Food Practices and Social Determinants: The Dietary Fructose Project

Why does obesity follow the fault lines of social inequality? Why do people who know exactly what they should eat so often fail to eat accordingly? And why does the neighbourhood you live in shape your chances of developing a chronic disease as powerfully as your genes? This book argues that obesity — one of the most consequential public health challenges of our time — cannot be understood through a biomedical lens alone. Drawing on two original research projects conducted across five Italian cities (Bari, Naples, Novara, Pisa, and Rome), it shows how social stratification, urban environments, cultural norms, and territorial inequalities combine to produce the unequal distribution of obesity we observe in contemporary Italy. The SIDERALE Project reveals that vulnerability to disease is not only measurable through clinical markers, but lived through stigma, fatigue, care burdens, and the everyday constraints that make self-care structurally difficult. The Dietary Fructose Project uncovers a persistent gap between nutritional knowledge and dietary practice — and identifies a blind spot at its heart: the widespread misclassification of fruit-based sugars as nutritionally safe, a gap that persists across clinical populations and the general public alike. Together, these findings advance a new conceptual framework. Vulnerability must be understood as both measured and lived. Nutritional awareness must be understood as both declared and practised. And obesity itself must be understood as a socially embedded condition — produced not by individual failure, but by the unequal conditions in which people live, eat, and care for themselves and their families. Combining sociological theory, social epidemiology, urban studies, and original mixed-methods research, this volume offers an accessible account of what it means to take social inequality seriously in the study of chronic disease. It speaks to researchers, public health professionals, clinicians, and policymakers who believe that effective responses to obesity require not only medical knowledge, but structural change.