Obesity No Longer Drives Higher Cardiovascular Risk in Older Adults, Global Study Finds

For middle‑aged and older individuals, obesity no longer carries the same cardiovascular risk burden as it once did, according to a large, longitudinal, multi‑country analysis. The study revealed that mean levels of non‑HDL cholesterol and systolic blood pressure have fallen across industrialized nations from 1990 to 2024, narrowing the metabolic gap between people with excess weight and those of normal body‑mass index (BMI). In overweight and obese groups, the difference in non‑HDL cholesterol declined by about 0.05 mmol/L per decade for women and 0.07 mmol/L per decade for men, while systolic blood pressure fell by roughly 0.7 mmHg for women and 0.6 mmHg for men per decade.

These trends are largely driven by increased use of antihypertensive and lipid‑lowering therapies among older adults. As a result, individuals older than 40 with obesity now exhibit metabolic profiles that are comparable— and in several countries even better—than those of their normal‑BMI peers. “In England, the U.S.A., Thailand, South Korea, and Japan, older people with obesity often became indistinguishable from, or better off than, those with normal BMI in terms of non‑HDL cholesterol and systolic BP,” noted Majid Ezzati, PhD, of Imperial College London, and colleagues in the NCD Risk Factor Collaboration published in The Lancet.

Conversely, the picture for younger adults remains stark. Those under 40 with obesity or overweight continue to show larger lipid and blood‑pressure gaps compared with normal‑weight peers, and they are rarely treated for these risk factors. “Young adults with obesity remain metabolically at higher risk than their counterparts with normal weight,” the authors reported. The investigators suggest that low treatment rates may stem from clinicians’ reliance on age‑adjusted absolute risk calculations, as well as lower healthcare utilization or medication adherence among younger people who are transitioning into work.

The findings highlight a missed opportunity in preventive cardiology. Yuan Lu, ScD, of Yale School of Medicine, wrote in an accompanying editorial that the field “has advanced substantially, with broader screening, earlier detection, and expanding use of antihypertensive and lipid‑lowering therapies.” She cautioned that obesity is still linked to numerous health problems—diabetes, chronic kidney disease, fatty liver disease, cancer, sleep disorders, musculoskeletal conditions, and systemic inflammation—many of which are not captured by blood pressure or non‑HDL cholesterol alone.

“The observations should not be interpreted as evidence that obesity has become benign,” Dr. Lu emphasized. “Instead, they show that medical management is increasingly attenuating some cardiovascular consequences of excess weight.”

The NCD Risk Factor Collaboration analyzed data from 110 national health surveys across seven countries—Japan, South Korea, Taiwan, Thailand, Finland, England, and the United States—enrolling 978,425 participants aged 20‑79. Obesity prevalence was highest in the U.S. (35.7‑47.2% in 2024) and lowest in Japan (3.2‑9.6%). Despite rising obesity rates in all nations and age groups, the metabolic disadvantage linked to excess weight has narrowed for older populations.

Study authors noted limitations, including variations in survey years across countries, modest sample sizes for certain BMI‑sex‑age subgroups (especially obese individuals in Asian cohorts), and response rates ranging from 60‑80%. Additionally, some experts argue that BMI alone may not adequately define obesity.

Projections suggest that by 2035, roughly 46.9% of U.S. adults—about 126 million people—may be living with obesity.

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