Over the past three decades, the cardiovascular risk gap between people with obesity and those with normal BMI has narrowed significantly in high-income countries — but mainly for older adults. A major new Lancet study credits wider use of BP- and cholesterol-lowering medications. Younger adults with obesity, however, remain undertreated and at elevated risk, making them a critical target for early intervention.
A sweeping new study published in The Lancet — drawing on 110 health surveys and nearly 1 million participants across seven high-income countries from 1990 to 2024 — finds that the cardiovascular risk gap between people with obesity and those with normal BMI has largely closed among adults over 40. The driver? Better medicine. Wider use of antihypertensive and lipid-lowering drugs has brought blood pressure and non-HDL cholesterol in older adults with obesity down to levels comparable with — and in some cases better than — their normal-weight peers.
But the good news comes with a big asterisk. Adults under 40 with obesity are rarely screened or treated for high BP and cholesterol, and their cardiovascular risk gap versus normal-weight peers remains essentially unchanged. Experts also caution that obesity's broader health toll — diabetes, kidney disease, fatty liver, cancer, and more — is not captured by BP or cholesterol alone, meaning the condition is far from "benign."
Key Takeaways
Why it matters: These findings reframe how we think about BMI as a cardiovascular risk marker — medical management is increasingly doing the heavy lifting for older patients. But they also expose a treatment blind spot in younger adults that, left unaddressed, could fuel a future wave of cardiovascular disease.
