Obesity in over-40s no longer linked to worse cholesterol and blood pressure, study finds

Medications level the playing field

According to a study published in The Lancet, many adults with obesity have "indistinguishable" cholesterol and blood pressure levels compared to those with a healthy weight, largely because of the use of statins and antihypertensives. In some cases, people with obesity were "better off" than those with a normal BMI.

Researchers analyzed data from nearly 1 million adults aged 20 to 79 from England, Japan, South Korea, Taiwan, Thailand, Finland, and the USA. The data came from 110 health surveys conducted between 1990 and 2024, including information on blood pressure, cholesterol levels, BMI, and medication use.

Convergence after age 40

The study found that unhealthy cholesterol levels and blood pressure declined over time, especially among those aged 40 and over. The declines were larger among people with obesity, leading to a "convergence" of these risk factors between obesity and normal BMI in people older than 40. In England, the USA, 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 blood pressure.

Caveats on other risks

However, researchers caution that obesity still increases the risk of other health problems, including diabetes, kidney disease, and some cancers. Prof Edward Gregg from Imperial College London stressed that "it doesn't mean that obesity does not still increase your risk of other outcomes."

Furthermore, the study found that in adults under 40, those with obesity still had higher levels of bad cholesterol and higher blood pressure compared to peers with normal BMI. Co-author Yse d'Ailhaud de Brisis noted that early lifestyle interventions, screening, and medication should be considered for this younger group to prevent long-term cardiovascular complications.

Prof Bryan Williams from the British Heart Foundation commented that the study highlights a public health success story, showing how effective modern treatments for blood pressure and cholesterol have become, but warned against losing sight of the bigger picture: these medications are needed because of the adverse effects of obesity on cardiovascular risk.