Let's talk about obesity

WHY SHOULD WE TALK ABOUT EXCESS WEIGHT?

Obesity is one of the most serious modern health problems, and its scale is growing progressively. According to data from the World Obesity Federation, more than 1 billion people worldwide are currently living with obesity or excess body weight. Particularly alarming is the fact that this includes 159 million children – a trend that threatens the health of future generations. If current rates continue, projections for 2035 indicate that half of the world's population will be overweight.

Statistics for Bulgaria (2025)

54% of Bulgarian adults are overweight.                          

22% of Bulgarian adults are obese.

WHAT IS OBESITY?

Obesity is recognized as a chronic disease by leading organizations such as the World Health Organization (WHO). It involves an excessive accumulation of adipose tissue in the body, which increases the risk of a number of serious health complications. Obesity is not just an aesthetic issue, but a disease that affects the quality and length of life.

WHAT CAUSES WEIGHT GAIN?

There is much more behind obesity than just an imbalance between food intake and physical activity expenditure. It is the result of a complex interaction of multiple factors, many of which are beyond an individual's direct control.

Key risk factors:

• Biological and genetic – hereditary predisposition, metabolic peculiarities, and individual genetic characteristics;

• Physiological conditions and changes – pregnancy, menopause;

• Hormonal disorders – for example, hypercortisolism, hypothyroidism;

• Quitting smoking;

• Demographic factors – age, gender, race, and ethnicity;

• Lifestyle – dietary habits and level of daily physical activity;

• Socio-economic environment – cultural factors, social status, and access to quality food;

• Psychological state – emotional eating, stress, and other psychological factors.

HOW IS OBESITY DIAGNOSED?

Fat is a natural and necessary part of the human body. It builds cell membranes, participates in the structure of the brain and nervous system, serves as an energy reserve, protects the body from cold, acts as a shock absorber to protect organs from mechanical injury, and plays a key role in hormonal balance and reproductive health (including estrogen production).

Normal fat levels for healthy men are considered to be 15-20% of their body weight, and for women – 25-30%.

The most commonly used method for assessing body weight is the Body Mass Index (BMI). It correlates relatively well with body fat content, with the exception of people with low BMI or highly developed musculature. A person's BMI is calculated by dividing their weight in kilograms by the square of their height in meters.

Calculation formula: BMI = weight (kg) / height (m) 2

There are many online calculators for quickly calculating BMI.

What the resulting figures mean according to the WHO classification for adults:

• Overweight: BMI 25 to 29.9 kg/m2

• Obesity Class I: BMI 30 to 34.9 kg/m2

• Obesity Class II: BMI 35 to 39.9 kg/m2

• Obesity Class III: BMI greater than or equal to 40 kg/m2 (severe or morbid obesity).

For the Asian population, the thresholds are lower: overweight is defined as a BMI of 23-24.9 kg/m2, and obesity as 25 kg/m2 or more.

DIAGNOSIS IN CHILDREN

For children, BMI is assessed relative to age and gender using percentiles:

• Overweight: above the 85th percentile.

• Obesity: above the 95th percentile.

ADDITIONAL ANTHROPOMETRIC MEASUREMENTS

BMI does not show the distribution of adipose tissue. Therefore, other indicators are also used, such as waist circumference and waist-to-hip ratio, which are important for assessing metabolic risk.

BODY COMPOSITION ANALYSIS METHODS

For a more precise assessment, modern methods are used:

• ‍DXA (or DEXA, dual-energy X-ray absorptiometry) – considered the "gold standard." A quick and painless examination with minimal radiation exposure.

• ‍Bioelectrical Impedance Analysis (BIA) – an accessible method for determining body fat percentage, muscle mass, and water content. Bioelectrical impedance analysis is performed using a bioimpedance meter – a body composition analyzer that, unlike a standard scale, does not just measure total weight but breaks the body down into its constituent components: fat, muscle, bone mass, and water. This method measures body fat percentage, providing a more accurate picture of metabolic health.

During a consultation with an endocrinologist at Haelan on Bulgaria Blvd., your body composition can be measured and analyzed using a bioimpedance meter.

FOR MEN:

• Obesity: over 25% body fat

• Borderline values: 21% – 25% (a signal of increased risk)

• Normal: typically between 15% and 20%

FOR WOMEN:

• Obesity: over 33% body fat

• Borderline values: 31% – 33% (preventive measures are needed)

• Normal: typically between 25% and 30%

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Part 2 coming soon
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Author: Dr. Stella Yordanova

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