Bulgaria is struggling to fight obesity because its institutions fail to collect reliable data. Insufficient data is masking the scale of the problem, says paediatrician and child rheumatologist Dr Tanya Andreeva.
Andreeva, an obesity researcher, told Euractiv that according to a World Health Organisation (WHO) report on school-age children’s health behaviour, Bulgarian children rank among the top in Europe for overweight and obesity, following North Macedonia, Malta and Portugal.
The rates are particularly alarming among those aged 11 to 13. In Bulgaria, 37% of boys and 24% of girls are obese at the age of 11. By age 13, the share of obese girls drops to 17%, while the proportion among boys remains unchanged.
“A worrying finding in the WHO report is that more than 30% of Bulgaria’s data is missing,” Andreeva said.
Bulgarian data ‘desert’
In October, the European Federation of Pharmaceutical Industries and Associations (EFPIA) released a special report titled “A Blueprint for Action to Address Obesity in the EU”, which urges the European Commission to encourage the exchange of obesity-related data between Member States.
The report advises the Commission to “introduce timely, routine and systematic data collection of the number of people living with obesity and monitor the progress and effectiveness of public health, clinical and health services policy interventions.”
Even if the European Commission were to follow this advice by financing obesity research through national health and research programmes under EU4Health and Horizon Europe, Bulgaria currently has little to contribute.
“The prevalence of childhood obesity in Bulgaria varies significantly, between 4% and 32%, due to the lack of a unified measurement methodology,” says Dr Andreeva, criticising local institutions for their near-total lack of engagement with the issue.
She explains that the significant variation in official data makes it impossible to draw reliable conclusions, identify trends, make projections or plan evidence-based interventions to curb overweight and obesity.
Fighting chronic conditions
“Early identification of children at risk of [being] overweight and obesity is key to prevention and management and helps avert the development of many socially significant diseases in adulthood,” she says.
Controlling obesity is a major preventive measure against chronic diseases such as type 2 diabetes, hypertension, liver steatosis, and increased cardiovascular risk.
The report “(Un)Defeated Pandemics – Obesity” estimates Bulgaria’s total economic costs linked to obesity at over €3.25 billion per year.
According to the Global Obesity Observatory, Bulgaria spends the highest share of GDP in the world on obesity-related costs — 4.7% of GDP in 2019. If no action is taken, this figure is projected to exceed 7% of GDP by 2060.
“Direct medical costs, such as treatment, outpatient care and reimbursed medication related to obesity, exceed €130 million in 2024, while the total economic burden is around €6 billion,” Dr Andreeva notes.
EU-wide crisis
A UNICEF report similarly ranks Bulgaria among the European countries with the highest levels of childhood obesity, with nearly one in three children being overweight – a finding that echoes WHO data.
“Given the heavy economic burden, investments in the prevention and treatment of overweight and obesity should be seen not as healthcare costs but as strategic economic investments with a high return potential,” Dr Andreeva argues.
The EFPIA report shows that in 2022, obesity rates in the EU increased gradually with age, peaking at around 20% among those aged 65–74 and 15% among adults aged 18–64.
Researchers estimate that by 2030, more than 30% of Europeans will be living with obesity, with the direct and indirect costs to healthcare systems potentially reaching €1.6 trillion if no holistic action is taken.
[VA, BM]
