Life-Course Clinical Obesity and Midlife Cognitive Function: The Bogalusa Heart Study
Christian P. Corsten1,2,3, Franklin M. Epps1,3, Ileana De Anda-Duran4, Jacob R. Albers5,6, Lydia A. Bazzano4,7, David J. Libon8, Owen T. Carmichael1
1Pennington Biomedical Research Center, Baton Rouge, LA, USA, 2LSU Health Sciences Center, New Orleans, LA, USA, 3LSU College of Science, Baton Rouge, LA, USA, 4Tulane University, New Orleans, LA, USA, 5Emergency Medicine, LSUHSC, Baton Rouge, LA, USA, 6Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA, 7Internal Medicine, UTSW, Dallas, TX, USA, 8Department of Psychology and New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, USA
Obesity's link to midlife cognition is inconsistent, and may depend on sex.
•Obesity is a major driver of global morbidity, yet its cognitive link is inconsistent – some studies report a paradoxical link to preserved cognition [1,2]
•BMI is an imprecise proxy for adiposity; the Lancet Commission's framework distinguishes non-obesity, preclinical, and clinical obesity [5]
•Most prior studies capture only a single snapshot, not obesity's cumulative burden across adulthood [6]
•This study tests whether cumulative obesity burden predicts midlife cognition, and whether this differs by sex
A 50-year cohort tracks obesity from childhood into midlife.
•White and Black American children followed since 1972
•This study draws upon a 20 year window of cross-sectional study surveys with obesity classification roughly every 5 years
•Included: ≥2 cardiometabolic exams (1985–2010) + cognitive assessment (2013–2016) (Figure 1)
Key terms:
•GCS – sum of 9 standardized neuropsych z-scores (age/sex/race-adjusted); higher = better
•Cumulative obesity burden (AUC) – time-weighted area under the obesity classification curve, z-scored
AUC captures obesity trajectories across adulthood.
•Classified non-obese (0), preclinical (1), or clinical (2) at each of up to 6 exams; integrated across age and z-scored
Cognition was scored from 9 tests across 4 domains.
•4 domains (attention/speed, executive function, episodic memory, language); standardized for age/sex/race into a global score (GCS)
OLS models tested whether obesity burden predicts cognition, and whether education explains it.
•OLS regression sequentially adjusted for education (Model 2), lifestyle (Model 3), both (Model 4)
•Post hoc sex-interaction and sex-stratified analyses used the same framework
•AUC–education association examined separately
The sample (N = 965) was mostly female and White.
•60.0% female; 65.9% White; mean age 43.2 ± 4.4y
•Clinical obesity occurred in 63.4%; preclinical-only was rare (5.0%) (Table 1)
Cumulative obesity burden reveals a complex, sex-specific relationship with cognition.
•Overall (N=965): no significant link to cognition, unadjusted (β = −0.335, p = 0.062) or fully adjusted (β = −0.151, p = 0.342)
•A striking AUC × sex interaction emerged unadjusted/lifestyle-adjusted (p = 0.001, 0.005), fading after adjusting for education (p = 0.085, 0.142)
•Females: higher burden linked to lower cognition, unadjusted (β = −0.777, p < 0.001) and fully adjusted (β = −0.368, p = 0.050); males: no link, positive estimates throughout – the obesity paradox (Figure 3)
•Greater obesity burden independently predicted lower educational attainment (β = −0.067, p = 0.042)
Obesity's cognitive cost is sex-specific, and partly explained by education.
•No independent link overall; sex-stratified analyses revealed a borderline female-specific association after adjustment
•Education explained much of the sex difference; male pattern matched the obesity paradox
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4.Gwizdala KL, Bazzano LA, Carmichael OT, Newton RL Jr. Greater BMI across the lifespan is associated with better midlife cognition: the Bogalusa Heart Study. Sci Rep. 2025;15:5336.
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8.Stern Y, Arenaza-Urquijo EM, Bartrés-Faz D, et al. Whitepaper: defining and investigating cognitive reserve, brain reserve, and brain maintenance. Alzheimers Dement. 2020;16(9):1305–1311.
Funded by the Pennington Biomedical Research Foundation and NIH grants R01AG077497, R01AG077000, RF1AG075769, RF1AG041200, and R01AG062309.
Corresponding Author: Christian P. Corsten | ccorsten1@gmail.com
