News · Heart & Metabolic
Medication has closed an obesity risk gap in older adults
A Lancet analysis of 978,425 people across seven countries found blood pressure and cholesterol in older adults with obesity now often match those at normal weight, largely because more of them are medicated.
Based on a peer-reviewed multi-country analysis in The Lancet
- Researchers analyzed 110 national health surveys conducted from 1990 to 2024, covering 978,425 people aged 20 to 79 across Japan, South Korea, Taiwan, Thailand, Finland, England and the USA, in The Lancet.
- The gap in non-HDL cholesterol between people with obesity and those at normal weight shrank by about 0.05 to 0.07 mmol/L per decade.
- The blood pressure gap shrank by roughly 0.7 mmHg per decade for women and 0.6 for men.
- In England, the USA, Thailand, South Korea and Japan, older people with obesity often became indistinguishable from, or better off than, those at normal weight on these two measures.
- The likely driver is treatment: use of lipid-lowering and antihypertensive medicines rose faster in people with obesity than in those at normal weight.
- HDL cholesterol moved the other way, rising more in normal-weight people, so that gap widened.
- Under-40s show almost no convergence, and young adults were rarely treated regardless of weight.
- This tracks two risk markers, not obesity's other consequences, and it cannot prove medication caused the convergence.
For thirty years the case against obesity has partly rested on two readings: blood pressure and cholesterol. A study in The Lancet reports that in older adults, across most of the rich world, those two readings have quietly stopped separating people with obesity from everyone else.
The study drew on 110 health surveys and 978,425 participants across seven countries. 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 blood pressure.
Why anyone would look
The starting point is that we now treat the consequences well. Effective treatments are available for obesity and for hypertension and hypercholesterolaemia, which mediate the cardiovascular and renal effects of obesity.
Until now nobody had answered the obvious follow-up at scale: whether the excess risk carried by a high body mass index has actually diminished as treatment spread. The researchers set out to compare blood pressure, cholesterol, and the use of antihypertensive and lipid-lowering medicines in people with obesity and normal weight.
Thirty-four years, seven countries
The data are national rather than clinical. The team used data from 110 health surveys conducted from 1990 to 2024 with 978 425 participants aged 20-79 years, sampled from Japan, South Korea, Taiwan, Thailand, Finland, England, and the USA.
People were grouped by body mass index into normal range, overweight and two bands of obesity. Each group was tracked over time on mean systolic blood pressure, non-HDL cholesterol, HDL cholesterol, and medicine use.
The gap narrowed from both ends
Cholesterol and blood pressure fell broadly, but they fell fastest where they had been highest. The declines were larger in individuals with obesity than in normal BMI. That led to a convergence of these risk factors between obesity and normal BMI in people older than 40 years, and the effect was strongest in the most severe obesity classes.
In pooled terms, the difference in mean non-HDL cholesterol with normal BMI became smaller each decade. The pooled estimate of change in the difference with normal BMI for blood pressure moved the same way.
Small annual numbers. Compounded across three decades, they erased a difference that once defined a risk group.
What appears to have done it
The medicine cabinet. These trends accompanied a larger increase in the use of lipid-lowering and antihypertensive medicines in middle-aged and older people with obesity than in those with normal BMI, rising by about 1.5 percentage points per decade for lipid-lowering drugs.
A control of sorts sits inside the data. Mean HDL cholesterol increased more in people with normal BMI than those with obesity, leading to a divergence. Statins do little for HDL, and HDL is exactly where the convergence failed to appear.
The group left behind
The reassuring headline stops abruptly at age 40. For people younger than 40 years, there has been little change in the gap between those with obesity or overweight and those with normal BMI, and young adults were rarely treated for high cholesterol or blood pressure regardless of their BMI.
The authors’ interpretation makes the limit explicit: young adults with obesity remain metabolically at higher risk than their counterparts with normal weight.
Reading it correctly
This is a trend analysis of survey data, not a trial, so the link between rising prescriptions and narrowing gaps is inference rather than proof. Country patterns also varied, with the authors noting heterogeneity across countries in the extent of convergence.
More importantly, two numbers are not the whole of obesity. Joints, sleep, liver, cancers and diabetes run through other routes. Neither a statin nor a blood pressure tablet touches them.
What the study documents is a genuine public health achievement with an uncomfortable shape: medicine has neutralised part of obesity’s damage in the people who get prescribed it, and left the younger, untreated half of the problem exactly where it was.
People also ask
Does this mean obesity is no longer a health risk?
No, and that would be a serious misreading. The study tracked two mediators of obesity's cardiovascular harm, blood pressure and non-HDL cholesterol, and found the gap narrowing on those. Obesity affects joints, sleep apnea, several cancers, fatty liver and diabetes risk through routes these two numbers do not capture. What has narrowed is one pathway, largely by treating it.
So the pills are doing the work?
That is the researchers' leading explanation, and the pattern fits. Use of lipid-lowering and antihypertensive medicines rose faster among people with obesity than among those at normal weight, by roughly 1.5 percentage points per decade for lipid drugs. This is an observational trend analysis, so it cannot prove the medication caused the convergence, but the timing and direction line up.
Why does this matter if the numbers now look fine?
Because it changes what the numbers mean. A normal cholesterol reading in someone with obesity may now reflect successful treatment rather than absent risk, and stopping the treatment would reverse it. It also means population comparisons of obesity's effect on cholesterol and blood pressure will increasingly understate the underlying biology.
What about younger adults?
They are the study's warning. For people younger than 40 there has been little change in the gap between those with obesity or overweight and those at normal weight, and young adults were rarely treated for high cholesterol or blood pressure regardless of their weight. The convergence is a story about medicated older populations, and younger adults with obesity remain metabolically at higher risk.
Why did HDL cholesterol go the other way?
HDL, often labelled the good cholesterol, increased more in people with normal weight than in those with obesity, so that gap widened rather than closed. Statins mainly lower non-HDL cholesterol; they do relatively little for HDL. That asymmetry is consistent with treatment explaining the convergence in one measure and not the other.