It is available, it is just not common, I'm from Sardinia, in my province ( Oristano: an area of 3000 square km) there's only 1 McDonald's, and only teens go there. If you don't live in the main city, a trip to McDonald's can take easily 1 hour or more.

We dove a lot of pizza places, but it is Italian pizza and it is not as caloric as the American version, ours is made with 200grams of dough and has less stuffing as possible, one pizza should be around 800kcal and majority of people I know usually eats 3/4 of it and leaves the remaining 1/4 for the day after