This volume examines obesity as a socially embedded chronic condition whose population-level distribution reflects systematic inequalities in the structural, cultural, territorial, and clinical determinants of health. Drawing on the theoretical frameworks of fundamental causes theory (Link & Phelan, 1995; Phelan et al., 2010), ecosocial embodiment (Krieger, 2001, 2005), Bourdieu's theory of habitus and cultural capital (Bourdieu, 1984, 1986, 1990), Cockerham's health lifestyle theory (Cockerham, 2005, 2022), and the Dahlgren–Whitehead model of social determinants of health (Dahlgren & Whitehead, 1991, 2021), the volume develops an integrated analytical model capable of connecting clinical evidence, social inequalities, and territorial context within a unified interpretive framework. The empirical analysis is organised around two original research projects conducted across five Italian cities — Bari, Naples, Novara, Pisa, and Rome. The SIDERALE Project (PRIN 2021) investigates susceptibility to infectious diseases in individuals with obesity through a three-phase design combining a clinical survey (n=150), an online CAWI survey of the general population (n=260 valid completions), and qualitative interviews and focus groups. The Dietary Fructose Project (Fondazione Cariplo, 2021) examines nutritional practices, food awareness, and family representations in adolescents with obesity and in the wider Italian population through a dual quantitative design comprising a clinical survey and an online CAWI survey. Both designs are built on the same epistemological premise: that obesity must be analysed simultaneously as a clinical condition situated within healthcare pathways and as a social phenomenon embedded in the everyday practices, cultural classifications, and structural conditions of the wider population. The analysis advances two principal conceptual contributions. The first is the analytical distinction between measured vulnerability — reconstructed through clinical indicators including comorbidities, inflammatory markers, anthropometric data, and a composite susceptibility index (66.3% of the clinical sample in the medium-to-high range) — and lived vulnerability, which emerges from qualitative accounts of stigma, time scarcity, care burdens, and the everyday negotiation of chronic illness under conditions of structural constraint. The second is the distinction between declared nutritional awareness and practised dietary behaviour. The evidence documents a consistent and socially structured gap between the two across both samples: more than 70 per cent of online respondents in the Dietary Fructose survey fall into medium or low adherence to the Mediterranean diet despite reporting high levels of nutritional knowledge, and a systematic tendency to classify processed fruit-based products as nutritionally benign — here termed the fructose blind spot — is documented across clinical and general population groups. Both gaps are interpreted as structural phenomena shaped by the unequal distribution of material, temporal, and cultural resources, rather than as expressions of individual informational deficit or motivational inconsistency. The ecological analysis of the five Italian cities, conducted through secondary institutional data across socio-demographic, environmental-territorial, and health dimensions, establishes the territorial context for these findings and documents significant variation in the configuration of urban vulnerability across the North–South gradient — with overweight and obesity prevalence reaching 35.7 per cent in Naples and 31.1 per cent in Bari, compared with 20–24 per cent in Novara and Pisa. Among social predictors in the SIDERALE online survey, family cultural capital shows the most consistent inverse association with mean BMI — proving more robust than income — a finding consistent with the fundamental causes framework and with the interpretation that health-protective social advantage operates substantially through dispositional and symbolic channels. The volume contributes to the sociology of health inequalities by operationalising an integrated model in which clinical evidence, social determinants analysis, and territorial comparison are constitutively rather than additively combined. Its findings indicate that effective responses to obesity and related chronic NCDs require analytical frameworks and intervention designs that address the structural conditions producing health inequality, rather than focusing exclusively on clinical management or individual behavioural modification.
Health Inequalities, Urban Vulnerability and Obesity in Italy. Social Determinants and an Integrated Model of Analysis
LENZI, FRANCESCA ROMANA
2026-01-01
Abstract
This volume examines obesity as a socially embedded chronic condition whose population-level distribution reflects systematic inequalities in the structural, cultural, territorial, and clinical determinants of health. Drawing on the theoretical frameworks of fundamental causes theory (Link & Phelan, 1995; Phelan et al., 2010), ecosocial embodiment (Krieger, 2001, 2005), Bourdieu's theory of habitus and cultural capital (Bourdieu, 1984, 1986, 1990), Cockerham's health lifestyle theory (Cockerham, 2005, 2022), and the Dahlgren–Whitehead model of social determinants of health (Dahlgren & Whitehead, 1991, 2021), the volume develops an integrated analytical model capable of connecting clinical evidence, social inequalities, and territorial context within a unified interpretive framework. The empirical analysis is organised around two original research projects conducted across five Italian cities — Bari, Naples, Novara, Pisa, and Rome. The SIDERALE Project (PRIN 2021) investigates susceptibility to infectious diseases in individuals with obesity through a three-phase design combining a clinical survey (n=150), an online CAWI survey of the general population (n=260 valid completions), and qualitative interviews and focus groups. The Dietary Fructose Project (Fondazione Cariplo, 2021) examines nutritional practices, food awareness, and family representations in adolescents with obesity and in the wider Italian population through a dual quantitative design comprising a clinical survey and an online CAWI survey. Both designs are built on the same epistemological premise: that obesity must be analysed simultaneously as a clinical condition situated within healthcare pathways and as a social phenomenon embedded in the everyday practices, cultural classifications, and structural conditions of the wider population. The analysis advances two principal conceptual contributions. The first is the analytical distinction between measured vulnerability — reconstructed through clinical indicators including comorbidities, inflammatory markers, anthropometric data, and a composite susceptibility index (66.3% of the clinical sample in the medium-to-high range) — and lived vulnerability, which emerges from qualitative accounts of stigma, time scarcity, care burdens, and the everyday negotiation of chronic illness under conditions of structural constraint. The second is the distinction between declared nutritional awareness and practised dietary behaviour. The evidence documents a consistent and socially structured gap between the two across both samples: more than 70 per cent of online respondents in the Dietary Fructose survey fall into medium or low adherence to the Mediterranean diet despite reporting high levels of nutritional knowledge, and a systematic tendency to classify processed fruit-based products as nutritionally benign — here termed the fructose blind spot — is documented across clinical and general population groups. Both gaps are interpreted as structural phenomena shaped by the unequal distribution of material, temporal, and cultural resources, rather than as expressions of individual informational deficit or motivational inconsistency. The ecological analysis of the five Italian cities, conducted through secondary institutional data across socio-demographic, environmental-territorial, and health dimensions, establishes the territorial context for these findings and documents significant variation in the configuration of urban vulnerability across the North–South gradient — with overweight and obesity prevalence reaching 35.7 per cent in Naples and 31.1 per cent in Bari, compared with 20–24 per cent in Novara and Pisa. Among social predictors in the SIDERALE online survey, family cultural capital shows the most consistent inverse association with mean BMI — proving more robust than income — a finding consistent with the fundamental causes framework and with the interpretation that health-protective social advantage operates substantially through dispositional and symbolic channels. The volume contributes to the sociology of health inequalities by operationalising an integrated model in which clinical evidence, social determinants analysis, and territorial comparison are constitutively rather than additively combined. Its findings indicate that effective responses to obesity and related chronic NCDs require analytical frameworks and intervention designs that address the structural conditions producing health inequality, rather than focusing exclusively on clinical management or individual behavioural modification.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
