Linee di indirizzo per la prevenzione e il contrasto del sovrappeso e dell’obesità

Objectives

Provide Italy with a national, evidence-based framework for preventing, diagnosing and managing overweight and obesity across the life course, recognising obesity as a complex, chronic, progressive and relapsing disease shaped by individual vulnerability and obesogenic social, physical and commercial environments.[1][2][3]The framework aims to reduce associated metabolic, cardiovascular, respiratory, musculoskeletal, reproductive and psychosocial harms, disability, inequalities and National Health Service costs, while improving quality of life and participation.[4][5][6]

• Promote healthy, active and sustainable lifestyles from preconception, pregnancy and the first 1,000 days through childhood, adulthood and older age.[1][7]
• Prevent obesity onset universally, provide selective prevention for people at higher risk, and deliver secondary and tertiary prevention for people with overweight, obesity or related comorbidities.[3][8]
• Address determinants of diet and activity, including food affordability, marketing, availability, work and living conditions, transport, urban design, sedentary environments and socioeconomic disadvantage.[2][3]
• Reduce weight stigma and promote respectful, person-centred care across families, schools, workplaces and health services.[9]
• Improve food quality and nutrition literacy through the Mediterranean dietary model, breastfeeding protection and support, healthier collective catering and vending, and clear consumer information.[10][11][12]
• Increase physical activity and reduce sedentary behaviour through supportive schools, workplaces, communities, active travel, green spaces and accessible public places.[13][14][15]
• Establish accurate diagnosis, phenotyping and risk stratification, using body composition, metabolic indicators and functional assessment where appropriate, rather than body mass index alone.[16][17][18]
• Link prevention with integrated clinical, nutritional, therapeutic and rehabilitative care pathways tailored to children, adolescents, adults and older people.[19][18][20]

Implementation

Implement the strategy through an intersectoral Health in All Policies approach, coordinated nationally by the Ministry of Health and delivered through Regions and Autonomous Provinces, Regional Prevention Plans, health and social-care services, schools, employers, local authorities, communities and professional networks.[5][7][21]The approach combines population-wide environmental change, health promotion, targeted prevention, early identification, multidisciplinary care, workforce development, communication and surveillance.[1][22][8]

• Deliver prevention through nationally defined programmes including Health-promoting Schools, Active Communities and Health-promoting Workplaces, with implementation in every Region and indicators consistent across Regions.[21][23]
• Strengthen schools through whole-school health promotion, nutrition education, healthier catering, curriculum and extracurricular activity, active breaks, family engagement and partnerships with municipalities, health services and civil-society organisations.[24][25][15]
• Implement workplace health promotion through leadership-supported, multidisciplinary action involving employers, workers, trade unions, occupational health professionals and internal project groups. Actions include healthier food provision, activity opportunities, active breaks, reduced sedentary time and measures addressing stressful working conditions.[26][27][28]
• Improve urban and community settings through integrated planning, regeneration of disadvantaged areas, walking and cycling infrastructure, public transport, safe routes and accessible green spaces, with emphasis on health equity.[14][29][11]
• Support breastfeeding through evidence-based, commercially independent information, appropriate postnatal care and training for professionals working with pregnant women, mothers and children.[11][30]
• Use Prevention Departments, including Food Hygiene and Nutrition Services, to collect risk data, build inter-institutional networks, train professionals, coordinate nutrition and activity programmes, and promote health literacy.[31]
• Use paediatricians, general practitioners and occupational physicians for early identification, routine assessment, brief motivational counselling, personalised goals, follow-up and referral to specialist care when needed.[31][32][27]
• Organise obesity care through Preventive, Diagnostic and Therapeutic Care Pathways for Obesity, connecting community care, Prevention Departments, clinical-nutrition Spoke centres and specialised hospital Hub centres.[18][8]Care should use shared records, coordinated multidisciplinary teams, risk stratification and age-appropriate personalised interventions.[18][33]
• Provide comprehensive clinical assessment of adiposity, body composition, cardiometabolic risk, nutritional status, eating behaviour, complications and functional capacity, with referral for severe or complicated cases and selective consideration of bariatric surgery after multidisciplinary assessment.[16][20][34]
• Build professional capacity through undergraduate, postgraduate and continuing training in prevention, clinical nutrition, obesity management, counselling, communication and collaborative working across health and non-health sectors.[35][36][37]
• Use communication, social marketing, digital-health programmes and nutrition education to improve health literacy, counter misinformation, support informed choices and avoid stigmatising language.[38][39][40]
• Monitor population trends through nationally and territorially representative surveillance systems, including OKkio alla SALUTE, Health Behaviour in School-aged Children, PASSI and PASSI d’Argento, to assess weight status, behaviours and inequalities.[41][42][43]
• Evaluate implementation using process and outcome indicators integrated with surveillance systems. Regions and Autonomous Provinces are responsible for measuring implementation, with staged targets for adoption of the guidance of at least 66% in year one, 90% in year two and 100% in year three.[6][44][45]

Monitoring & Evaluation

Monitoring combines nationally and territorially representative surveillance with implementation tracking, clinical follow-up and process-and-outcome evaluation. Existing systems are intended to describe population health profiles and risk factors, identify inequalities and vulnerable groups, assess intervention effectiveness, and monitor progress towards health objectives.[23]

• Use OKkio alla SALUTE to measure children’s weight status, lifestyles and family and school contexts in every Italian region through standardised measurements and questionnaires.[41]In 2019, among third-year primary-school children aged 8 to 9 years, 20.4% were overweight and 9.4% were obese using International Obesity Task Force thresholds.[41]
• Track behavioural determinants, including breakfast consumption, fruit and vegetable intake, sugary-drink consumption, physical activity, screen time and parental recognition of children’s weight status.[41]
• Use Health Behaviour in School-aged Children, Progressi delle Aziende Sanitarie per la Salute in Italia and PASSI d’Argento surveillance to monitor excess weight, diet, physical activity, sedentary behaviour, socioeconomic inequalities, geographical variation and trends across age groups.[42][43][5]
• Implement pre-established prevention programmes in every region and use indicators consistent across regions.[21]Monitor school-health processes continuously, including health, environmental and equity considerations and family involvement.[15]
• Define measurable workplace objectives and target groups, assign internal project groups responsibility for planning, monitoring and evaluation, and assess results using short-, medium- and long-term indicators.[26]
• Collect nutritional-risk indicators to develop community health profiles and monitor coordinated population programmes using process and outcome indicators.[31]
• Evaluate Preventive, Diagnostic and Therapeutic Care Pathways for Obesity through process and outcome indicators integrated with surveillance systems.[6]Clinical pathways include repeated body-composition assessment, risk stratification, shared patient records and follow-up of growth, lifestyles, complications and treatment response.[17][33]
• Conduct clinical and biochemical follow-up after obesity treatment, including bariatric surgery, to identify weight regain and nutritional deficiencies.[46]
• Monitor implementation of the guidance by Regions and Autonomous Provinces during the first five years after approval, interpreting outcome measures alongside process indicators because prevalence changes may take longer to emerge.[44]
• Track formal adoption through regional programme documents, with targets of at least 66% of Regions and Autonomous Provinces in year one, 90% in year two and 100% in year three.[45]
• Assign each Region or Autonomous Province responsibility for measuring implementation indicators relating to intersectoral action, catering, communication, professional training and obesity care pathways.[45][47][48]
• Monitor communication guidance to identify implementation difficulties and success factors, assess actual use and support sharing of results among Regions and Autonomous Provinces.[40]

Several sections identify monitoring activities but do not define indicator specifications, reporting frequencies, quantitative outcome targets or formal accountability bodies.[6][44][48]

Costing & Financing

Obesity and excess weight are presented as substantial health-system, social and economic burdens, while the guidance does not provide a dedicated programme budget, funding allocation, financing plan, funding gap or quantified resource-mobilisation target.[49][44][48]

• Recognise that health systems across a 52-country analysis spent an average 8.4% of their budgets treating diseases associated with excess weight.[49]
• Recognise that overweight in Italy was associated with 9% of health expenditure and a 2.8% reduction in gross domestic product.[49]
• Reduce National Health Service expenditure associated with chronic conditions linked to obesity as a strategic rationale for prevention and treatment.[5]
• Address financial barriers, food prices and food availability that can constrain healthier dietary choices, particularly for people experiencing socioeconomic disadvantage.[2][3]
• Use cost-effectiveness- and equity-oriented methods, alongside evidence-based recommendations and documented good practice, in implementing prevention programmes.[21]
• Consider non-monetary fiscal and incentive mechanisms for workplace health promotion, including tax relief for workplace gyms and canteens, incentives for fruit and vegetable consumption, productivity awards and subsidised access to sports organisations or gyms.[28]
• Recognise resource implications for diagnostic assessment: some methods are characterised as relatively inexpensive or low cost, whereas computed tomography and magnetic resonance imaging are identified as costly; dual-energy X-ray absorptiometry is described as balancing imaging capability, invasiveness, price and examination time.[50][16]

No monetary costs, unit prices, expenditure ceilings, earmarked funding sources, financing responsibilities or assumptions for implementation, workforce training, surveillance, obesity pathways or bariatric surgery are specified.[18][51][37]