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The understanding that diet plays a pivotal role in health dates back to the 5th century BC. However, in ancient times, the term “diet” had a different connotation from its modern meaning. Hippocrates described it as a “lifestyle”, encompassing not only what and how much to eat but also under what environmental conditions and in relation to physical activity and different seasons.

Today, unfortunately, for most people, “diet” primarily means a dietary regimen to adopt when one wants to lose weight. Scientific research has produced numerous studies that have allowed us to understand the real nutritional needs—considered as nutrients—to provide the body with everything it needs to function. Science has also been able to demonstrate how qualitative or quantitative errors in diet can cause serious diseases and how different pathologies can be cured and/or prevented through specific dietary therapies.

All this has led to the concept in medicine of professional figures who, in addition to medical studies, have a specialized curriculum in “nutrition science” (another four years of study after a degree in medicine and surgery), to whom prevention and treatment of diseases related to poor diet, including obesity, diabetes, cardiovascular and ischemic diseases, tumors, osteoporosis, atherosclerosis, anemias, nephropathies, etc., could be delegated.

With the spread of these pathologies – consider that only overweight and obesity affect more than 50% of the population – the demand for care, understood mainly as slimming down, has increased so much that, also due to the relative scarcity of the specific professional figures mentioned above, “dietology” has escaped from the scientific-medical field to be managed by “false prophets,” hucksters, or in any case by incompetents. Just consider how many television or radio shows and how many newspapers and magazines provide dietary indications considered appropriate for all listeners or all readers without having seen them, let alone questioned or visited them.

Bookstores are full of volumes with the diet of Dr. So-and-so or Dr. Caio to demonstrate that some hucksters hide behind the title of doctor. A true doctor, however, should know that there cannot be an equal diet for everyone, each individual is different from the other not only by sex, age, and physical or sports activity but also by genetic heritage, psychological and socioeconomic conditions, culture and traditions, but above all by pathophysiological conditions. Therefore, in order to suggest a personalized diet to the specific needs of those who request it, first of all an anamnesis is necessary that includes the history of the patient from conception and takes into account previous pathologies and their familiarity. If, moreover, one wishes to modify his diet, we must know his behaviors and the motivations underlying those behaviors, whether the person has self-esteem and how he sees and judges his physical appearance – body image is not what the mirror reflects but what the individual has developed in his brain following his experiences and situations in his life.

If, therefore, we want to correct a wrong diet, we must know how and when the individual makes mistakes and, to know this, a food anamnesis is necessary, which is usually carried out through a food diary of one or more weeks, from which the doctor can see if the diet is balanced in the various macronutrients (carbohydrates, lipids, proteins), if the contributions of the various minerals and vitamin and/or antioxidant substances are present and sufficient, if hydration is respected during the day and, finally, if the calories ingested are equivalent to those spent for metabolic activity and physical or sports exercise.

Eating behavior varies from individual to individual not only in qualitative and quantitative terms but also in relation to specific psychosocial situations: there are those who eat continuously during the day, those who eat only once or twice in 24 hours, those who empty the refrigerator during the night and only realize it is empty the next morning, those who binge without being able to stop due to lack of satiety signals, those who are always hungry and those who do not have enough when they should. Any dietary advice provided without these necessary information is not only wrong but can be downright dangerous.

It is different to give advice for a correct diet to healthy people or to educate young people about a balanced and varied diet. Even in this case, science has taken the trouble to conduct very long and difficult experiments because they had to involve entire populations for periods of several years. From these studies, conducted in different countries of the world, by measuring the relationships between eating habits and the prevalence of various pathologies, it was possible to indicate the characteristics of a diet, or rather of a lifestyle associated with greater longevity and lower morbidity and mortality. This diet corresponds to what has been called the “Mediterranean diet”, which has been internationally recognized as the healthiest and designated, also for this reason, as an intangible heritage of humanity.

It was born after the war to answer a question from the Americans who, interested in knowing why the Italians had a longer life expectancy than theirs, sent some scientists to Italy – including Ancel Keys who, together with other Italians, including Flaminio Fidanza and Mario Mancini, are considered the fathers of the “Mediterranean diet.” Thanks to their research published in the famous “Seven country study” the characteristics of the diet associated with a lower incidence of cardiovascular diseases and therefore mortality were identified. Many thousands of other studies have confirmed that the dietary characteristics associated with greater longevity are: moderate consumption of eggs, cheeses, red meats, sausages and animal fats; more abundant consumption of fish, whole grains, vegetables, legumes, extra virgin olive oil, fresh fruit and nuts.

Passed down from mother to daughter for several generations, today Italians are losing adherence to the characteristics of the “Mediterranean diet” due to many factors including advertising, created to induce eating behaviors not related to well-being but to the economic interest of those who produce them, confusion, linked to an excess of irrational messages sponsored and disseminated by the mass media to attract audience, the lack of a nutritional culture of those who should educate young people and above all the failure of the Institutions to adopt policies aimed at changing this situation.

In conclusion, talking about diet today does not simply mean simplistically classifying foods as good or bad, but judging the goodness and correctness of eating behaviors made not only from qualitative choices but also from more or less abundant portions, from frequencies of intake in each meal, within the daily or weekly scope and from the variety of foods taken respecting the balance between the various nutrients. It may seem complicated but it is enough to learn from those who know and are also capable of teaching.