi says. ''But everything comes from America: clothes, music, fat.''
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