Blood pressure and cholesterol in older adults with obesity found to be similar to people with healthy BMIs

People with obesity aged 40 years and older typically show blood pressure and cholesterol levels similar to those of people with healthy BMIs, which is a “significant shift from 30 years ago”, a study has found.

Publishing their findings in The Lancet on 1 July 2026, researchers analysed data from health surveys conducted in seven nations, including the UK, between 1990 and 2024, which involved 978,425 participants aged 20–79 years.

They also looked at mean systolic blood pressure (SBP), non-high-density lipoprotein (HDL) cholesterol and HDL cholesterol alongside BMI.

Non-HDL cholesterol is considered bad for cardiovascular health.

“In England, the United States, 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 SBP,” the study authors revealed.

They added that, in the 1990s, people aged over 40 years with obesity typically had higher levels of non-HDL cholesterol and higher SPB than people with healthy BMIs.

However, during the following decades, the difference between the two groups narrowed to the point where little difference is seen, most notably among adults aged 60-79 years, the authors said.

The authors also found that in England and the United States, “older adults with obesity, and especially with severe obesity, had similar or even lower blood pressure and unhealthy cholesterol levels at the end of the study period than older adults with normal BMI”.

The findings coincide with greater use of cholesterol-lowering medication and blood pressure medication in more recent years among adults aged over 40 years with obesity, compared with those with a normal BMI, they continued.

However, the researchers did not find the convergence in SBP and non-HDL cholesterol levels in people aged 40 years and younger with obesity, who continue to show raised non-HDL and SPB compared with people without obesity.  

Increased use of medication is the “likely driver of the blood pressure and cholesterol level convergence” between people with obesity and those without, the authors said, noting that younger people are less likely to receive these medications regardless of BMI.

The authors added that low treatment rates in younger adults “might be because treatment decisions at least partly rely on calculated absolute risk, which increases with age”.

Study author Ysé d’Ailhaud de Brisis, research assistant in population health at Imperial College London, commented: “While good news for older adults with obesity, our results suggest that cardiovascular health risks remain higher for adults under 40 [years] than for their counterparts with a normal BMI.

“Early lifestyle interventions, screening and, when appropriate, medication in this younger group should be considered to prevent long-term cardiovascular complications linked to obesity.”

Robert Storey, professor of cardiology at the University of Sheffield, said: “It is well known that obesity is associated with harmful increases in blood pressure and cholesterol levels. The findings of the study suggest that recognition of this fact has led to individuals with obesity being increasingly prescribed medication to help control blood pressure and lower cholesterol levels. This will help to reduce some, but not all, of the risk of heart attacks and strokes in people with obesity.”

“The study also shows very limited use of cheap medications in people under the age of 40 [years], even though heart attacks and strokes can occur in people in their 20s and 30s related to high cholesterol and blood pressure,” he added.

“This requires further research to establish the benefits of early use of preventive medication in younger adults who have inherited a high risk of cardiovascular disease.”