• Overview
  • Obesity prevalence
  • Population breakdowns
  • Drivers
  • Comorbidities
  • Health systems
  • Policies
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Obesity prevalence

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

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, 2019-2020

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, 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

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

Perceived barriers to treatment

  • Lack of financial investment by government and health system
  • High cost of out of pocket payments
  • Lack of evidence, monitoring and research

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

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Policies, Interventions and Actions

Trans-fat policy

The content of trans fat, other than trans fat naturally occurring in fat of animal origin, in food intended for the final consumer and food intended for supply to retail, shall not exceed 2 grams per 100 grams of fat.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2021 (ongoing)
Organisation:The content of trans fat, other than trans fat naturally occurring in fat of animal origin, in food intended for the final consumer and food intended for supply to retail, shall not exceed 2 grams per 100 grams of fat.
Find out more:extranet.who.int
References:Countdown to 2023: WHO report on global trans-fat elimination 2020. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO

Bulgarian Food Act

In 2017, the Bulgarian Parliament passed an amendment to the Food Act which prohibits the advertisement and marketing of genetically modified and 'unhealthy' foods to children - including via television, print, and online.

Categories:Evidence of Marketing Guidelines/Policy
Year(s):2017 (ongoing)
Target age group:Children
Find out more:sustainablepulse.com
References:https://www.cms-lawnow.com/ealerts/2020/08/new-bulgarian-food-act-to-guarantee-quality-of-foodstuffs-and-implement-eu-food-regulations?cc_lang=en

NATIONAL STRATEGY ON THE IMPLEMENTATION OF A KINDERGARTEN AND SCHOOL FRUIT, VEGETABLES, MILK AND MILK PRODUCTS SCHEME IN THE REPUBLIC OF BULGARIA

Educating children, teachers and parents on achieving a healthy balanced diet and undertaking physical activity by delivering lectures. The general objective of the school fruit/vegetables and milk and milk products scheme is to provide legal and financial conditions for the long-term increase in the share of theseproducts in children's diets, especially at the age when their nutritional habits are formed.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Categories (partial):Evidence of Community Interventions/Campaign
Year(s):2017-2022
Target age group:Children
Organisation:REPUBLIC OF BULGARIA MINISTRY OF AGRICULTURE, FOOD AND FORESTRY
Find out more:ec.europa.eu
Linked document:Download linked document
References:REPUBLIC OF BULGARIA MINISTRY OF AGRICULTURE, FOOD AND FORESTRY VALIDATED BY: (Signature) RUMEN POROZHANOV MINISTER OF AGRICULTURE, FOOD AND FORESTRY NATIONAL STRATEGY ON THE IMPLEMENTATION OF A KINDERGARTEN AND SCHOOL FRUIT, VEGETABLES, MILK AND MILK PRODUCTS SCHEME IN THE REPUBLIC OF BULGARIA FROM 2017/2018 SCHOOL YEAR TO 2022/2023 SCHOOL YEAR [Internet]. 2017b. Available from: https://ec.europa.eu/info/sites/info/files/food-farming-fisheries/key_policies/documents/bg-school-scheme-strategy-2017-23_en.pdf

School Fruit, Vegetables and Milk Scheme

"Applicable since 1 August 2017, the EU school fruit, vegetables and milk scheme combines two previous schemes (the school fruit and vegetables scheme and the school milk scheme) under a single legal framework for more efficiency and an enhanced focus on health and educational. The scheme supports the distribution of products, educational measures and information measures. The scheme supports the distribution of fruit, vegetables, milk and certain milk products to schoolchildren, from nursery to secondary school. EU countries approve a list of products (in collaboration with their health and nutrition authorities) which will help achieve the schemes objective of helping children to follow a healthy diet. Priority is for fresh fruit and vegetables and for plain milk. In order to support a varied diet and/or specific nutritional needs, EU countries may also make processed fruit and vegetables such as juices and soups and certain milk products such as yoghurt and cheese, available. Additionally, under stricter conditions, milk-based drinks may be included." - EU Commission

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2017 (ongoing)
Organisation:European Commission
Find out more:ec.europa.eu
References:https://ec.europa.eu/info/food-farming-fisheries/key-policies/common-agricultural-policy/market-measures/school-fruit-vegetables-and-milk-scheme/school-scheme-explained_en

EU nutrient content lists

Passed in 2011, EU Regulation 1169/2011 on the Provision of Food Information to Consumers requires a list of the nutrient content of most pre-packaged food to be provided on the back of the pack from 13 December 2016.

Categories:Labelling Regulation/Guidelines
Year(s):2016 (ongoing)
Target age group:Adults and children
Organisation:European Commission
Find out more:eur-lex.europa.eu

Joint Action on Nutrition and Physical Activity (JANPA)

The overall aim of the project is to contribute to halting the rise of overweight and obesity in children and adolescents by 2020.

Categories (partial):Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Evidence of Physical Activity Guidelines/Policy
Year(s):2015-2017
Target age group:Children
Organisation:European Commission
Find out more:www.janpa.eu
Linked document:Download linked document
References:Overview of the Joint Action JANPA HLG/EU Platform DG Santé Luxembourg [Internet]. 2017. Available from: https://ec.europa.eu/health/sites/health/files/nutrition_physical_activity/docs/ev_20171130_co05_en.pdf

National Health Strategy 2015-2020

The strategy contains priorities and policies for overcoming the growing health challenges of Bulgarian citizens. The ways of linking health policies with measures ensuring equal treatment, the necessary impacts on the social determinants of health and the basic prerequisites for the functioning of the health system are presented.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2015-2020
Target age group:Adults and children
Organisation:Ministry of Health
Find out more:extranet.who.int
Linked document:Download linked document
References:Policy - Национална Здравна Стратегия 2020 [National Health Strategy 2020] | Global database on the Implementation of Nutrition Action (GINA) [Internet]. extranet.who.int. [cited 2020g Jul 21]. Available from: https://extranet.who.int/nutrition/gina/en/node/24691.

National program for prevention of chronic non-communicable diseases 2014-2020

The main objective of the program is to improve public health and enhance the quality of life by reducing premature mortality, morbidity and disability.

Categories:Evidence of NCD strategy
Year(s):2014-2020
Target age group:Adults and children
Organisation:Ministry of Health
Find out more:janpa-toolbox.eu
Linked document:Download linked document
References:NATIONAL PROGRAMME FOR PREVENTION OF NON-COMMUNICABLE DISEASES 2014-2020 [Internet]. Available from: https://janpa-toolbox.eu/files/Bulgaria-NATIONAL%20PROGRAMME%20FOR%20PREVENTION%20OF%20NON-COMMUNICABLE%20DISEASES%202014-2020.pdf

NCD targets for Bulgaria

Bulgaria released their National Program for Prevention of Chronic Noncommunicable Diseases 2014-2020. NCD targets include: 'by 2020, halt the trend of increasing incidence of obesity in adults and children' & '20% reduction in premature mortality (death before 65 years) from cardiovascular disease by 2020'.

Categories:Evidence of NCD strategy
Year(s):2014-2020
Target age group:Adults and children
Find out more:srzi.bg
References:https://extranet.who.int/ncdccs/Data/BGR_Bulgaria_NCD_targets.pdf

Salt content regulations

Between 2011-12, legislation was introduced in Bulgaria which set mandatory limits on the maximum salt content of certain products: bread, cheese, meat and poultry products, and lutenica.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2011 (ongoing)
References:https://ec.europa.eu/health/sites/default/files/nutrition_physical_activity/docs/salt_report1_en.pdf

School food ordinances

Ordinances in Bulgaria were mandated in the years of 2009, 2011, and 2013 which set restrictions for the standards (and nutrient content) of foods. The ordinances had a specific goal of reducing the levels of salt, fat, and sugar available in school food and also restricted the sale of certain items.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2009 (ongoing)
Target age group:Children
References:https://ec.europa.eu/jrc/sites/default/files/jrc-school-food-policy-factsheet-bulgaria_en.pdf

Food based dietary guidelines for adults in Bulgaria

While the main focus of this guideline is on diet and nutrition, it also contains guidelines on physical activity to maintain a healthy weight, suggesting to be physically active at least 60 minutes a day. The dietary guidelines were developed by an expert group from the National Center of Public Health Protection from the Ministry of Health, with support from the WHO Regional Office for Europe. The group also received input from consultative meetings with representatives from other relevant ministries, academia, associations of food producers and regional bodies for public health protection

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Evidence of Physical Activity Guidelines/Policy
Year(s):2006 (ongoing)
Target age group:Adults
Organisation:Ministry of Health
Find out more:www.fao.org
Linked document:Download linked document
References:Bulgarie [Internet]. Food and Agriculture Organization of the United Nations. [cited 2020 Jul 21]. Available from: http://www.fao.org/nutrition/education-nutritionnelle/food-dietary-guidelines/regions/bulgaria/fr/

FOOD BASED DIETARY GUIDELINES FOR ADULTS IN BULGARIA

National obesity guidelines for Bulgaria

Categories:Evidence of National Obesity Strategy/Policy or Action plan
Year(s):2006 (ongoing)
Target age group:Adults
Linked document:Download linked document

Food And Nutrition Action Plan 2005 - 2010

The plan calls for legislative measures on the marketing of unhealthy foods for children (TBI, MH 2005-2006) and new standards for nutritional content, food labelling, and food marketing to reduce the risk for obesity and its complications. The NFNAP was launched in December 2004 and adopted by the Council of Ministers in August 2005. The strategic goal is to improve the health of the Bulgarian population by improving nutrition and the reducing the risk of foodborne and diet-related chronic diseases. The Action Plan covers the three strategic areas of nutrition, food safety and food security

Categories (partial):Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2005-2010
Target age group:Adults and children
Organisation:Council of Ministers
Find out more:extranet.who.int
Linked document:Download linked document
References:Policy - Food and Nutrition Action Plan 2005-2010 | Global database on the Implementation of Nutrition Action (GINA) [Internet]. extranet.who.int. [cited 2020 Jul 21]. Available from: https://extranet.who.int/nutrition/gina/en/node/8062

Framework for Responsible Commercial Communication of Food and Drinks

Self-regulatory policy introduced in Bulgaria by: the Bulgarian Association of Advertisers (BAA), the Association of the Advertising Agencies - Bulgaria (ARA) and the Association of the Bulgarian Radio- and TV operators (ABBRO). Aims to achieve responsible marketing of food and drinks towards children.

Categories:Evidence of Marketing Guidelines/Policy
Target age group:Children
Find out more:www.nss-bg.org

No actions could be found for the above criteria.

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