This multi-country analysis compared systolic blood pressure (SBP), non-HDL cholesterol, HDL cholesterol, and use of antihypertensive and lipid-lowering medicines across BMI categories (normal, overweight, class I, and class II/III obesity) using 110 national health surveys from 7 industrialised countries (Japan, South Korea, Taiwan, Thailand, Finland, England, USA) with 978,425 adults aged 20–79, spanning 1990–2024.
Non-HDL cholesterol gap vs. normal BMI narrowed by ~0.05–0.07 mmol/L per decade and SBP gap narrowed by ~0.6–0.7 mmHg per decade in people with obesity, driven largely by greater uptake of lipid-lowering (1.5–1.6 percentage points/decade) and antihypertensive medicines (0.7–2.0 percentage points/decade) in older adults with obesity; in contrast, HDL cholesterol diverged (rising more in normal BMI), and young adults with obesity (<40 years) remained at consistently higher metabolic risk with little convergence.
- Observational trend analysis cannot establish causality between medicine use and risk factor convergence. - Thailand showed notable exceptions to overall trends, suggesting findings may not generalise uniformly even within the studied countries. - Young adults were rarely treated regardless of BMI, leaving an important high-risk group under-characterised.
Older adults with obesity are increasingly being treated to blood pressure and cholesterol levels similar to those of normal-weight peers — clinicians should not assume untreated metabolic risk in this group without checking medicine use. However, young adults with obesity remain undertreated and at higher metabolic risk, warranting proactive screening and earlier intervention.
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