http://www.nytimes.com/2008/09/24/wo...pe/24diet.html

September 24, 2008

Fast Food Hits Mediterranean; a Diet Succumbs

By ELISABETH ROSENTHAL

"KASTELI, Greece - Dr. Michalis Stagourakis has seen a transformation of his
pediatric practice here over the past three years. The usual sniffles and
stomachaches of childhood are now interspersed with far more serious
conditions: diabetes, high blood pressure, high cholesterol. A changing
diet, he says, has produced an epidemic of obesity and related maladies.

Small towns like this one in western Crete, considered the birthplace of the
famously healthful Mediterranean diet - emphasizing olive oil, fresh produce
and fish - are now overflowing with chocolate shops, pizza places, ice cream
parlors, soda machines and fast-food joints.

The fact is that the Mediterranean diet, which has been associated with
longer life spans and lower rates of heart disease and cancer, is in retreat
in its home region. Today it is more likely to be found in the upscale
restaurants of London and New York than among the young generation in places
like Greece, where two-thirds of children are now overweight and the health
effects are mounting, health officials say.

"This is a place where you'd see people who lived to 100, where people were
all fit and trim," Dr. Stagourakis said. "Now you see kids whose longevity
is less than their parents'. That's really scaring people."

That concern has been echoed by the Food and Agriculture Organization of the
United Nations, which said in a report this summer that the region's diet
had "decayed into a moribund state."

"It is almost a perfect diet, but when we looked at what people were eating
we noticed that much of the highly praised diet didn't exist any more," said
the report's author, Josef Schmidhuber, a senior economist at the food
organization. "It has become just a notion."

Greece, Italy, Spain and Morocco have even asked Unesco to designate the
diet as an "intangible piece of cultural heritage," a testament to its
essential value as well as its potential extinction.

The most serious effects of its steady disappearance are on people's health
and waistlines. Alarmed by the trends, the Greek government has been
swooping into schools in villages like Kasteli annually for the past few
years to weigh children and lecture them on nutrition. The lessons include a
food pyramid focused on the Mediterranean diet.

It is an uphill battle, though. This spring, a majority of children who were
tested at the elementary school of this sleepy port town of 3,000, also
known as Kissamos, were found to have high cholesterol. "It was the talk of
the school," said Stella Kazazakou, 44. "Instead of grades, the moms were
comparing cholesterol levels."

In Greece, three-quarters of the adult population is overweight or obese,
the worst rate in Europe "by far," according to the United Nations. The
rates of overweight 12-year-old boys rose more than 200 percent from 1982 to
2002 and have been rising even faster since.

Italy and Spain are not far behind, with more than 50 percent of adults
overweight. That compares with about 45 percent in France and the
Netherlands.

In the United States, 66 percent of adults older than 20 were overweight in
2004, and 31.9 percent of children 2 through 19 were overweight in 2006,
although childhood statistics are compiled somewhat differently in different
countries.

In Greece, the increase in the number of fat children has been particularly
striking, parents and doctors say.

"Their diet is totally different than ours was," said Soula Sfakianakis, 40,
recalling breakfasts of goat milk, bread and honey. Her son, Vassilis, a
husky 9-year-old who had a chocolate mustache from a recently conquered ice
cream cone, said he preferred cornflakes in the morning and steak or
macaroni and cheese for dinner.

Dr. Antonia Trichopoulou, a professor of epidemiology at the University of
Athens Medical School, said the problem had grown acute with the spread of
supermarkets and, especially, convenience foods.

"In the last five years it's become really bad," she said. "The children are
all quite heavy. The market is pushing a lot, and parents and schools seem
unable to resist."

Advertising geared toward children has invaded Greece full force, stretching
into the countryside. On television there are commercials for chips; at
supermarkets there are stands of candy. Last year, Coca-Cola sponsored a
play about healthful eating.

But facing both aggressive convenience food marketing and obesity for the
first time, many rural residents here have little resistance to or knowledge
of the dangers.

Dr. Trichopoulou said that some older people might have been tolerant of
childhood chubbiness because Greece had for so long been a poor nation where
hunger was a recurrent problem.

Outside one of Kasteli's several ice cream parlors, Argyro Koromylla said,
"You don't want your child complaining or feeling left out, so you give him
what he wants." Her son Manolis, 12, was finishing a cone, a large T-shirt
draped over his stocky frame.

Dimitris Loukakis, 44, said he was so concerned about changing eating habits
that he had bought a farm to grow traditional crops himself. Sitting at an
outdoor cafe by the beach, he and his wife drank iced coffee while their
chunky 9-year-old daughter, Maria, nibbled on spinach pie and glumly drank
water.

"I'm on a diet; I have to eat less," Maria piped up, noting that the local
school had recently started to teach students about nutrition.

"Some diet," interjected her father. "We're trying to keep her off sugar
now. If we continue like this, we're going to become like Americans, and no
one wants that."

The traditional diet, low in saturated fats and high in nutrients like
flavonoids, was based on vegetables, fruit, unrefined grains, olive oil for
cooking and for flavoring, and a bit of wine - all consumed on a daily
basis.

Fish, nuts, poultry, eggs, cheese and sweets were weekly additions. Red
meat, refined sugar or flour, butter and other oils or fats were consumed
rarely, if at all.

Research on the diet took off in the 1990s, as scientists noted that people
in Mediterranean countries lived longer and had low rates of serious disease
despite a penchant for patently unhealthy habits like smoking and drinking.
But that protection is now seen as rapidly eroding.

A generation ago, the typical diet in all Mediterranean countries complied
with nutritional recommendations by the World Health Organization that less
than 10 percent of calories come from saturated fats and that less than 300
milligrams of cholesterol be consumed per day.

Today, the typical diet in all of the countries exceeds those limits
significantly, Dr. Schmidhuber said. In Greece, average daily cholesterol
consumption has risen to 400 milligrams from 190 in 1963. Germany's is
similar. In Portugal, consumption went to 460 milligrams from 155.

In 2002, a British study found that 31 percent to 34 percent of 12-year-olds
in Greece were overweight - a 212 percent increase since 1982 - and "it has
gotten worse, much worse, since then," Dr. Stagourakis said. One-quarter of
all children on Crete have cholesterol problems, he said, and seeing
children with diabetes and high blood pressure is no longer uncommon.

Unlike in the United States, where obesity is more pronounced in adults than
in children, in the Mediterranean region the rise in weight problems has
been more common among the young. Parents' taste buds still tend to hew to a
more traditional diet.

A survey by the World Health Organization last year of statistics from
various countries found that among children in the first half of primary
school, 35.2 percent in Spain were overweight - the worst rate - and 31.5
percent in Portugal. The lowest rates were in Slovakia (15.2 percent),
France (18.1 percent) and Switzerland (18.3 percent). Greece was not
included.

Being overweight, particularly being obese, is associated with a wide
variety of medical problems, like diabetes and liver disease. While heavy
children may not suffer immediate health effects, they are statistically far
more likely to grow into obese adults than their trimmer classmates. And in
adulthood the conditions can be lethal.

On traditional Crete, there was no need for calorie counting or food
pyramids. People were poorer then, so their food was mostly homegrown, and
producing it required more physical activity.

"We ate what we grew and what we could make from it," said Eleni Klouvidaki,
46, who lives in Kalidonia, a mountain village outside Kasteli, and
describes her preferred diet as "whatever's green." On a recent day she
prepared a meal of her staple mix of zucchini, tomatoes and other
vegetables, and tossed it all in homemade olive oil. Now and again, she
augments this dish with beans, or meat from her chickens or rabbits.

But she said that as more women worked and shops had moved in, the food
culture had changed. "We've entered an era of convenience," she said. "Even
in this rural village, the diet is very different than it used to be."

She, too, occasionally grabs dinner in town, and four nights a week her son,
who works in a car repair shop, drives to a fast-food restaurant. "They don'
t deliver here yet," she explained..."

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