Why obese adults are catching up on heart health – and why it's not the full story

A Lancet study found older adults with obesity now often record blood pressure and cholesterol levels close to normal-weight peers. Researchers and cardiologists say wider use of statins, blood pressure medicines and screening may explain the shift, while younger adults remain behind.

In Short

• Researchers analysed nearly one million records across seven high-income countries
• Adults aged 40 to 79 showed the sharpest improvement in readings.
• Younger adults saw little change as screening and preventive treatment lagged

For years, doctors have warned that obesity raises the risk of heart disease by increasing blood pressure and unhealthy cholesterol. But a major new study published in The Lancet suggests that this picture has changed significantly for many adults over 40 in high-income countries.

Today, many older adults living with obesity have blood pressure and cholesterol levels that are close to – or in some cases, even better than – those of people with a normal body weight.

The study analysed data from nearly one million people collected between 1990 and 2024 across seven high-income countries, including the UK, the US, Japan, Finland and South Korea but also has a significant message for India, which has a huge obesity burden.

Researchers found that the gap in blood pressure and unhealthy cholesterol between people with obesity and those with a normal body mass index (BMI) has steadily narrowed over the past three decades.

The biggest improvements were seen among adults aged 40 to 79 years. In the UK and the US, older adults with obesity, even those with severe obesity, ended up with blood pressure and cholesterol readings that were similar to, or sometimes lower than, those of their normal-weight peers.

Researchers believe the main reason is not that obesity has become less harmful, but that people with obesity are far more likely to receive cholesterol-lowering drugs such as statins and medicines to control blood pressure.

These treatments have become increasingly common over the last 30 years and appear to have reduced cardiovascular risk substantially in this age group.

The study also found that this pattern does not extend to younger adults. Among people below 40 years, the gap in blood pressure and cholesterol between those with obesity and those with a normal BMI has changed very little.

Researchers say this is likely because younger adults are much less likely to be screened or prescribed preventive medicines.

MORE 'CAREFUL APPROACH’

Senior cardiologist Dr Rajnish Sardana, who is with Sitaram Bhartia Institute of Medical Sciences in the capital, says the findings are not surprising and reflect decades of changes in preventive heart care. He compares the situation to road safety.

"It is akin to people driving cars with better safety features having more accidents than people driving cars with fewer safety features, because the latter are more careful," he says.

In other words, people with obesity often receive closer medical attention, while many people with normal weight may assume they are at low risk and therefore pay less attention to their heart health.

Dr Sardana explains that industrialised countries recognised obesity as a major driver of diabetes, high blood pressure and heart disease as early as the 1990s. This led to treatment guidelines that focused on controlling blood pressure, cholesterol and diabetes, particularly in adults above 40 years.

As evidence supporting statins grew, doctors became more aggressive in treating people considered at higher cardiovascular risk.

According to him, obese adults were not only more obvious candidates for these medicines but were often more motivated to take them regularly.

Better control of cholesterol, blood pressure and blood sugar among these patients reflects stronger medical follow-up and better adherence to treatment.

Meanwhile, many non-obese adults became complacent, believing they were naturally protected from lifestyle diseases and therefore less likely to undergo screening or stick to preventive advice.

SCREENING STILL MATTERS

These results, though remarkable, should not be interpreted to mean that obesity has become harmless, underlined Dr Vikash Goyal, associate director, cardiology with Paras Health in Gurugram.

The study's authors have also stressed that obesity continues to increase the risk of diabetes, kidney disease, liver disease, several cancers and many other health problems. Medication can reduce some cardiovascular risks, but it cannot erase all the harmful effects of excess body weight.

Dr Sardana says the lesson extends beyond obesity. In recent years, doctors have begun recommending earlier screening, sometimes starting in the teenage years or early adulthood, so that unhealthy cholesterol, high blood pressure and diabetes can be detected before complications develop.

He believes the benefits of this approach may become evident over the next two decades.

According to Dr Goyal, the new result is a positive public health achievement and reinforces the value of regular health screening, early diagnosis, and adherence to prescribed treatment.

But equally important is the finding that younger adults with obesity are not seeing the same benefits, largely because they are less likely to be screened or started on preventive therapies.

This underlines the need to identify cardiovascular risk much earlier through routine health check-ups, lifestyle modification, and, where clinically appropriate, medical intervention, according to the cardiologist.

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