The economic and social burden of obesity in Bulgaria

Objective : To explore the economic and social impact of obesity in Bulgaria and to examine its burden on public health and society. Methods : This study is a quantitative cost-of-illness (COI) analysis from a societal perspective, focusing on the adult population with obesity (BMI ≥ 30 kg/m 2 ). Direct medical costs (medication costs, hospitalisations, bariatric surgery, and complications such as diabetes, cardiovascular complications, and surgical complications) and indirect costs were calculated during the first half of 2025. The social burden was estimated through disability-adjusted life years (DALYs). Results : Epidemiological data show that two-thirds of the population is expected to have a high BMI or obesity, and these numbers will increase substantially until 2030. Direct healthcare costs accounted for €55 935 208.00 for a 6-month period, with hospitalisations due to complications (47%) and anti-obesity medicines (48%) having the leading shares. The minimal value of indirect costs generated due to absenteeism was €57 922 356.06 for the first 6 months of 2025. DALYs calculated for major obesity complications accounted for €42 468 for 1 year. Years of life lost due to premature death were the larger contributor to DALYs. Conclusions : Obesity is a widespread chronic disease with a high prevalence in Bulgaria, consistent with global trends. It is associated with substantial healthcare costs, productivity losses, and DALYs. The indirect costs related to obesity are slightly higher in the country than the direct costs of its treatment. Total DALYs related to obesity are also significant. Diabetes and cardiovascular diseases are the main contributors to DALYs due to obesity in Bulgaria.