Popular Diets of the World: The Italian Way with Food

From the WebMD Archives

When it comes to weight, it's clear the Italians know something we don't. According to the International Association for the Study of Obesity, just 9% of people in Italy are heavy enough to be considered obese, compared to 32% of Americans. It's not that Americans are unfamiliar with Italian food.

In Italian restaurants across the country, Americans enjoy heaping plates of spaghetti and meatballs, pasta smothered in Alfredo sauce, and slabs of buttery, cheese-coated garlic bread. Italian food is tied with Mexican as the most popular ethnic food in the U.S., and is served regularly in American homes, according to market research firm NPD Group in its 21st Annual "Eating Patterns in America" report. But is the Italian food we know and love in the U.S. the same food people eat in Italy?

Far from it, experts say. So forget everything you think you know about Italian cooking. Here's the real story behind this healthy cuisine.

Not just pizza and pasta. In Italy, pasta is never intended to be an entire meal, says Susan McKenna Grant, author of Piano Piano Pieno: Authentic Food From a Tuscan Farm. Instead, it's eaten as a small first course, and either preceded by an antipasto -- salami, olives, and maybe some crostini (small, thin slices of toast with toppings such as olive oil, garlic, and diced tomatoes), or followed by a "secondo" -- meat, fish, or even a plate of fresh, seasonable vegetables, such as grilled mushrooms or asparagus -- or both. Fresh, seasonal vegetables -- not pasta -- are the mainstay of Italian food.

Lighter fare. American portions of Italian food are much larger than those in Italy, agrees Eldo E. Frezza, MD, chief of general surgery and director of the Bariatric Weight Loss Center at Texas Tech University Health Science Center, and author of Slim the Italian Way. The sauces here are much heavier, too, nearly drowning the pasta instead of simply enhancing its flavor. Italians do eat American favorites like meat sauce and Alfredo sauce, but during a normal week, most pasta dishes are served in a light sauce with basil or a small amount of meat.

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Small portions, many courses. In Italy, even a light meal includes more than one course, but portions are small. A plate of pasta is probably half the size Americans normally eat, according to Frezza, who recommends ordering kid-sized portions at Italian restaurants. Knowing that a second or even third course is coming tends to limit overeating because you want to leave room in your belly for whatever is going to arrive next.

Breakfast -- light and delicious. Italian breakfasts are small -- usually a coffee, espresso, or cappuccino with a pastry, piece of toast, or light brioche (a type of bread or cake), according to Frezza.

Lunch -- the main meal. A typical Italian lunch has an antipasto, a primo (soup, rice, or pasta), a secondo (meat or fish), contorno (vegetables), and a dolci (sweet) -- all small portions, of course. Not every meal includes all these courses, Grant tells WebMD, but important meals like a Sunday lunch or festive meal would definitely feature them all.

Dinner -- small, but satisfying. Italians keep things light for their last meal of the day. A typical dinner might include soup, cold cuts, or a small plate of pasta, served with vegetables and a small piece of cheese.

Snacks and sweets. Italians seldom eat between meals, according to Susan Mckenna Grant, which keeps their consumption of junk food fairly low. When you visit a supermarket in Italy, you'll notice that potato chips, soft drinks, and breakfast cereals occupy a small amount of shelf space compared to stores in North America. When Italians do snack, they enjoy an espresso or piece of fruit, Frezza tells WebMD. As for desserts, most meals end with small portions of cheese, nuts, or fruit -- peaches, plums, grapes, pears, apricots, figs, or cherries. Cakes and other sweets are reserved for special occasions and holidays.

Italian food, American favorites. In this country, we can't seem to get enough pizza. In one recent survey, for example, 67% of respondents said they'd purchased pizza away from home at least once in the past month. But, at around 300 calories per cheese and pepperoni-topped slice, this out-of-hand consumption may play a role in the expanding size of the American waistline.

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In Italy, pizza is the type of food you'd eat on a Saturday, when you're out and about with friends, Frezza tells WebMD. While young Italians are increasingly turning to American-style toppings, traditional Italian pizza is eaten only with cheese and vegetables, keeping it lower in calories and higher in both fiber and nutrients.

As for the butter-soaked garlic bread that is often served with pasta, it's very different from the Italian version. Italians rarely use butter on bread, according to Frezza. They sometimes use olive oil, but just a drop! The Italian version of garlic bread, called "Bruschetta," is never served with pasta, but with fish, salads, or stews.

Food awareness. To Italians, ingredient quality is of utmost importance, says Grant, and people spend more time and money on their food than Americans do. Food is seldom imported, and Italians are generally suspicious of products that aren't local. Besides knowing the source of their food, most Italians know just what to do with it -- how to prepare and cook it to maximize taste, nutrition, and presentation, she says. Americans, on the other hand, are motivated more by convenience than concern for health or freshness. Even though 92% of respondents to a recent NPD Group survey agreed that it's important for the food we buy to be fresh, last year less than half of main meals prepared in U.S. homes included even one fresh product.

The family table. Food plays a big role in the life of the average Italian, says Susan McKenna Grant: "Meals are still important daily events and families sit down together for them." Because meals are prepared fresh and eaten slowly, friends and family members have time to talk and enjoy each other's company.Since more than four in five Americans wish they had more time to spend with family (according to a poll commissioned by the Center for a New American Dream), designating two or three nights per week "Family Dinner Nights" could help enhance family closeness. Family dining may have health benefits, too. Research shows that American families who eat dinner together tend to feast on healthier foods than those who rarely or never eat meals as a family. It turns out that families who eat together consume more fruits and vegetables, and fewer foods that are fried or high in trans fats.

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Beverage basics. Italians don't drink sugary sodas with meals; instead, they quench their thirst with water, wine (or watered-down wine), or beer. Portions are kept small -- a glass of wine, not a bottle, according to Frezza. And refills of beer are unusual at dinner. Not so in America, where non-diet soft drinks, including sodas and other sugary beverages like fruit drinks, lemonade, and iced tea, now account for nearly half of all the added sugar we eat or drink -- and are the main source of calories in the average American diet, according to preliminary research from the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. All this sugar doesn'tlook good on our waistlines. A study in the American Journal of Clinical Nutrition examined more than 40 years' worth of research and found a clear link between the rise in sugary drink consumption and the swell in obesity.

The pleasure of food. When was the last time you really enjoyed eating? Although we're consuming more calories, the average American derives less pleasure from them than in the past, a survey from the Pew Research Center finds. Despite a barrage of magazines and cookbooks devoted to the pursuit of gustatory pleasure, only 39% of respondents claimed to greatly enjoy eating, compared to 48% who said they did in a 1989 Gallup survey. We can learn a lot from the Italians, to whom food and eating are a pleasure. "You eat to taste the food and enjoy it -- not to get full," according to Frezza. Which could be part of our problem -- Americans are prone to consume without tasting; to eat, but feel too guilty to relish our food. The Pew Research Center survey found that people who enjoyed their food were more likely to also enjoy cooking. To Italians, preparing the food is as important as eating it, says Frezza, since it's part of the ritual.

Bottom line: "All real food is healthy if you eat it in moderation," says Grant. "And that's the Italian way."

Italian Diet RECIPES

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Caprese Salad

Mozzarella cheese and tomatoes is a very popular summer dish in Italy. Use the best summer tomatoes you can find -- preferably locally grown -- and mozzarella made from the milk of a water buffalo if you can find it. With a slice or two of crusty bread, it can make a perfect lunch dish.

4 tomatoes

2 cups mozzarella cheese

Fresh basil leaves

2 tablespoons extra-virgin olive oil

Salt and freshly-ground black pepper

1. Slice the tomatoes and mozzarella into thick rounds. Arrange in overlapping slices on dish, alternating between the cheese and the tomatoes.

2. Top with few basil leaves. Sprinkle with olive oil, salt, and black pepper.

Serves 2 to 4.

Reprinted from Slim the Italian Way, by Dr. Eldo E. Frezza, MD, FACS. Copyright 2006 by Cine-Med, Inc., Woodbury, Conn.

Green Pesto

2 garlic cloves

3 cups fresh basil leaves

3 tablespoons pine nuts

1 oz. fresh flat-leaf parsley

½ cup extra-virgin olive oil

¼ cup mixed grated Pecorino cheese and Parmigianino Reggiano cheese

salt and freshly-ground pepper

1. Crush the basil, parsley, and garlic using a pestle and mortar or food processor. Process until you get a thick paste.

2. Add the cheese. Then proceed to add the oil in a thin drizzle.

3. Taste and adjust seasoning.

4. Pour into a serving dish, and serve with hot cooked pasta.

Note: Traditional Genoese pesto is made with pine nuts, but for an interesting variation try hazelnuts or walnuts instead.

Reprinted from Slim the Italian Way, by Dr. Eldo E. Frezza, MD, FACS. Copyright 2006 by Cine-Med, Inc., Woodbury, Conn.

Published January 2007.

WebMD Feature Reviewed by Charlotte E. Grayson Mathis, MD on January 01, 2007

Sources

SOURCES: Susan McKenna Grant, author, Piano Piano Pieno: Authentic Food From a Tuscan Farm, Harper Collins Canada, 2006.Eldo E. Frezza, MD, chief of general surgery and director of the Bariatric Weight Loss Center at Texas Tech University Health Science Center, Lubbock; author, Stay Slim the Italian Way, Cine-Med, Inc, 2006. Giobbi, E. & Giobbi Bone, E. Italian Family Dining: Recipes, Menus, and Memories of Meals with a Great American Food Family Rodale, 2005. Technomic Services, Inc.: "Take-out takes over America," American Express Market Brief, Feb. 2005. International Obesity TaskForce of the International Association for the Study of Obesity: "Global Obesity Prevalence in Adults," Updated Nov 22, 2006. Multi-Sponsor Surveys, Inc.: "2005 Gallup study of home meal replacements." NPD Group: "21st Annual Eating Patterns in America Report." Center for a New American Dream, Takoma Park, Md. WebMD Medical News: "Eat as a Family, Lose Weight." Guthrie, J. Journal of the American Dietetic Association, Jan 2000; vol 100: pp 43-51. Malik, V.American Journal of Clinical Nutrition, August 2006; vol 84: pp 274-288. U.S. Department of Agriculture: "USDA National Nutrient Database for Standard Reference, Release 18." Bermudez, O. Abstract # 839.5, Experimental Biology 2005, San Diego, April 2005. Technomic Information Services: "The 2006 Pizza Category Report."

© 2007 WebMD, Inc. All rights reserved.

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