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Italy’s child obesity time-bomb
00:27:10
How Italian children have become some of the most overweight in Europe
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A
This BBC podcast is supported by ads outside the uk. If you are currently overpaying on software to run your business, remember this number 10,000. That's the number of new businesses that join Odoo per month. Join odoo today@odoo.com that's odoo.com Decisions made in Washington can affect your portfolio every day. But what policy changes should investors be watching? Washington Wise is an original podcast from Charles Schwab that unpacks the stories making news in Washington right now and how they may affect your finances and portfolio. Listen@schwab.com WashingtonWise that's schwab.com WashingtonWise
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B
thank you
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C
for downloading this podcast from the BBC. Hi, I'm Sofia Beticia and you're listening to the documentary from the BBC World Service in this edition of Assignment. I'm in Naples, the biggest city in southern Italy. This 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? This 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. Salvatore 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.
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D
I can't even sign him up for the gym because he's so obese. They don't want to take on the responsibility.
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B
Your son is not allowed to. Why?
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D
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.
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C
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.
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D
How many times did the wheels break in a week?
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E
Seven times.
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D
Seven. He broke the motorcycle wheel in a week because he weighs so much.
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C
That's dangerous.
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D
Yes, it is. Those who are not living through it cannot understand it.
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C
Salvatore is under the care of Dr. Sonia Chiapetta, an expert in the surgical treatment of obesity. She has been working with and operating on obese patients for 15 years. Salvatore and Anna are from Torre Annunziata, a suburb very close to the world famous archaeological remains of Pompeii. Other patients come from Ponticelli, where the Britannia 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. And demand is increasing. World Health Organization figures show Italian children are the second most overweight in the EU and the joint third most obese.
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F
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.
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C
This is the documentary from the BBC World Service. Hi, I'm Sofia Betica. 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. And if anything is being done about it.
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G
Bethlehta is basically a simple strategy.
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D
His weight has always been excessive. When he was 12, he weighed 100 kilos. Overeating is normal for him.
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C
Salvatore is not this boy's real name. He didn't want to be recognized. His mother, Anna, 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. Chiappetta 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. Still, she says people blame her for Salvatore's condition, even though she says she's done her best for all three children.
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B
Do you ever feel judged as a parent?
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G
Sempre
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D
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 easier. Easy to say it's your fault, but it's not like that.
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C
Being 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. Chiapetta says those causes can sometimes be traced Back to early childhood.
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F
In Italy, love is also connected to, to food. So when 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.
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B
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?
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F
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.
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C
Dr. Chiapetta is very clear that blaming parents or their children for this obesity explosion is unfair and misunderstands the nature of obesity.
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F
It'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.
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C
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. It'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 Ps food words, which in Italian at least all begin with the letter P and are blamed for people gaining weight.
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F
The five Ps are pasta, pizza pane, which is bread, potatoes and meat proteins.
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C
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. When 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 with chips and hot dogs. It's all the classics of pasta, omelets, 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. This is the documentary from the BBC World Service on the under $3 menu
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A
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C
I'm Sofia Betica, 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? I've come to a primary school in the old part of Naples which is working hard to keep his children healthy. The Ugo Foscolo 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 Valter Longo foundation, based 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. We've arrived just in time to hear the Vive la Papa Culpomodoros song, a famous tune celebrating tomato and bread soup. It makes fun of poor school meals and suggests that hungry people eventually rebel.
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B
We are in a classroom. The kids are about 7, 8 year old. They're all standing up and they're about to do some physical activity. They're wearing white T shirts and blue jeans. The kids are now doing Jumping jacks. And you can hear the floor rumbling. There's a lot of enthusiasm here.
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C
Now the children are playing again.
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B
If something is true, they have to
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jump, and if something is false, they
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B
have to crouch to the floor.
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C
Eating well and exercising helps us grow
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B
up in a stronger, healthier way. And everyone's jumped. That was an easy one, wasn't it? So the children are being asked yes or no answers. Are chips good for you? A fizzer drink's good for you. They all say the right thing, but what they do when they go home is a different question.
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C
The children seem to really enjoy this session. Leonardo, Nicolo, Sophia and Shainulia are going to give me their impressions.
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B
What did you think of the session today?
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C
It was interesting. Give me an example of something you've learned.
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H
There are so many plants I didn't know were there.
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B
Okay, so a lot of them are saying they didn't know that grains were a thing to eat, like old Zo. So that's something new they learned.
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C
And at home, what do your parents feed you? Healthy stuff.
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H
Hamburger.
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C
How often do you eat pizza?
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H
We eat pizza every two months or every two weeks. It's a long time since I had pizza. I eat more pasta.
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D
I eat pizza only when I leave the house for dinner. And then I hardly ever eat pizza at home.
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C
And when you come to school, what do you bring for a snack?
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H
Bread and oil. Bread oil and some apple breadsticks.
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C
Do you think kids your age eat healthily?
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H
Yes.
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C
That sounded to me like a rock. Rather qualified. Yes. Francesca Pecce 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.
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I
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.
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B
And what do the parents give them?
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I
It's a piece of cake, which is called brioche. And it's big. It's very big.
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B
Can children here do physical activities?
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I
In the center of Naples, we have schools that are in old buildings, without any gym, so we can't do a proper lesson of physical education.
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B
All of you students at this school don't get any sport as part of their curriculum.
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I
Only the fourth and fifth grade. They have two hours a week.
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B
Are you worried about your students?
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I
Yes, I have one student that I'm really worried about because I think he weighs maybe 60 kilos.
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B
He's 60 kilos. How old is he?
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I
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. Because in Neapolitan culture, if you're a little fat, if you're chubby, you're healthy.
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C
So that's younger children, but what about teenagers? Now I'm leaving Piazza del Gesur 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 Valterlongo Project. They're going to be working with 25 schools over an extended period to help educate students about living a healthy lifestyle.
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B
So 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 jacks. Most of them are kind of refusing to do them, but I think some of them are starting to get involved, mostly just laughing. There's a round of applause for that one person that managed to get the jumping jacks correctly.
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C
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. They'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. As soon as the 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.
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I'm Romina Cervini, I'm a nutritionist and chief scientific officer in Fondazione Valterlongo in Italy. During the first day, there are around 1,100 kilocalories, and from day two to five, around 800. So it's a calorie restriction.
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B
I mean, 800 calories for teenagers is very little.
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G
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 has the same level of micronutrients. So vitamins and minerals. They can choose whether follow it or not every month.
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B
So in those five days, what can you eat?
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G
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.
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B
Sounds like very less of food to me.
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G
Chocolate also no meat or fish?
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B
No, no, no.
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G
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 soon supervise them all the time. And of course, if they should have any problem, we will stop it.
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C
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.
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G
So you are 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.
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B
What do you think the parents would say?
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G
Yeah, we know that it 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.
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C
Other medical experts in Naples are also working hard to combat obesity. CITY I've traveled up into the hills of the city to a university founded 800 years ago and still going strong.
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E
I'm Roberto Bernicanani, I'm a full professor in pediatrics here at University Federico, second in Nepal, is the oldest public university at the worldwide level.
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C
What kind of patients do you treat?
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E
The vast majority of these patients are affected by obesity of overweight.
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B
And how young are your patients?
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E
Two, three years.
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B
So you seeing children who are two
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E
or three who are already affected by overweight or obesity.
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B
How much do these children weigh?
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E
Our normal child at 2, 3 years of age, we weigh the body weight to be around 10 kilos. But you can find that a child weighing, I don't know, 20 kilos, 25 kilos. Many children are unable to drink regular water. They are consuming Coca Cola, can, Fanta can or Gatorade. Obesity is under recognized by the families and by the doctors.
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B
These parents who bring their children who are maybe 20 kilos, and they are three years old, do they see it
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E
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.
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B
Could there be psychological risks around food restriction at that age?
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E
I feel that limiting proposing food restriction in teenager or pre adolescent adolescents could be not super safe.
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B
So childhood obesity is a crisis in Italy. Do experts agree on how to solve it?
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E
We are interacting 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.
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C
Professor Roberto Benicani 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. Effectively, 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.
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H
Since she was a baby, she doesn't eat a lot, but she doesn't eat a little. Her throat gets very irritated, she finds it difficult to breathe and she always has this cough.
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C
Carmen says her daughter eats quite healthy things like pasta and lentils. But when it comes to food, fruit and vegetables.
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H
You don't eat vegetables, you don't eat salad. You really don't want them. I put them next to you, but you don't want them.
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B
She doesn't want vegetables. What about fruit?
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I
La fruta, la mila manga.
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H
She only eats apples and strawberries.
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B
And from a medical perspective, does her weight have an impact on her life at the moment? Are you worried?
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H
She's not a child who suffers, who gets tired. She does two sports, a gymnastics and Latin dance.
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B
Seeing a situation like this, what would your initial assessment be?
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E
In this case, it's clear that the quality of the diet is not very good. She receives a lot of snacks, but too low the quantity of vegetables. In this case, we are suspecting an inflammation of the esophagus could be relatively hard to drink or to eat.
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B
Do you see cases like this often?
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E
Yep. This is a typical example because the mother is a very good mother, the father is a good father and they are not able to recognize the importance of the quality of the diet and the weight of the body weight. But when the condition occurs, they need some help.
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B
So are you now going to give them a bit of a scary talk
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E
to explain what does it mean a healthy diet? What does it mean a healthy lifestyle factor? And to treat of course, the condition and to start a very, very, very, very effective follow up.
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C
Last year, Italy became one of the first countries in the world to officially recognize obesity as a disease. And yet when we asked the local government heir if you had a budget to fund education programs, it said there were too many other priorities in healthcare and elsewhere. Some believe weight loss drugs are the answer, but they're expensive and the long term side effects are still unclear and some people could end up injecting themselves or taking pills for decades. Changes are happening in education and treatment, so I hope that if I come back in the future to talk to the 7 and 8 year olds I met at the primary school, they'll be healthy and happy. After all, a lot depends on it. A final word from Dr. Chiapetta, who we heard from earlier at the Betania Hospital.
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F
The youngsters are the future and when they're ill at the age of 18, 20, in the next 10, 15, 20 years, this will be patients who have so many problems and it will be impossible to cure them because there is no prevention.
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C
This edition of Assignment was presented by me, Sophia Betica. The producer was Bob Howard, the editor is Penny Murphy and the studio manager, James Beard.
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J
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