Nearly 7 months later, I’ve not found it. Not because vegetables, beans, olive oil and whole foods don’t exist here, I mean of course they do. But what Americans call “the Mediterranean diet” and what I’ve encountered while actually living and traveling in Italy are two completely different things.
So how exactly did Americans like me come to believe that Italians eat the way American nutritionists tell us to eat “Mediterranean”?
Where is the Mediterranean diet?
I’m standing in yet another Italian breakfast bar. The case is filled with cornetti (croissants): plain, cream, chocolate, pistachio, Nutella. I watch person after person order one with an espresso, eat it standing at the counter lickety-split, gulp down two euros’ worth of teeny-tiny espresso and take off like their pants are on fire.
Me? I’m still looking around for something to eat and wondering: Where are the whole grains? The fruit? The protein? For Pete’s sake, where is the fiber?
I came here believing I was moving to the homeland of one of the world’s healthiest diets. After six and a half months, I’m starting to wonder whether the Mediterranean diet is something Americans think they should eat because Italians supposedly eat it and are, supposedly, healthier for it.
First surprise: This is breakfast?
Breakfast is not really a thing here in Italy. At least not the kind of breakfast I know. In fact, it’s pretty much the antithesis of everything I was taught about a good start to the day.
For “food,” there’s a cornetto, pastry, dry (and I mean dusty kind of dry) cookies or biscuits, Nutella, white bread or rusks, and maybe some jam. This is washed down with a sip of teeny-tiny espresso, even smaller than the shot (or two, or three) we ask to be added to our drip coffee at the coffee shop when we need and extra boost. Sweet thing in one hand, coffee in the other, eaten standing up.
Unless I eat at home or stay in a hotel that offers a full breakfast buffet, finding breakfast as an actual meal is mostly not possible. We’ve taken to bringing our own fruit, oatmeal and yogurt when we travel. Even in tourist areas, there may be one or two places with something resembling pancakes. And the closest thing to pancakes by-the-way, may be crêpes – with Nutella, of course.
To be fair, Italians aren’t trying to make breakfast a balanced meal. It’s small by design. Dinner tends to be much, much later, and maybe people just aren’t that hungry first thing in the morning. It’s culturally different from the American expectation of what breakfast should be.
But I still can’t help wondering: If breakfast isn’t where the fiber, fruit, vegetables or protein are coming from, where are they coming from?
Seriously. Where is the fiber?
There is a lot of bread in Italy, as you might imagine. A LOT. But so much of what I see is white bread, white pasta, pizza, focaccia and cornetti. Refined flour everywhere. I continue to be surprised by how difficult it can be to find whole-grain choices, especially when we’re traveling.
I’ve heard about the Mediterranean diet for years. I was imagining beans, lentils, chickpeas, vegetables, whole grains and nuts. Weren’t you?
And I’m not just talking about restaurant food. I’ve spent a considerable amount of time with my family in Calabria, in the south of Italy – the very part of the country that figures so prominently in the Mediterranean-diet story. I can’t remember ever being served legumes. I ate fish with them once. Their staples are cheese, salami, cured meats, beef, pork and pasta. When I told them I’m mostly vegetarian, they were unsure what to say.
Being mostly vegetarian in the land of the Mediterranean diet
“Whata? You don’ta eata the meata? Butta why? I don’ta undastanda!”
And then sausage appears anyway. There is genuine bewilderment. Head pulled back. Confused look. Sometimes I think they assume something has been lost in translation, because I’ll turn my head and when I look back there are meatballs, pork, salami or cured meats on my plate, food I am certain I didn’t put there.
I’ve tried explaining that I limit meat for my health, that too much bothers my stomach, that I love animals and prefer not to eat very much of it. This mostly seems to make me more of an alien.
And that got me thinking about something I hadn’t considered before coming here. Nutritionists have turned the Mediterranean diet into a health practice. I haven’t encountered many Italians who necessarily think of their food as an avenue to health. Food is family, region, pleasure, identity and tradition. Health has little to do with it.
The Mediterranean Diet™ vs. the Italian diet
The “Mediterranean diet” described in American health literature really does exist. It’s a defined way of eating built around vegetables, fruit, legumes, whole grains, nuts and olive oil, with relatively little red and processed meat.
Where I went wrong was assuming that meant: This is what people living in Italy eat today. It doesn’t.
The idea of the Mediterranean diet grew out of research beginning in the 1950s, when American physiologist Ancel Keys studied populations in places including Southern Italy. The people he observed ate lots of vegetables, beans, grains, bread and olive oil, with relatively little meat, dairy or sugar.
But there was another piece of the story I had never really considered: they were eating this way partly because of the realities of the time. Meat was expensive, most people were relatively poor and they were far more physically active. Food was local and seasonal. What we now romanticize as cucina povera was quite literally the food of people who didn’t have much money.
Over time, researchers took the healthiest parts of that way of eating and developed them into the dietary pattern we now call the Mediterranean diet. Meanwhile, Italy changed. Economic prosperity made meat, cheese, sweets and other once-limited foods much more available. Lifestyles changed too. Researchers even returned to Nicotera, Calabria—one of the communities involved in the early Mediterranean-diet research—and found that by the 1990s the people living there had moved substantially away from the eating pattern observed decades earlier. Suddenly my experience in my homeland region of Calabria started making a lot more sense.
The Mediterranean diet is a dietary pattern inspired by how certain Mediterranean populations ate at a particular point in history. It isn’t a promise that this is how people living around the Mediterranean eat today. Apparently I arrived looking for a diet whose heyday I missed by about 70 years.
Wait—Italy has an obesity problem?
In my mind’s eye, I pictured this glowing, healthy, slightly tanned population with shiny hair and beautiful skin, nourished by olive oil, fresh produce and lots of legumes. Then I got here and looked around. Eventually I started looking at the numbers (my old data analyst job in my bones).
In 2023, 19% of Italian children ages eight and nine were overweight and another 9.8 percent had obesity. More surprising to me was where those numbers were highest. Italy’s national health institute reports a clear geographic divide, with childhood excess weight more common in the south.
Campania is particularly striking. In 2023, 24.6% of children were overweight, 12.6% had obesity and another 6% had severe obesity. That’s more than four in ten kids. Sicily was also above the national average, with 33.9% of children carrying excess weight.
These are some of the very places we picture when we talk about traditional Mediterranean eating. Adults have a similar story. National surveillance data from 2020–2021 found that about 43% of Italian adults ages 18–69 were either overweight or obese, again with excess weight more common in Southern Italy and Campania recording the highest prevalence.
There is an important caveat: Italy isn’t simply getting fatter every year. Childhood overweight has actually fallen since national monitoring began in 2008–2009, and childhood obesity declined from 12% to 9.8%, although that decline has mostly leveled off since 2014.
So this isn’t a story about Italians abandoning the Mediterranean diet and suddenly becoming obese. It’s more complicated than that. None-the-less, I still find the contradiction fascinating. Some of the places most closely associated in our imagination with the famously healthy Mediterranean way of eating are now the same places struggling the most with excess weight.
Fresh doesn’t automatically mean healthy
Americans romanticize the idea of fresh food in Italy: locally made sausage, fresh mozzarella, handmade white pasta, bread baked just this morning, local wine, prosciutto from the guy down the road….
While all of these things are indeed fresh, traditional, local and absolutely delicious; none of those adjectives automatically makes something healthy. I think as Americans we may have bundled local + handmade + European + traditional together and somehow arrived at healthy. Apparently, if the pig lived within a 20-kilometer radius and someone’s nonno personally turned it into sausage, the saturated fat no longer counts.
We do the same thing with bread. At home we know that for better health, white bread should be replaced with whole grain. But white bread made this morning by a fourth-generation baker in a tiny Tuscan village? Suddenly we’re discussing the craftsmanship. The flour hasn’t magically acquired fiber because I can see a bell tower from the bakery.
And then there’s cheese. Fresh mozzarella may be worlds apart in taste and processing from an individually wrapped slice of American cheese, but that doesn’t transform cheese into broccoli. Local wine doesn’t become water because the grapes grew on the hill behind the restaurant. Prosciutto is still processed meat even when you know the name of the farmer—and possibly the pig.
None of this means these foods are bad or that we shouldn’t enjoy them. I certainly have. It just means fresh, local, traditional, artisan are not synonyms for healthy. Sometimes a beautiful loaf of bread is simply a beautiful loaf of white bread, and a locally produced sausage is still… well a sausage.
And then there is the wine
For decades, wine, particularly red wine- somehow earned a supporting role in the Mediterranean health story. Many of us grew up hearing that a glass of red wine with dinner was actually good for us. And some of us (my hand in the air) assumed that if one glass is good, more is even better and developed a problem.
It was part of the image: fresh vegetables, olive oil, a little fish, a leisurely meal and, naturally, a glass of local red wine. Very civilized, very European, and practically medicinal! Except the health conversation around alcohol has changed. The supposed protective benefits of any kind of drinking have come under increasing scrutiny, and major health organizations now emphasize that alcohol carries health risks even at relatively low levels of consumption.
That doesn’t mean no one should enjoy a glass of Chianti. It means that being local, traditional and served beside a bowl of olives doesn’t turn alcohol into a health food. Wine is also part of the culture here in a way that’s difficult to appreciate until you’re living in it. It appears at lunches, dinners, celebrations, tastings and family gatherings, and declining it can sometimes generate considerably more interest than I ever expected.
Somehow, I’m the nutritional oddball
One thing I didn’t expect was how often my food choices would become a topic of conversation.
Saying I don’t eat much meat can be met with genuine bewilderment, often followed by another attempt to feed me meat. Looking for whole grains or asking about vegetarian options can make me feel like I’ve announced some complicated dietary disorder when really I’d just like to eat some greens sometimes.
I’ve had people seem almost concerned about what I eat while I’m standing there wondering how I’m the nutritional oddball in this situation. To be fair, this isn’t everyone. I’ve met Italians who eat very differently but it’s not the norm and it still has surprised me.
Before coming to Italy, I assumed that being interested in vegetables, legumes and whole grains and eating less meat would make me fit naturally into Mediterranean food culture. Instead, at times, I’ve felt remarkably American for wanting to eat the very foods Americans have been told are Mediterranean.
My unlikely Italian health-food store
After all my romantic expectations of shopping in tiny Italian markets, one of the places where I’ve most reliably found hummus, vegan products, whole grains and other foods that work for me is… Drum roll, please…
Lidl. Yes. Lidl.
Oddly enough something interesting I notice at Lidl is that the shoppers seem much more internationally diverse than what I encounter in many traditional Italian grocery stores. I hear different languages and see people from many different backgrounds. And the store itself feels remarkably like Lidl in the U.S., right down to the coin for the cart and the warehouse look.
But here’s the thing: I can consistently find whole-grain fresh bread, hummus, tofu, vegan products, smoked salmon and other staples that are either nonexistent or require way too much hunting in some traditional Italian grocery stores.
I moved to Italy and apparently found my health-food haven in a German discount supermarket. I did not see that coming.
So was the Mediterranean diet a lie?
Not at all, but I did misunderstood what the name meant.
There is good evidence behind the dietary pattern we call the Mediterranean diet. Its historical roots in Mediterranean communities are real. Those diets really did feature olive oil, vegetables, legumes, nuts, fruit and whole grains. What isn’t true is the assumption I brought with me: that modern Italians necessarily eat this way simply because they live by the Mediterranean Sea.
And I don’t think I was completely crazy for expecting to find it here. Americans constantly hear “Mediterranean diet” accompanied by photographs of Tuscan farmhouses, Italian grandmothers, baskets of tomatoes, bottles of olive oil and beautiful rustic tables. Of course we connect the health benefits with the people living here now.
After actually living here, I’ve realized that Italy’s food culture and “the Mediterranean diet” are related, but they aren’t synonymous. And now, after all the research, traveling, family meals and restaurant menus, I walk into an Italian bar in the morning and see the same familiar lineup. Cornetti. Nutella. Espresso.
I’m no longer wondering where they’re hiding the Mediterranean diet. This is the Italian diet. The Mediterranean diet is something else.
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Namaste!