Associations Between Body Mass Index and Cognitive Change in the ACTIVE Study: Variations by Race and Social Determinants of Health

<strong>Objectives:</strong> The current study examines relationships between Body Mass Index (BMI) and cognitive performance and change in processing speed, memory, and reasoning, while accounting for variations by race and the influence of social determinants of health. <strong>Methods:</strong> Secondary data analysis of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, which included participants who self-identified as African American or Black (<em>n</em> = 728) and White (<em>n</em> = 2028). Latent growth curve modeling was used to assess study aims. <strong>Results:</strong> Increases in BMI were associated with less cognitive decline over 10&nbsp;years across each cognition domain. Race moderation effects were noted for speed and memory. Relationships between BMI and cognitive trajectories were mediated by economic stability for speed and reasoning. <strong>Discussion:</strong> Overall, these findings are consistent with the "obesity paradox." Further research is needed to elucidate patterns of results by race.