Across seven industrialized countries, differences in systolic blood pressure (SBP) and non–HDL-C between adults with obesity and normal body mass index (BMI) have narrowed substantially over time, particularly among adults over 40 years old.  However, young adults with obesity remain at higher cardiometabolic risk, according to new research from the NCD Risk Factor Collaboration published July 1 in The Lancet.

Investigators analyzed data from nearly 979,000 adults aged 20 to 79 years obtained from 110 national health surveys conducted between 1990 and 2024 in Japan, South Korea, Taiwan, Thailand, Finland, England and the U.S., categorizing them based on BMI and assessing age-standardized SBP, non–HDL-C, HDL-C, and use of antihypertensive and lipid-lowering medications.

Results showed that BP and non–HDL-C improved more in people with overweight and obesity (BMI ≥25 kg/m²) than those with normal BMI, especially among middle-aged and older adults, with differences in non–HDL-C between obesity and normal BMI decreasing by 0.05 mmol/L per decade in women and 0.07 mmol/L per decade in men, and SBP differences narrowing by 0.7 mm Hg per decade in women and 0.6 mm Hg per decade in men.

At the same time, use of lipid-lowering medications increased more among people with obesity than those with normal BMI by 1.5 percentage points per decade in women and 1.6 percentage points per decade in men, while antihypertensive use increased by 0.7 and 2.0 percentage points per decade, respectively – which investigators point to as “a possible driver of this convergence,” in non–HDL-C and SBP, along with changing trends in diet, smoking and alcohol use.

The largest reductions were observed in middle-aged and older adults and those with more severe obesity. “For young adults, who are less commonly treated for high cholesterol or [BP] regardless of BMI, there has been little change in the gap in treatment or cardiometabolic traits between obesity and normal BMI,” note the investigators. “Young adults with obesity remain at elevated cardiometabolic risk. Public health and health system [programs] should use early lifestyle interventions, screening and, when appropriate, pharmacological treatment in this younger group to prevent long-term cardiovascular and other complications.”

“The study arrives at a pivotal moment in obesity medicine,” writes Yuan Lu, DSc, FACC, in an accompanying editorial comment. “As GLP-1 receptor agonists and related therapies become increasingly integrated into clinical care, future research should move beyond describing risk factor trajectories to determining how combinations of weight reduction, preventive pharmacotherapy, and coordinated longitudinal care influence cardiovascular outcomes, multimorbidity and healthy aging across populations.”