Older obese people no longer at higher risk, study shows
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A new study suggests that older adults (over 40) with obesity now often have blood pressure and cholesterol levels similar to - or sometimes better than - people of a healthy weight.
Researchers involved in the study, which has just been published in The Lancet, believe this is because people with obesity are more commonly prescribed medications such as statins and blood pressure treatments, especially from middle age onwards.However, this improvement is mainly seen in older adults as people under 40 with obesity are less likely to receive these medications.
Researchers, including those at the University of Leicester, say this is a public health success but warn that obesity still increases the risk of other serious health problems, including diabetes, kidney disease, liver disease and some cancers.Dr Francesco Zaccardi is an Associate Professor in Clinical Epidemiology and Health Data Science at the University of Leicester, and Deputy Director of the Leicester Real World Evidence Unit at the Leicester Diabetes Centre (LDC).
He said: "In the industrialised countries investigated in the study, older adults with obesity now often have blood pressure and cholesterol on par with, or better than, people of normal weight, likely in relation to the increased use of statins and blood pressure medications. But young adults with obesity remain at elevated metabolic risk relative to their normal-weight peers.“Notably, obesity's health impact extends well beyond blood pressure and cholesterol, as individuals living with obesity also have an increased risk of type 2 diabetes, cancer, and kidney, liver, and musculoskeletal disease."
The study analysed data on blood pressure and cholesterol in people with obesity, overweight, and normal BMI from 110 health datasets including almost one million participants from 1990 to 2024 in seven high-income countries: England, the USA, Japan, South Korea, Taiwan, Thailand and Finland.
It found that in the 1990s adults with obesity generally had higher blood pressure and high-density lipoprotein (non-HDL) cholesterol levels than people with a normal BMI.Since 1990, in the majority of the seven countries studied including England and the USA, blood pressure and unhealthy cholesterol fell more steeply among middle-aged and older adults (40–79 years old).
The findings were most striking in older adults (60–79 years old). In England and the USA, 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.
Heart medication likely driving the convergence
Over the past three decades, people with obesity were more likely to be prescribed cholesterol-lowering medication (such as a statin) and blood pressure medication than those with a normal BMI.Author Professor Majid Ezzati, from the School of Public Health at Imperial College London (UK), said: “Our study suggests that, in high-income countries, taking medication to lower blood pressure and cholesterol has helped middle-age and older adults lower their cardiovascular risk to levels that are similar to people with normal BMI.”
He continued “At a time that weight-loss medications are becoming more widely used, our results give a picture of the cardiovascular health of people likely to be prescribed them, which allows the healthcare system to understand how blood pressure and cholesterol treatments benefit the population alongside weight-loss medications.”
Fellow author Ysé d'Ailhaud de Brisis, from the School of Public Health at Imperial College London, added: "While good news for older adults with obesity, our results suggest that cardiovascular health risks remain higher for adults under 40 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.”
The researchers note some limitations of the study, including that their analysis was limited to seven countries which were all high-income, therefore the finding may not be applicable elsewhere, especially for low- and middle-income countries where the use of unhealthy cholesterol and blood pressure lowering medicines is likely to be lower. Additionally, it was not possible to look at the impact of different medication doses, which require data on prescriptions.