Adults over the age of 40 living with obesity now have cholesterol and blood pressure levels that are virtually indistinguishable from those of a healthy weight, according to a major new study. Researchers at Imperial College London, who analysed nearly one million adults across seven high-income countries, found that the gap in cardiovascular risk factors has narrowed or even disappeared in older age groups. The finding, published in The Lancet, is largely attributed to the widespread use of statins and blood pressure-lowering drugs – medications far more commonly prescribed to people with a higher body mass index.
Older adults: a narrowing gap
The study drew on data from 110 health surveys conducted between 1990 and 2024 in England, Japan, South Korea, Taiwan, Thailand, Finland and the United States. Researchers examined blood pressure, levels of non-HDL cholesterol (often termed “unhealthy” cholesterol) and Body Mass Index (BMI) scores. They found that since the 1990s, both blood pressure and unhealthy cholesterol levels have declined more rapidly among adults aged 40–79 with obesity than among their normal-BMI counterparts. In many cases, the differences have “narrowed or disappeared” – particularly in those aged 60–79. In England, the US, 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 systolic blood pressure,” the authors wrote.
Professor Majid Ezzati, from the School of Public Health at Imperial College London and a leader of the NCD Risk Factor Collaboration (NCD-RisC), 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.”
The role of medication – statins and antihypertensives
The convergence is driven by a dramatic increase in the use of cholesterol-busting drugs such as statins and antihypertensives among people with obesity. Professor Edward Gregg, also from Imperial College London (and holding a position at RCSI University of Medicine and Health Sciences), explained that older adults with obesity are far more likely to be prescribed these treatments. By the early 2020s, around 70–72% of older men with severe obesity in England and the US were taking cholesterol-lowering medication, compared with 40–48% of older men with a normal BMI. This disparity in prescription rates has effectively neutralised the traditional disadvantage in blood pressure and cholesterol that obesity once carried.
The study’s findings come at a time when weight-loss medications such as Wegovy, Mounjaro and Zepbound are surging in popularity. An estimated 1.6 million adults in England, Wales and Scotland used weight-loss drugs between early 2024 and early 2025, with over two million people paying privately for them by July 2025 – far more than those receiving them on the NHS. Use is twice as common among women as men and peaks in the 45–55 age group. Wegovy (semaglutide) is notably the first obesity medication that doctors can prescribe in the UK specifically to reduce the risk of circulatory and heart disease in those who are obese or overweight.
Professor Ezzati noted the relevance: “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.”
However, experts cautioned that the benefits of medication do not mean obesity is no longer a health concern. Professor Edward Gregg stressed: “It doesn’t mean that obesity does not still increase your risk of other outcomes.” Professor Bryan Williams, chief scientific and medical officer at the British Heart Foundation, described the study as “a powerful public health success story” showing the effectiveness of modern treatments, but added: “We must not lose sight of the bigger picture. These medications are needed because of the adverse effects of obesity on cardiovascular disease risk. Moreover, obesity still affects the body in many other ways and increases the risk of other health problems, including diabetes, kidney disease and some cancers.”
Younger adults still at risk
While the news is encouraging for the over-40s, the study found that adults under 40 with obesity still have significantly higher levels of unhealthy cholesterol and higher blood pressure compared with their peers of a healthy weight. Little or no improvement in the gap was observed in this younger group, likely because medication use remains low regardless of BMI. Ysé d’Ailhaud de Brisis, a research assistant at Imperial College London and co-author of the study, said: “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.”
Other independent experts echoed the need for a dual approach. Professor Robert Storey of the University of Sheffield noted the high quality of the study and raised concerns that individuals who are not overweight may not be aware of their own risks, while preventive medication remains underused in younger adults. Dr Marie Spreckley of the University of Cambridge described the research as a large, high-quality observational study providing robust evidence, but emphasised that younger individuals with obesity need more proactive management. Professor Naveed Sattar of the University of Glasgow said the study provides important evidence that advances in cardiovascular prevention have reduced some consequences of obesity in mid-life and older age, but stressed that “obesity management should not be optional and must be addressed alongside cardiovascular risk management.”
The study was limited to seven high-income countries, meaning findings may not apply to low- and middle-income countries where access to medications is lower. Researchers also could not assess the impact of different medication doses due to a lack of prescription data. Broader research has shown that the duration of obesity, in addition to its severity, may affect cardiovascular outcomes, and that cardiorespiratory fitness can attenuate some risks. Meanwhile, recent work suggests that a simple blood test could identify people with “unhealthy fat” who may face a higher heart attack risk, potentially helping to better target weight-loss drugs.
In England, between 2003 and 2018, raised total cholesterol decreased across all BMI groups but fell more sharply among women with obesity; hypertension decreased among men with obesity, but total diabetes increased among adults with obesity. The latest study underscores that BMI alone does not determine cardiovascular health. As Professor Williams put it, the medications address the effects of obesity, not obesity itself – and the condition still exacts a heavy toll on the body in many other ways.