(updated in August 2026)
For some time now, I have been on a mission to find good trofie. The search began after lunch with an Italian friend, who told me that one of the things she was most looking forward to during her summer in Italy was eating plenty of it.
Trofie is the short, twisted pasta from Liguria that pesto is traditionally served with. Its distinctive shape, including the little tapered ends, is perfect for holding onto the sauce.
Neither of the supermarkets near us carried it, but I eventually found some in a shop in Tiong Bahru, at a price that would probably surprise anyone from Genoa.
I mention this because it illustrates something important about the assumptions we often make when we think about moving to, or retiring in, Italy.
Here I am, around six thousand miles from Liguria, and with a little persistence and a little passion, I can still cook up a simple Ligurian dinner on a Tuesday evening. At the same time, in Campania, where the ingredients and culinary traditions are much closer at hand, 43.2% of eight-year-olds are now overweight or obese.
Where we live no longer determines what we eat as much as it once did. This is true both inside and outside Italy, and it is worth keeping in mind when we consider the idea that moving to Italy will automatically lead to a healthier life.
The promise, and the reality behind it
Most articles about retiring in Italy eventually paint a familiar picture: olive groves, long lunches and a ninety-four-year-old nonna who is still tending her garden.
It is a lovely image, and there is some truth behind it. But it can also create the impression that Italy is a healthy lifestyle we can simply move into, as though buying a home in Puglia might achieve what years of conscious habits could not.
That assumption deserves a closer look.
The Mediterranean diet itself has stronger evidence behind it than almost any other dietary pattern. What is less certain is the idea that living in Italy naturally leads people to follow it.
In fact, the country that gave the Mediterranean diet its name has gradually been moving away from it for around forty years. The shift has been particularly pronounced in parts of southern Italy, the same areas where lower property prices, retirement incentives and lifestyle marketing are encouraging people to settle.
This is not a reason not to move. It is simply a reason to make the decision with a fuller understanding of what daily life may actually involve.
What the evidence tells us
One of the strongest studies supporting the Mediterranean diet is PREDIMED, a Spanish randomized trial involving 7,447 older adults at high cardiovascular risk.
Participants followed one of three approaches: a Mediterranean diet supplemented with free extra virgin olive oil, the same diet supplemented with nuts, or a low-fat control diet. They were followed for a median of 4.8 years.
The results, published in the New England Journal of Medicine, showed an approximately 30% relative reduction in heart attack, stroke and cardiovascular death.
There are two important points to understand about this figure.
First, the original study was retracted and later republished. In 2018, concerns were raised about whether all participants had been properly randomized. The authors subsequently found problems affecting 1,588 participants, or around 21% of the study population.
The paper was withdrawn, reanalyzed and republished, with broadly similar conclusions. This is an example of the scientific process correcting itself, rather than a reason to dismiss the findings. However, it is still important context, particularly as some researchers believe the effect could be smaller if the data were independently reanalyzed.
Second, the 30% figure describes a relative reduction. The absolute event rates were 3.8% in the olive oil group and 4.5% in the control group over almost five years, a difference of slightly less than one percentage point.
Put another way, more than one hundred high-risk people would need to follow the diet for five years to prevent one heart attack or stroke.
That may sound modest, but it is still meaningful. There are relatively few interventions available to older adults that are enjoyable, affordable, low-risk and potentially protective at the same time.
Looking more carefully at the Blue Zones
Another idea often associated with retirement in Italy is the concept of the Blue Zone. Sardinia is frequently described as one of the original Blue Zones, where unusually large numbers of people are said to live to one hundred and beyond.
In recent years, however, some of the evidence behind these claims has been questioned.
The demographer Saul Justin Newman received the first Ig Nobel Prize in Demography in 2024, an award given to published research that makes people laugh and then think, for work suggesting that the strongest predictors of reported supercentenarian status were not necessarily diet or genetics. They included less obvious factors such as poverty, illiteracy and incomplete birth records.
Newman traced roughly 80% of the world’s documented 110-year-olds and found that almost none had a birth certificate. Italy has also had historical problems with inaccurate pension records, including the discovery in 1997 of around thirty thousand pensions still being claimed on behalf of people who had died.
Another useful point of reference is regional life expectancy. When Eurostat began tracking old-age life expectancy in 1990, Sardinia ranked 51st out of 128 European regions. It was not an outlier, but closer to the middle of the group.
None of this suggests that Sardinians are unhealthy or that Sardinia is not a wonderful place to live. It just means that the centenarian data may not be strong enough to serve as the foundation for a retirement decision.
The lifestyle may still be attractive. It’s just that the statistics should be treated with more care.
Italy is moving away from the Mediterranean diet
Probably the most important point is that adherence to the traditional Mediterranean diet has been declining across the Mediterranean region for decades, including in Italy.
A cohort study in Castellana Grotte, in Puglia, compared eating patterns in the town between 1985–1986 and 2005–2006. It found that adherence to the Mediterranean diet had fallen in every age group, with the largest decline among younger people. The most significant change was a reduction in olive oil consumption.
A 2026 review by Temple University’s Domenico Praticò describes this as the “Mediterranean diet paradox”: the diet is attracting more followers around the world while becoming less common in the countries where it originated.
The effects can already be seen in children.
Italy’s national surveillance program, OKkio alla Salute, measures the weight and height of eight- and nine-year-olds across every region. In 2023, 19.0% of children nationally were overweight and 9.8% were obese.
The regional differences were considerable. In Campania, 24.6% were overweight and 18.6% were obese, meaning that 43.2% were carrying excess weight. In the province of Bolzano, the equivalent figure was 15.3%.
Children growing up in the historic heartland of the Mediterranean diet are therefore almost three times as likely to be overweight as children in the German-speaking Alps.
Physical activity follows a similar pattern. Italy’s PASSI surveillance found that, in 2023–2024, 38% of adults in the South were sedentary, compared with 16% in the North. In Calabria, the figure was above 50%.
The image of Italians walking everywhere is not entirely inaccurate, but it is more characteristic of certain northern cities and urban communities. It may be less true in a small hill town where everyday services, including the pharmacy, are several miles away and easiest to reach by car.
The regional gap that deserves our attention
Italy’s overall life expectancy remains among the highest in the world. In 2024, it stood at 83.4 years.
However, national averages hide substantial regional differences. Life expectancy reached 84.7 years in the province of Trento and 84.6 in Bolzano, compared with 81.7 in Campania, 82.1 in Sicily and 82.3 in Calabria.
That is a difference of around three years within one country, and according to ISTAT, the gap has widened rather than narrowed over the past two decades.
For someone choosing where to retire, healthy life expectancy may be more relevant than total life expectancy. It measures the number of years a person can expect to live before chronic illness or disability significantly affects daily life.
On this measure, the regional gap is much larger. Bolzano records 69.7 healthy years at birth, compared with 53.4 in Calabria, 54.9 in Campania and 56.0 in Sicily. The national average is 58.1.
A difference of around sixteen healthy years is significant. It can shape not only how long people live, but also the quality and independence of their later years.
There is, of course, an important limitation to these figures. They describe populations who have lived in these regions throughout their lives, and their outcomes have been shaped by many factors: income, education, occupation, childhood nutrition and lifelong access to preventive care.
An American arriving at sixty-five with a pension, a history of regular healthcare and the resources to buy good food is not representative of the average resident of Calabria. They should not assume they will automatically experience the same outcomes.
That is an important caveat.
However, two aspects of regional life will affect a newcomer from the moment they arrive: the local food environment and the healthcare system.
What does transfer when you move
The food environment
Extra virgin olive oil has become increasingly expensive, and Italian households have responded much as households do everywhere.
After two years of record prices, Italy entered 2026 with continued volatility in the olive oil market. The agricultural agency Ismea recorded falling per-capita consumption in 2024, together with a shift toward more affordable alternatives.
The olive oil available in an average supermarket may therefore be very different from the artisanal bottle that often appears in photographs of Italian life.
The healthcare system
Italy has a national health service, but healthcare is administered regionally. This means that access and quality can vary significantly depending on where you live.
The Ministry of Health measures regional performance through its LEA scoring system. In the 2024 results, Calabria ranked last with a score of 189, followed by Molise at 192 and Sicily at 196, with Veneto and Emilia-Romagna among the highest-performing regions. The pattern is not purely a North-South one: Valle d’Aosta and the province of Bolzano also sit in the bottom eight, which is a reminder that small autonomous regions can struggle too.
The GIMBE Foundation’s analysis of the previous year’s data found that only three of the thirteen regions meeting the required standard were in southern Italy, and that the divide between North and South was not narrowing.
Hospital care remains relatively robust across much of the country. The greater weakness is often in prevention and community-based care, the services people are likely to rely on more frequently as they move through their seventies and beyond.
This is where several retirement considerations come together.
The 7% flat-tax regime for foreign pensioners applies only to smaller comuni in certain southern regions. Property prices are often lowest in these areas, and they feature prominently in retirement marketing.
At the same time, these regions tend to have lower adherence to the Mediterranean diet, higher childhood obesity, more sedentary adults, shorter healthy life expectancy and weaker community-based healthcare.
This does not mean that someone cannot retire very well in Calabria, Sicily, Campania or Puglia. Many people do.
It simply means that the benefits should not be assumed. Choosing the right town, and understanding the services available around it, becomes especially important.
What should you do with this information?
The Mediterranean diet is a set of habits, not a postcode.
Passing through immigration at Fiumicino does not automatically change what appears on your plate. People who eat well before moving are likely to continue eating well in Italy, perhaps with better ingredients and at a more reasonable cost. Those who do not already have those habits will still find supermarkets, delivery apps and ultra-processed foods readily available.
What may genuinely improve is access: fresher produce, closer to where it was grown, at prices that can make cooking from scratch feel easier and more natural.
That is a real advantage, and over twenty years it can make a meaningful difference. But it is still an opportunity rather than a guarantee.
Before committing to a particular comune, there are four practical questions worth considering. We plan to explore each of these in more detail, supported by data, in future articles.
How far is the nearest emergency department?
Consider the journey in winter driving conditions rather than during a summer visit. In practical terms, this may matter more than almost any question about the local diet.
How well does the region perform on healthcare?
Look beyond the overall LEA score and pay particular attention to the prevention and territorial-care components. These are the services that may have the greatest effect on everyday life in your seventies.
Can you reach good food easily?
Is there a covered market, greengrocer or working ortofrutta within walking distance, or are the nearest options a supermarket and a bar?
Will the town remain walkable for you as you age?
A hill town may be beautiful, but it may also be steep. Consider how manageable it would feel at eighty, perhaps with reduced mobility or a replaced hip.
When I finally found the trofie, it was excellent. It cost around four times what it would in Liguria, and I would happily buy it again.
That, in a way, is the point.
The Mediterranean diet is something we practice, not somewhere we live. It is worth following whether we eventually settle in Lecce or remain in New Jersey.
Italy may make those habits easier, more enjoyable and more affordable. But the diet itself is not a reason to move, and it should not be presented as something that comes automatically with an Italian address.
For those who have already made the move, we would be interested to know what has happened to your diet. Has it become better, worse or broadly similar, perhaps with the addition of better-quality tomatoes?
Write to us and let us know. We’d love to hear from you.
A note on the numbers. Regional life expectancy and healthy life expectancy figures come from ISTAT’s 2025 BES report, covering 2024. Healthcare scores come from the Ministry of Health’s LEA monitoring for 2024. Childhood weight data comes from the Istituto Superiore di Sanità’s OKkio alla Salute 2023 survey, which measures children directly rather than relying on what parents report.