In adulthood, excess BMI is associated with cardiovascular disease (CVD); it is unknown whether risk differs by BMI trajectories from adolescence to adulthood.

The National Longitudinal Study of Adolescent Health, a nationally representative, longitudinal adolescent cohort (mean age: 16.9 years) followed into adulthood (mean age: 28.8 years) [n = 13,984 individuals (41,982 observations)] was examined. Separate logistic regression models for diabetes, hypertension, and inflammation were used to examine odds of risk factors at given adult BMI according to varying BMI trajectories from adolescence to adulthood.

CVD risk factor prevalence at follow‐up ranged from 5.5% (diabetes) to 26.4% (hypertension) and 31.3% (inflammation); risk differed across BMI trajectories. For example, relative to men aged 27 years (BMI = 23 kg/m² maintained over full study period), odds for diabetes were comparatively higher for men of the same age and BMI ≈ 30 kg/m² with ≈8 BMI unit gain between 15 and 20 years (OR = 2.35; 95% CI, 1.51, 3.66) or in those who maintained BMI ≈ 30 kg/m² across the study period (OR = 2.33; 1.92, 2.83) relative to the same ≈8 BMI unit gain, but between 20 and 27 years (OR = 1.44; 1.10, 1.87).

Specific periods and patterns of weight gain in the transition from adolescence to adulthood might be critical for CVD preventive efforts.