{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:03:32Z","timestamp":1789653812496,"version":"4.0.0"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Childhood obesity is a major global public health challenge resulting from the interaction between changing food systems, dietary behaviors, and social inequalities. This Perspective argues that childhood obesity should be addressed through an integrated systems-based framework that links food environments, socioeconomic determinants, and emerging digital health technologies.<\/jats:p>\n                  <jats:p>Across Europe, children\u2019s dietary patterns have shifted toward increased consumption of ultra-processed foods and energy-dense products, alongside low adherence to healthy dietary guidelines. These trends disproportionately affect socially disadvantaged populations, reflecting persistent socioeconomic inequalities. Italy provides an informative case in which high levels of childhood overweight and obesity coexist with the cultural heritage of the Mediterranean diet, illustrating the gap between traditional dietary patterns and modern obesogenic environments. Although the Mediterranean diet remains a key model for healthy and sustainable eating, adherence is declining among younger generations, which points to the need for structural and educational interventions. Artificial intelligence (AI) and digital health technologies are being investigated as tools to support surveillance, early risk detection, and personalized nutrition strategies. However, evidence of sustained effectiveness in childhood obesity prevention remains limited, and any benefit will depend on equitable access, robust governance, and integration within existing health and education systems. Preventing childhood obesity therefore requires moving beyond exclusively individual-level interventions toward coordinated, multisectoral strategies that address food environments, social determinants of health, and equity. The combination of sustainable dietary models such as the Mediterranean diet, school- and community-based interventions, and responsibly implemented digital innovations may contribute to more effective and equitable prevention strategies.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1883078","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:18:12Z","timestamp":1789651092000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Childhood obesity in changing food systems: mediterranean diet, socioeconomic inequalities and AI-driven personalized nutrition \u2014 the case of Italy"],"prefix":"10.3389","volume":"14","author":[{"given":"Maria Teresa","family":"Montagna","sequence":"first","affiliation":[{"name":"Interdisciplinary Department of Medicine, Hygiene Unit, University of Bari Aldo Moro","place":["Bari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Caggiano","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Hygiene Unit, University of Bari Aldo Moro","place":["Bari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osvalda","family":"De Giglio","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Hygiene Unit, University of Bari Aldo Moro","place":["Bari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachele Maria","family":"Russo","sequence":"additional","affiliation":[{"name":"Local Health Authority","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Triggiano","sequence":"additional","affiliation":[{"name":"Interdisciplinary Department of Medicine, Hygiene Unit, University of Bari Aldo Moro","place":["Bari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Orlando","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria Doro","family":"Altan","sequence":"additional","affiliation":[{"name":"Department of Life Sciences, Health and Health Professions, Link Campus University","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele Fernando","family":"Panunzio","sequence":"additional","affiliation":[{"name":"Local Health Authority","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref1","volume-title":"European Childhood Obesity Surveillance Initiative (COSI): Report on the Sixth round of data Collection, 2022\u20132024","year":"2025"},{"key":"ref2","volume-title":"Obesity Exceeds Underweight for the first time among school-age children and Adolescents Globally","year":"2025"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e70002","DOI":"10.1111\/ijpo.70002","article-title":"Nutrition transition's latest stage: are ultra-processed food increases in low- and middle-income countries dooming our preschoolers' diets and future health?","volume":"20","author":"Popkin","year":"2025","journal-title":"Pediatr Obes"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/obr.12107","article-title":"Ultra-processed products are becoming dominant in the global food system","volume":"14","author":"Monteiro","year":"2013","journal-title":"Obes Rev"},{"key":"ref5","volume-title":"Farm to Fork Strategy: for a fair, healthy and environmentally-friendly food system","year":"2020"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2481","DOI":"10.3390\/nu12082481","article-title":"A snapshot of European children\u2019s eating habits: results from the fourth round of the WHO European childhood obesity surveillance initiative (COSI)","volume":"12","author":"Williams","year":"2020","journal-title":"Nutrients"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e13226","DOI":"10.1111\/obr.13226","article-title":"Childhood overweight and obesity in Europe: changes from 2007 to 2017","volume":"22","author":"Buoncristiano","year":"2021","journal-title":"Obes Rev"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/j.jadohealth.2020.03.014","article-title":"Enhancing understanding of adolescent health and well-being: the health behaviour in school-aged children study","volume":"66","author":"Inchley","year":"2020","journal-title":"J Adolesc Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1608136","DOI":"10.3389\/ijph.2025.1608136","article-title":"Four decades of advancing research on adolescent health and informing health policies: the health behaviour in school-aged children study","volume":"70","author":"Samdal","year":"2025","journal-title":"Int J Public Health"},{"key":"ref10","first-page":"331","article-title":"I comportamenti alimentari dei bambini della scuola primaria in Italia fotografati dal sistema di sorveglianza nazionale OKkio alla salute","volume":"44","author":"Nardone","year":"2020","journal-title":"Epidemiol Prev"},{"key":"ref11","article-title":"Obesit\u00e0 e stili di vita dei bambini: OKkio alla SALUTE 2019 (Rapporto ISTISAN 22\/27). ISS Report","author":"Nardone","year":"2022"},{"key":"ref12","article-title":"OKkio alla Salute report","year":"2024"},{"key":"ref13","first-page":"64","article-title":"Variabilit\u00e0 sociodemografica nelle prevalenze di sovrappeso e obesit\u00e0 dei bambini in Italia nel 2014","volume":"39","author":"Nardone","year":"2015","journal-title":"Epidemiol Prev"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e2022139","DOI":"10.23751\/pn.v24i4.13778","article-title":"Estimation of the impact of social determinants on childhood obesity in the Apulia region (southern Italy) in 2019","volume":"24","author":"Balducci","year":"2022","journal-title":"Prog Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3893","DOI":"10.3390\/nu15183893","article-title":"Inequalities in childhood nutrition, physical activity, sedentary behaviour and obesity in Italy","volume":"15","author":"Spinelli","year":"2023","journal-title":"Nutrients"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1080\/09637486.2025.2523393","article-title":"The southern Italian children, adolescents and paRents cOhort study on nutrition and health: protocol of the ICARO study","volume":"76","author":"Bonaccio","year":"2025","journal-title":"Int J Food Sci Nutr"},{"key":"ref17","volume-title":"Longitudinal adult risk factor Surveillance, Italy","year":"2022"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1017\/S1368980016003177","article-title":"Med diet 4.0: the Mediterranean diet with four sustainable benefits","volume":"20","author":"Dernini","year":"2017","journal-title":"Public Health Nutr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2599","DOI":"10.1056\/NEJMoa025039","article-title":"Adherence to a Mediterranean diet and survival in a Greek population","volume":"348","author":"Trichopoulou","year":"2003","journal-title":"N Engl J Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.3390\/nu9101063","article-title":"Adherence to Mediterranean diet and risk of Cancer: an updated systematic review and Meta-analysis","volume":"9","author":"Schwingshackl","year":"2017","journal-title":"Nutrients"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"842","DOI":"10.3390\/nu14040842","article-title":"Association of Adherence to the Mediterranean diet with all-cause mortality in subjects with heart failure","volume":"14","author":"Chang","year":"2022","journal-title":"Nutrients"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1038\/ijo.2016.59","article-title":"Adherence to the Mediterranean dietary pattern and BMI change among US adolescents","volume":"40","author":"Martin-Calvo","year":"2016","journal-title":"Int J Obes"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.orcp.2016.05.007","article-title":"Mediterranean diet adherence and body composition among southern Italian adolescents","volume":"11","author":"Mistretta","year":"2017","journal-title":"Obes Res Clin Pract"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.numecd.2017.01.002","article-title":"Adherence to the Mediterranean diet in children and adolescents: a systematic review","volume":"27","author":"Iaccarino Idelson","year":"2017","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"112121","DOI":"10.1016\/j.exger.2023.112121","article-title":"Mediterranean diet in the management and prevention of obesity","volume":"174","author":"Dominguez","year":"2023","journal-title":"Exp Gerontol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1402S","DOI":"10.1093\/ajcn\/61.6.1402S","article-title":"Mediterranean diet pyramid: a cultural model for healthy eating","volume":"61","author":"Willett","year":"1995","journal-title":"Am J Clin Nutr"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1017\/S1368980012002116","article-title":"Guidelines for the new Nordic diet","volume":"15","author":"Mithril","year":"2012","journal-title":"Public Health Nutr"},{"key":"ref28","volume-title":"Dietary Guidelines for the Brazilian Population","year":"2014"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1016\/j.advnut.2023.04.011","article-title":"Mediterranean diet-based interventions to improve anthropometric and obesity indicators in children and adolescents: a systematic review with Meta-analysis of randomized controlled trials","volume":"14","author":"L\u00f3pez-Gil","year":"2023","journal-title":"Adv Nutr"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1093\/nutrit\/nuaf191","article-title":"Dietary interventions based on the Mediterranean diet to treat obesity in children and adolescents: a systematic review with Meta-analysis and Meta-regressions","volume":"84","author":"Rosi","year":"2026","journal-title":"Nutr Rev"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"8758","DOI":"10.3390\/ijerph17238758","article-title":"Updating the Mediterranean diet pyramid towards sustainability: focus on environmental concerns","volume":"17","author":"Serra-Majem","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"nzac123","DOI":"10.1093\/cdn\/nzac123","article-title":"Toward systems models for obesity prevention: a big role for big data","volume":"6","author":"Tufford","year":"2022","journal-title":"Curr Dev Nutr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"100929","DOI":"10.1016\/j.bj.2025.100929","article-title":"Artificial intelligence in infection surveillance: data integration, applications and future directions","volume":"49","author":"Li","year":"2025","journal-title":"Biom J"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"128","DOI":"10.7416\/ai.2024.2644","article-title":"Machine learning vs. regression models to predict the risk of Legionella contamination in a hospital water network","volume":"37","author":"De Giglio","year":"2025","journal-title":"Ann Ig"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-performance medicine: the convergence of human and artificial intelligence","volume":"25","author":"Topol","year":"2019","journal-title":"Nat Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2058","DOI":"10.1093\/eurheartj\/ehz056","article-title":"Deep learning for cardiovascular medicine: a practical primer","volume":"40","author":"Krittanawong","year":"2019","journal-title":"Eur Heart J"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1093\/ije\/dyw186","article-title":"Effect of personalized nutrition on health-related behaviour change: evidence from the Food4Me European randomized controlled trial","volume":"46","author":"Celis-Morales","year":"2017","journal-title":"Int J Epidemiol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"k2173","DOI":"10.1136\/bmj.k2173","article-title":"Personalized nutrition and health","volume":"361","author":"Ordovas","year":"2018","journal-title":"BMJ"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2566","DOI":"10.1017\/S1368980022001392","article-title":"Machine learning can improve the development of evidence-based dietary guidelines","volume":"25","author":"Bodnar","year":"2022","journal-title":"Public Health Nutr"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.3390\/nu16071073","article-title":"Applications of artificial intelligence, machine learning, and deep learning in nutrition: a systematic review","volume":"16","author":"Theodore","year":"2024","journal-title":"Nutrients"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1017\/S136898001900048X","article-title":"Measuring lunchtime consumption in school cafeterias: a validation study of the use of digital photography","volume":"22","author":"Marcano-Olivier","year":"2019","journal-title":"Public Health Nutr"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1454466","DOI":"10.3389\/fnut.2024.1454466","article-title":"Nutritional composition analysis in food images: an innovative Swin transformer approach","volume":"11","author":"Wang","year":"2024","journal-title":"Front Nutr"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1017\/S0029665112002911","article-title":"New technology in dietary assessment: a review of digital methods in improving food record accuracy","volume":"72","author":"Stumbo","year":"2013","journal-title":"Proc Nutr Soc"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"20552076241272589","DOI":"10.1177\/20552076241272589","article-title":"Effectiveness of utilizing step-monitoring devices to prevent and treat obesity in children and adolescents: a systematic review and meta-analysis","volume":"10","author":"Wang","year":"2024","journal-title":"Digit Health."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"20552076241260507","DOI":"10.1177\/20552076241260507","article-title":"Promoting child and adolescent health through wearable technology: a systematic review","volume":"10","author":"Zhang","year":"2024","journal-title":"Digit Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e62944","DOI":"10.2196\/62944","article-title":"Exploring the use of smartwatches and activity trackers for health-related purposes for children aged 5 to 11 years: systematic review","volume":"27","author":"Thompson","year":"2025","journal-title":"J Med Internet Res"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s40137-021-00297-3","article-title":"The age of artificial intelligence: use of digital Technology in Clinical Nutrition","volume":"9","author":"Limketkai","year":"2021","journal-title":"Curr Surg Rep"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"103549","DOI":"10.1016\/j.eclinm.2025.103549","article-title":"Using artificial intelligence and computer vision to detect and monitor unhealthy child-directed food and beverage marketing: a data-driven study","volume":"89","author":"Hu","year":"2025","journal-title":"EClinicalMedicine"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"100657","DOI":"10.1016\/j.obmed.2025.100657","article-title":"Artificial intelligence for obesity management: a review of applications, opportunities, and challenges","volume":"58","author":"Teke","year":"2025","journal-title":"Obes Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"107823","DOI":"10.1016\/j.ypmed.2023.107823","article-title":"Prediction models for children\/adolescents with obesity\/overweight: a systematic review and meta-analysis","volume":"179","author":"Gou","year":"2024","journal-title":"Prev Med"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"CD015877","DOI":"10.1002\/14651858.CD015877","article-title":"Precision nutrition-based interventions for the management of obesity in children and adolescents up to the age of 19 years","volume":"2025","author":"Huey","year":"2025","journal-title":"Cochrane Database Syst Rev"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1136\/bmjnph-2023-000663","article-title":"Food environment and obesity: a systematic review and meta-analysis","volume":"7","author":"Pineda","year":"2024","journal-title":"BMJ Nutr Prev Health"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e13905","DOI":"10.1111\/obr.13905","article-title":"Digital health interventions to treat overweight and obesity in children and adolescents: an umbrella review","volume":"26","author":"Fl\u00f8lo","year":"2025","journal-title":"Obes Rev"},{"key":"ref54","volume-title":"Equity across the Regulation, Implementation and Evaluation of digital Health: Scoping Review","year":"2026"},{"key":"ref55","volume-title":"Health data Governance in the age of artificial Intelligence: Policy Imperatives for the WHO European Region","year":"2025"},{"key":"ref56","volume-title":"Cittadini e ICT \u2013 anno 2024","year":"2025"},{"key":"ref57","volume-title":"Ethics and Governance of artificial Intelligence for Health","year":"2021"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"e13821","DOI":"10.1111\/obr.13821","article-title":"Addressing disparities: a systematic review of digital health equity for adolescent obesity prevention and management interventions","volume":"25","author":"Partridge","year":"2024","journal-title":"Obes Rev"},{"key":"ref59","article-title":"Agreement of July 27, 2022 (Rep. Atti No. 136\/CSR): Guidelines for the Prevention and Counteracting of Overweight and Obesity [Linee di indirizzo per la prevenzione e il contrasto del sovrappeso e dell\u2019obesit\u00e0]. Rome: Italian Ministry of Health","year":"2022"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1883078\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:18:14Z","timestamp":1789651094000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1883078\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":59,"alternative-id":["10.3389\/fpubh.2026.1883078"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1883078","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"article-number":"1883078"}}