Bulgaria
- Overview
- Obesity prevalence
- Population breakdowns
- Drivers
- Comorbidities
- Health systems
- Policies
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National obesity risk *8/10This is a composite ‘obesity risk’ score (out of 10, the highest risk) based on obesity prevalence, rate of increase, likelihood of meeting the 2025 target, treatment indicator and childhood stunting levels.Childhood obesity risk *7.5/11This is a ‘risk score’ for each country’s likelihood of having or acquiring a major childhood obesity problem during the 2020s, taking account of current prevalence levels and risk for future obesity (based on stunting among infants, maternal obesity, maternal smoking, and breastfeeding rates).
* Based on estimated data. For more information see Publications
Obesity prevalence
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Drivers
Insufficient activity
Sugar consumption
Soft drink consumption
Confectionery consumption
Sweet/savoury snack consumption
Fruit consumption
Vegetable consumption
Processed meat consumption
Grains consumption
Depression
Anxiety
Roots of obesity »
Like all chronic diseases, the root causes/drivers of obesity are complex. Select here to view 'other' root causes/drivers.Download report card
Comorbidities
Health systems
Obesity prevalence
Adults, 2019
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | Eurostat 2019. Data available at https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 09.08.21) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 2019-2020
| Survey type: | Self-reported |
| Age: | 15+ |
| Sample size: | 6410 |
| Area covered: | National |
| References: | EHIS 2019 Preliminary Results Bulgaria. Available at: https://www.nsi.bg/en/content/18648/preliminary-data. Last accessed: 02.06.21. |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 2017
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | EUROSTAT Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_hch10&lang=en |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 2014
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 2004
| Survey type: | Measured |
| Age: | 20+ |
| Sample size: | 1031 |
| Area covered: | National |
| References: | S. Petrova, K. Angelova (2006) Scientific background of Food-Based Dietary Guidelines for Bulgarians. Advances in Bulgarian Science, 4, pp.19 - 33. |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 1994
| Survey type: | Measured |
| Age: | 25-74 |
| Sample size: | 1996 |
| References: | WHO Infobase Ref:Vasilevski N, Tulevski B, Vukov M, Ilieva P, Marinova P, Iordaiov L. Risk factors and health of the population aged 25-64 years in the demonstration area Lovech of the Programme CINDI-Bulgaria. 1998 |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Children, 2015-2017
| Survey type: | Measured |
| Age: | 7 |
| Sample size: | 3,386 |
| Area covered: | National |
| References: | WHO European Childhood Obesity Surveillance Initiative (COSI) Report on the fourth round of data collection, 2015–2017 (2021). Available at: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/activities/who-european-childhood-obesity-surveillance-initiative-cosi/cosi-publications/who-european-childhood-obesity-surveillance-initiative-cosi-report-on-the-fourth-round-of-data-collection,-20152017-2021. Accessed 19.05.21. |
| Cutoffs: | WHO |
Children, 2011
| Survey type: | Measured |
| Age: | 6-9 |
| Sample size: | 4360 |
| Area covered: | National |
| References: | Rangelova L, Petrova S, Konstantinova M, Duleva V, Dimitrov P. Overweight and obesity prevalence in Bulgarian schoolchildren: Acomparison between two international standards. International Journal of Biomedical And Advance Research (2014) ISSN: 2229-3809 (Online) |
| Notes: | NB. Combined child data estimated. These estimates were calculated by weighting male and female survey results. Weighting based on World Bank Population % total female 2019 (https://data.worldbank.org/indicator/SP.POP.TOTL.FE.ZS - accessed 21.10.20)' |
| Cutoffs: | IOTF |
Children, 2007-2008
| Survey type: | Measured |
| Age: | 7 |
| Sample size: | 2917 |
| Area covered: | National |
| References: | Lissner L, Wijnhoven TMA, Mehlig K, et al. Socioeconomic inequalities in childhood overweight: heterogeneity across five countries in the WHO European Childhood Obesity Surveillance Initiative (COSI–2008). International Journal of Obesity (2005). 2016;40(5):796-802. doi:10.1038/ijo.2016.12. |
| Notes: | WHO Cut-offs |
| Cutoffs: | WHO |
Children, 2007-2013
| Survey type: | Measured |
| Age: | 7 |
| Sample size: | 5848 |
| Area covered: | National |
| References: | Spinelli et al (2019). 'Childhood Severe Obesity in Europe', Obes Facts.12, pp. 244–258. (Data from COSI round 1-3) |
| Notes: | NOTE - this data is from COSI round I and III (2007 - 2013) IOTF cut-offs used. |
| Cutoffs: | IOTF |
Children, 2004
| Survey type: | Measured |
| Age: | 5-17 |
| Sample size: | 1326 |
| Area covered: | National |
| References: | Petrova S. (2005). Current problems in nutrition of children in Bulgaria. GP News, 12: 5 - 8. |
| Notes: | IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3. |
| Cutoffs: | IOTF |
Boys, 2000
| Survey type: | Measured |
| Age: | 7-12 |
| Sample size: | 1202 |
| References: | Personal communication from Maria Konstantinova |
| Notes: | 90/97th centile cut off |
| Cutoffs: | Other |
Children, 1998
| Survey type: | Measured |
| Age: | 7-17 |
| Sample size: | 6655 |
| Area covered: | National |
| References: | Petrova S, Vatralova Kr, Ivanova L, et al. (2001). National Survey of Dietary and Nutritional Status of schoolchildren in Bulgaria. Anthropometric Nutritional status of schoolchildren aged 7 - 10 years. Hygiene and Public Health, vol XIV in press. (2) Petrova S, Vatralova Kr, Ivanova L, et al. (2001). National Survey of Dietary and Nutritional Status of schoolchildren in Bulgaria. Anthropometric Nutritional status of schoolchildren aged 10 - 18 years. Hygiene and Public Health, vol XIV. |
| Notes: | IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3. |
| Cutoffs: | IOTF |
Overweight/obesity by age and education
Adults, 2019
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2019. Available at https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 09.08.21). |
| Notes: | Insufficient sample size in 18-24 when broken down by gender and education |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Men, 2019
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2019. Available at https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 09.08.21). |
| Notes: | Insufficient sample size in 18-24 when broken down by gender and education |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2019
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2019. Available at https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 09.08.21). |
| Notes: | Insufficient sample size in 18-24 when broken down by gender and education |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Men, 2017
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_hch10&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2017
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_hch10&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Men, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Overweight/obesity by education
Men, 2014
| Survey type: | Self-reported |
| Age: | 18+ |
| Sample size: | Total sample size in EU = 35100 (Age 18+) |
| Area covered: | National |
| References: | Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 9 November 2016) |
| Notes: | Less than primary, primary and lower secondary education (levels 0-2) Upper secondary and post-secondary non-tertiary education (levels 3 and 4) Tertiary education (levels 5-8) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2014
| Survey type: | Self-reported |
| Age: | 18+ |
| Sample size: | Total sample size in EU = 35100 (Age 18+) |
| Area covered: | National |
| References: | Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 9 November 2016) |
| Notes: | Less than primary, primary and lower secondary education (levels 0-2) Upper secondary and post-secondary non-tertiary education (levels 3 and 4) Tertiary education (levels 5-8) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Men, 2008
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | http://ec.europa.eu/eurostat/web/health/health-status-determinants/data/database# (last accessed 17th July 2015) |
| Notes: | Definitions: Level 0-2 = Pre-primary, primary and lower secondary education, Level 3-4 = Upper secondary and post-secondary non-tertiary education, Level 5-6 = First and second stage of tertiary education. |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2008
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | http://ec.europa.eu/eurostat/web/health/health-status-determinants/data/database# (last accessed 17th July 2015) |
| Notes: | Definitions: Level 0-2 = Pre-primary, primary and lower secondary education, Level 3-4 = Upper secondary and post-secondary non-tertiary education, Level 5-6 = First and second stage of tertiary education. |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Boys, 2012-2014
| Survey type: | Measured |
| Age: | 8-15 |
| Sample size: | 881 |
| Area covered: | Smolyan region |
| References: | Mladenova S, Andreenko E. Influence of socio-economic and demographic factors, feeding and physical activity on nutritional status of 8-15-year-old Bulgarian children and adolescents: preliminary results. Nutr Hosp. 2015;32(6):2559-2569. |
| Notes: | Prevalence of obesity and overweight by Mother's level of Education. IOTF cut-off points used. |
| Cutoffs: | IOTF |
Girls, 2012-2014
| Survey type: | Measured |
| Age: | 8-15 |
| Sample size: | 881 |
| Area covered: | Smolyan region |
| References: | Mladenova S, Andreenko E. Influence of socio-economic and demographic factors, feeding and physical activity on nutritional status of 8-15-year-old Bulgarian children and adolescents: preliminary results. Nutr Hosp. 2015;32(6):2559-2569. |
| Notes: | Prevalence of obesity and overweight by Mother's level of Education. IOTF cut-off points used. |
| Cutoffs: | IOTF |
Boys, 2012-2014
| Survey type: | Measured |
| Age: | 8-15 |
| Sample size: | 881 |
| Area covered: | Smolyan region |
| References: | Mladenova S, Andreenko E. Influence of socio-economic and demographic factors, feeding and physical activity on nutritional status of 8-15-year-old Bulgarian children and adolescents: preliminary results. Nutr Hosp. 2015;32(6):2559-2569. |
| Notes: | Prevalence of obesity and overweight by Father's level of Education. IOTF cut-off points used. |
| Cutoffs: | IOTF |
Girls, 2012-2014
| Survey type: | Measured |
| Age: | 8-15 |
| Sample size: | 881 |
| Area covered: | Smolyan region |
| References: | Mladenova S, Andreenko E. Influence of socio-economic and demographic factors, feeding and physical activity on nutritional status of 8-15-year-old Bulgarian children and adolescents: preliminary results. Nutr Hosp. 2015;32(6):2559-2569. |
| Notes: | Prevalence of obesity and overweight by Father's level of Education. IOTF cut-off points used. |
| Cutoffs: | IOTF |
Overweight/obesity by age
Adults, 2019
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2019. Available at https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 09.08.21). |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 2019-2020
| Survey type: | Self-reported |
| Sample size: | 6410 |
| Area covered: | National |
| References: | EHIS 2019 Preliminary Results Bulgaria. Available at: https://www.nsi.bg/en/content/18648/preliminary-data. Last accessed: 02.06.21. |
| Notes: | Percentage of 15-24 year olds living with obesity data is missing. |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 2017
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_hch10&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 2004
| Survey type: | Measured |
| Sample size: | 1031 |
| Area covered: | National |
| References: | S. Petrova, K. Angelova (2006) Scientific background of Food-Based Dietary Guidelines for Bulgarians. Advances in Bulgarian Science, 4, pp.19-33 |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Children, 2017-2018
| Survey type: | Measured |
| Sample size: | 4548 |
| Area covered: | National |
| References: | World Health Organization (2020). Spotlight on adolescent health and well-being - Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. Available at: https://apps.who.int/iris/bitstream/handle/10665/332091/9789289055000-eng.pdf. Last accessed: 20.05.21. |
| Cutoffs: | WHO |
Children, 2004
| Survey type: | Measured |
| Sample size: | 1059 |
| Area covered: | National |
| References: | Petrova S. (2005). Current problems in nutrition of children in Bulgaria. GP News, 12: 5 - 8. |
| Cutoffs: | IOTF |
Children, 1998
| Survey type: | Measured |
| Sample size: | 6115 |
| Area covered: | National |
| References: | Provided by personal communication from S Petrova. Published in S. Petrova, Kr. Vatralova, L. Ivanova et al. National Survey of Dietary and Nutritional Status of Schoolchildren in Bulgaria. Anthropometric Nutritional Status of schoolchildren aged 7-10 years. Hygiene and Public Health, 2001, vol. XIV 2) S. Petrova, Kr. Vatralova, L. Ivanova et al. National Survey of Dietary and Nutritional Status of Schoolchildren in Bulgaria. Anthropometric Nutritional Status of Schoolchildren aged 10-18 years. Hygiene and Public Health, 2001, vol. XIV, |
| Cutoffs: | IOTF |
Overweight/obesity by age and region
Men, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1u&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1u&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Overweight/obesity by age and socio-economic group
Adults, 2019
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2019. Available at https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 09.08.21). |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Men, 2019
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2019. Available at https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 09.08.21). |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2019
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2019. Available at https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 09.08.21). |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Adults, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Men, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat Database http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 25.08.20) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Overweight/obesity by socio-economic group
Men, 2014
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | EUROSTAT Database: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 9 November 2016) |
| Notes: | Total sample number in EU: 35100 (Age 18+) 1st Quintile (lowest income), 5th Quintile (highest income) Please note where data = zero, there were insufficient data. |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2014
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | EUROSTAT Database: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 9 November 2016) |
| Notes: | Total sample number in EU: 35100 (Age 18+) 1st Quintile (lowest income), 5th Quintile (highest income) Please note where data = zero, there were insufficient data. |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Men, 2008
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | http://ec.europa.eu/eurostat/web/health/health-status-determinants/data/database# (last accessed 17th July 2015) |
| Notes: | SES assessed using annual income |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2008
| Survey type: | Self-reported |
| Age: | 18+ |
| Area covered: | National |
| References: | http://ec.europa.eu/eurostat/web/health/health-status-determinants/data/database# (last accessed 17th July 2015) |
| Notes: | SES assessed using annual income |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Boys, 2017-2018
| Survey type: | Self-reported |
| Age: | 11-15 |
| Sample size: | 4548 |
| Area covered: | National |
| References: | World Health Organization (2020). Spotlight on adolescent health and well-being - Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. Available at: https://apps.who.int/iris/bitstream/handle/10665/332091/9789289055000-eng.pdf. Last accessed: 20.05.21. |
| Notes: | HBSC Family Affluence Scale (FAS) - "HBSC uses an alternative measure, the Family Affluence Scale, which asks young people about material assets such as family cars, number of foreign holidays, computers, bathrooms and dishwashers in the household, holidays and having a bedroom to oneself. The scale, which enables users to add up how many of these assets a young person has in their home compared with other adolescents in their country/region, has been shown to provide a valid indicator of relative affluence." |
| Definitions: | HBSC Family Affluence Scale (FAS) |
| Cutoffs: | WHO |
Girls, 2017-2018
| Survey type: | Self-reported |
| Age: | 11-15 |
| Sample size: | 4548 |
| Area covered: | National |
| References: | World Health Organization (2020). Spotlight on adolescent health and well-being - Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. Available at: https://apps.who.int/iris/bitstream/handle/10665/332091/9789289055000-eng.pdf. Last accessed: 20.05.21. |
| Notes: | HBSC Family Affluence Scale (FAS) - "HBSC uses an alternative measure, the Family Affluence Scale, which asks young people about material assets such as family cars, number of foreign holidays, computers, bathrooms and dishwashers in the household, holidays and having a bedroom to oneself. The scale, which enables users to add up how many of these assets a young person has in their home compared with other adolescents in their country/region, has been shown to provide a valid indicator of relative affluence." |
| Definitions: | HBSC Family Affluence Scale (FAS) |
| Cutoffs: | WHO |
Overweight/obesity by age and limited activity
Adults, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2014 available at https://appsso.eurostat.ec.europa.eu/nui/submitViewTableAction.do (last accessed 06.10.21) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Women, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2014 available at https://appsso.eurostat.ec.europa.eu/nui/submitViewTableAction.do (last accessed 06.10.21) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Men, 2014
| Survey type: | Self-reported |
| Area covered: | National |
| References: | Eurostat 2014 available at https://appsso.eurostat.ec.europa.eu/nui/submitViewTableAction.do (last accessed 06.10.21) |
| Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m². | |
Insufficient physical activity
Adults, 2016
| References: | Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7 |
Men, 2016
| References: | Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7 |
Women, 2016
| References: | Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7 |
Children, 2016
| Survey type: | Self-reported |
| Age: | 11-17 |
| References: | Global Health Observatory data repository, World Health Organisation, https://apps.who.int/gho/data/node.main.A893ADO?lang=en (last accessed 16.03.21) |
| Notes: | % of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily. |
| Definitions: | % Adolescents insufficiently active (age standardised estimate) |
Boys, 2016
| Survey type: | Self-reported |
| Age: | 11-17 |
| References: | Global Health Observatory data repository, World Health Organisation, https://apps.who.int/gho/data/node.main.A893ADO?lang=en (last accessed 16.03.21) |
| Notes: | % of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily. |
| Definitions: | % Adolescents insufficiently active (age standardised estimate) |
Girls, 2016
| Survey type: | Self-reported |
| Age: | 11-17 |
| References: | Global Health Observatory data repository, World Health Organisation, https://apps.who.int/gho/data/node.main.A893ADO?lang=en (last accessed 16.03.21) |
| Notes: | % of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily. |
| Definitions: | % Adolescents insufficiently active (age standardised estimate) |
Children, 2010
| Age: | 11-17 |
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en |
| Notes: | % of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily. |
| Definitions: | % Adolescents insufficiently active (age standardised estimate) |
Boys, 2010
| Age: | 11-17 |
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en |
| Notes: | % of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily. |
| Definitions: | % Adolescents insufficiently active (age standardised estimate) |
Girls, 2010
| Age: | 11-17 |
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en |
| Notes: | % of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily. |
| Definitions: | % Adolescents insufficiently active (age standardised estimate) |
Sugar consumption
Adults, 2016
| References: | Source: Euromonitor International |
| Definitions: | Sugar consumption (Number of 500g sugar portions/person/month) |
Estimated per capita sugar sweetened beverages intake
Adults, 2016
| References: | Source: Euromonitor International |
Prevalence of at least daily carbonated soft drink consumption
Children, 2014
| Survey type: | Measured |
| References: | World Health Organization. (2017). Adolescent obesity and related behaviours: Trends and inequalities in the who european region, 2002-2014: observations from the Health Behavior in School-aged Children (HBSC) WHO collaborative cross-national study (J. Inchley, D. Currie, J. Jewel, J. Breda, & V. Barnekow, Eds.). World Health Organization. Sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org |
| Notes: | 15-year-old adolescents |
| Definitions: | Prevalence of at least daily carbonated soft drink consumption (% of at least daily carbonated soft drink consumption) |
Prevalence of confectionery consumption
Adults, 2016
| References: | Source: Euromonitor International |
| Definitions: | Prevalence of confectionery consumption (Number of 50g confectionery portions/person/month) |
Prevalence of sweet/savoury snack consumption
Adults, 2016
| References: | Source: Euromonitor International |
| Definitions: | Prevalence of sweet/savoury snack consumption (Number of 35g sweet/savoury snack portions/person/month) |
Estimated per capita fruit intake
Adults, 2017
| Survey type: | Measured |
| Age: | 25+ |
| References: | Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/ |
| Definitions: | Estimated per-capita fruit intake (g/day) |
Prevalence of less than daily fruit consumption
Children, 2014
| Survey type: | Measured |
| References: | Global School-based Student Health Surveys. Beal et al (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287. Sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system |
| Definitions: | Prevalence of less-than-daily fruit consumption (% less-than-daily fruit consumption) |
Prevalence of less than daily vegetable consumption
Children, 2014
| Survey type: | Measured |
| Age: | 12-17 |
| References: | Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system |
| Definitions: | Prevalence of less-than-daily vegetable consumption (% less-than-daily vegetable consumption) |
Estimated per-capita processed meat intake
Adults, 2017
| Survey type: | Measured |
| Age: | 25+ |
| References: | Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/ |
| Definitions: | Estimated per-capita processed meat intake (g per day) |
Estimated per capita whole grains intake
Adults, 2017
| Survey type: | Measured |
| Age: | 25+ |
| References: | Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/ |
| Definitions: | Estimated per-capita whole grains intake (g/day) |
Mental health - depression disorders
Adults, 2015
| References: | Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. |
| Definitions: | % of population with depression disorders |
Mental health - anxiety disorders
Adults, 2015
| References: | Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. |
| Definitions: | % of population with anxiety disorders |
Oesophageal cancer
Men, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000 |
Women, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000 |
Breast cancer
Women, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, breast, females, ages 20+. ASR (World) per 100,000 |
Colorectal cancer
Men, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000 |
Women, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000 |
Pancreatic cancer
Men, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000 |
Women, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000 |
Gallbladder cancer
Men, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000 |
Women, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000 |
Kidney cancer
Men, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000 |
Women, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000 |
Cancer of the uterus
Women, 2018
| Age: | 20+ |
| References: | Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020) |
| Definitions: | Estimated age-standardized incidence rates (World) in 2018, cervix uteri, females, ages 20+. ASR (World) per 100,000 |
Raised blood pressure
Adults, 2015
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en |
| Definitions: | Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90). |
Men, 2015
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en |
| Definitions: | Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90). |
Women, 2015
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en |
| Definitions: | Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90). |
Raised cholesterol
Adults, 2008
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885 |
| Definitions: | % Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate). |
Men, 2008
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885 |
| Definitions: | % Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate). |
Women, 2008
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885 |
| Definitions: | % Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate). |
Raised fasting blood glucose
Men, 2014
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en |
| Definitions: | Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication). |
Women, 2014
| References: | Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en |
| Definitions: | Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication). |
Diabetes prevalence
Adults, 2019
| Age: | 20-79 |
| References: | Reproduced with kind permission International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels,Belgium: 2019. Available at: https://www.diabetesatlas.org |
| Definitions: | Diabetes age-adjusted comparative prevalence (%). |
Adults, 2017
| References: | Reproduced with kind permission of IDF, International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium: International Diabetes Federation, 2017. http://www.diabetesatlas.org |
| Definitions: | Diabetes age-adjusted comparative prevalence (%). |
Health systems
Economic classification: Upper Middle Income
Health systems summary
Over the last 30 years, the healthcare system in Bulgaria has undergone significant change. In 1998, the Government introduced the National Health Insurance Fund, a mandatory social health insurance that is primarily sustained by contributions from employers and employees. All individuals are required by law to purchase insurance and have a right to access care, but insurance coverage is lost if 3 payments are missed in 36 months. The Government makes contributions on behalf of much of the non-working population such as the elderly, the unemployed and their dependents, but many are not aware of their entitlements.
Overall funding for the health system is insufficient. Bulgaria has one of the smallest healthcare budgets in Europe and in 2017 it was estimated to have fourth lowest healthcare spending per capita in the EU. This means that in practice, much healthcare is paid for directly by the patient. In 2017, it was estimated that out of pocket spending was approximately 46.6% (the highest in the EU).
Indicators
| Where is the country’s government in the journey towards defining ‘Obesity as a disease’? | No |
| Where is the country’s healthcare provider in the journey towards defining ‘Obesity as a disease’? | No |
| Is there specialist training available dedicated to the training of health professionals to prevent, diagnose, treat and manage obesity? | No |
| Have any taxes or subsidies been put in place to protect/assist/inform the population around obesity? | No |
| Are there adequate numbers of trained health professionals in specialties relevant to obesity in urban areas? | No |
| Are there adequate numbers of trained health professionals in specialties relevant to obesity in rural areas? | No |
| Are there any obesity-specific recommendations or guidelines published for adults? | No |
| Are there any obesity-specific recommendations or guidelines published for children? | No |
| In practice, how is obesity treatment largely funded? | Out of pocket |
Summary of stakeholder feedback
Stakeholders suggest that while the government and healthcare providers recognise that obesity should be classified as a disease, it is not formally, and it is certainly not acted upon. There is limited financial support provided for obesity prevention, treatment and management and the government has yet to introduce any fiscal measures designed to protect, assist and inform the population despite significant pressure from the scientific community. Overall, there are no significant prevention policies of note except state initiatives such as free meals at school.
There are few state-run treatment options in Bulgaria. However, stakeholders suggest that obesity treatment and management is significantly more advanced in paediatrics compared to adults. There are specialist units with clinical care pathways in place for those up to 18 years of age, with many affiliated outpatient facilities. Paediatric treatments are covered and therefore not subject to significant out of pocket expense. For adults however, it appears that most treatment is covered out of pocket.
There appears to be enough obesity specialists for child obesity, but a shortage of specialists for adults. There is also no national programme for streamlined obesity training for health professionals and no recognition of obesity specialisation. This combined with a failure to provide clinical treatment guidelines (with an implementation strategy) leave Bulgaria lagging behind its European counterparts in terms of obesity treatment and management.
Based on interviews/survey returns from 3 stakeholders
Last updated: June 2020
