Childhood Obesity – The New Pandemic

Childhood overweight and obesity have reached epidemic proportions, and the most alarming fact is the trend of their rapid increase.

Bulgaria is no exception—Bulgarian students rank among the highest in the European Union in terms of overweight and obesity. Survey data from the European COSI project, conducted by the National Center for Public Health and Analyses among 7-year-old children between 2008–2023, show that the rate of overweight among first-graders has risen from 28.2% to 32%, while obesity has increased from 12.4% to 15.2%. Severe obesity affects nearly 5% of children, which is a warning sign of a serious public health risk.

It is also concerning that in recent years, children living in villages and those from socially disadvantaged families are more overweight than children in cities—a trend that has reversed over the last decade. This shows that poorer families lack the resources to provide healthy nutrition for their children, leading to projections of less healthy and more vulnerable adults in the future.

Consequences in Adulthood

It is well known that childhood overweight often persists into adulthood, increasing the risk of type 2 diabetes, cardiovascular disease, and certain cancers. That is why achieving and maintaining a healthy weight, along with ensuring normal growth and harmonious physical development, is extremely important. This requires urgent preventive measures not only from individual families but also from relevant state institutions.

Genetic and Environmental Factors

Childhood obesity is a serious condition in which genetic and environmental factors interact to determine an individual’s susceptibility to weight gain. External factors contributing to childhood overweight are well known to many parents, but they often delay taking action, expecting the problem to resolve naturally as the child grows. In many cases, however, active intervention is necessary to overcome what is not merely a cosmetic but a medical condition.

Why Are First-Graders Especially at Risk of Gaining Excess Weight?

With the transition to school, their daily routine changes significantly:
- uncontrolled eating outside the home;
- increased intake of processed foods and soft drinks;
- more time sitting at a desk or in front of a computer;
- less time for play;
- more stress from the learning process;
- shorter sleep.

All these environmental changes greatly contribute to obesity, as they encourage unhealthy eating patterns and reduced physical activity. Factors include easier access to unhealthy, processed foods, aggressive marketing of products rich in sugar and saturated fats, and a lack of organized healthy meal options at school.

Added to this is low physical activity due to the lack of safe places for outdoor play and sports, limited access to parks, playgrounds, and cycling lanes. For younger schoolchildren, the family and social environment plays a crucial role—family eating habits, the behavior and example set by older siblings, and attitudes toward sports and physical activity.

Genetic Predisposition and the Role of Sugar

High consumption of sugary drinks and high-calorie foods, combined with certain genetic traits, influences appetite and the body’s metabolic response to high-carbohydrate diets. The craving for sweets increases, driving greater and greater consumption of sugary foods. Genetic predisposition makes children more vulnerable when their intake of sweets is high.

If we imagine obesity-predisposing genes as a barrel of gunpowder, then excessive sugar intake is the matchstick that ignites the process of excessive fat accumulation in the body.

Sugary, processed foods (such as wafers, cookies, and pastries) are high in calories but poor in essential nutrients such as vitamins and minerals. They are highly palatable and lead to excessive calorie intake. Children genetically predisposed to obesity have a stronger craving for sweets and may develop dependency due to disruptions in the brain’s appetite regulation. They also tend to overconsume sugary drinks and even 100% fruit juices.

This genetic predisposition can be mitigated by creating a supportive, healthy environment from early childhood, fostering healthy eating habits, and encouraging physical activity.

Risks of Artificial Sweeteners

Recent studies show that excessive consumption of artificial sweeteners by pregnant women may also contribute to childhood obesity after birth.
Artificial sweeteners can shift taste preferences toward sweeter foods, leading to higher intake of overly sweetened foods. Moreover, they may play an active metabolic role—a mechanism not yet fully understood in humans. For this reason, artificially sweetened foods and drinks are not a healthy alternative to vegetables and certain fruits.

What Should Be Known About Reducing the Risk of Childhood Obesity?

Prevention begins as early as pregnancy, with the mother’s diet. The later a child is exposed to sweets, processed foods, and sugary drinks, the lower the risk of developing a sweet dependency and becoming overweight. Outdoor play, hiking, and sports activities, combined with healthy eating from early childhood, are the best prevention. Parents must play a central role in creating and reinforcing a healthy environment from the earliest years. Educating pregnant women and parents of young children is a key step in preventing childhood obesity.

Healthy Choices in Daily Life

Water is the best and healthiest option for quenching thirst. It should replace sodas, juices, smoothies, and other drinks containing sugars and artificial sweeteners.

The focus should be on overall diet quality, not on restricting one particular food. Vegetables, legumes, whole grains, fish, and yogurt should occupy a central place in the diet of both children and the entire family.

Mayonnaise, ready-made sauces, ketchup, and mustard should be excluded, as they add extra fats and calories. Frying can be successfully replaced with grilling or poaching. A sandwich made at home with whole-grain bread, cheese, cucumber, and tomato is a great alternative to processed pastries or sweet temptations from the school cafeteria.

A family dinner in a calm atmosphere with fish, lean meat or legumes, and fresh salad is more satisfying and nurtures healthier taste preferences compared to delivered pizza, fries, or other industrially prepared foods.

Traditional Bulgarian cuisine from the past is not outdated—it is healthy and can serve as a foundation for modern eating habits, including the prevention of childhood obesity. Equally important are physical education and ensuring sufficient, restful sleep for children.

Consultation with a Dietitian at VITA Hospital

The prevention of childhood obesity is a shared responsibility—of families, schools, and society as a whole. Every parent can do a lot by encouraging healthy eating, more physical activity, and a balanced lifestyle. But when there are concerns about a child’s weight or eating habits, the best solution is to seek professional support. A consultation with a dietitian at VITA Hospital can provide tailored guidance and reassurance that the best possible care is being taken for the child’s health.