Childhood obesity in changing food systems: mediterranean diet, socioeconomic inequalities and AI-driven personalized nutrition - the case of Italy.

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. Across Europe, children's 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.