The Mediterranean diet is only superficially close to the American one. It would be more accurate to speak of separate lifestyles than diets. The relationship to food that Americans have is almost completely alien to what most Italians experience, although with the spread of American culture this might not last beyond a few generations.

It's a bit like what used to be called the 'French paradox' in that American observers mistook a tradition of rich foods as the constant ingestion of such food.