When it comes to weight management, cholesterol is one of the key health markers that often flies under the radar. We tend to focus on the number on the scales, but what’s happening inside your body is just as important. Carrying extra weight can lead to higher cholesterol levels, which puts your heart at risk.
Obesity is a global problem, and not one that’s entirely attributed to how you look.1 If you think weight loss is just about fitting into the clothes hidden in the back of your wardrobe, you may have to think again.
The relationship between cholesterol and obesity
Obesity and cholesterol are closely linked, and this relationship goes much deeper than you might expect. Carrying extra weight, especially around your belly, can trigger a cascade of changes in your body’s lipid levels.2 In particular, obesity often leads to dyslipidemia—a fancy way of saying your blood fats are out of balance. When you’re obese, you’re likely to see higher levels of triglycerides (the fats found in your blood after eating), and an increase in small, dense LDL cholesterol, the kind that’s more likely to clog your arteries.2 On top of that, your “good” cholesterol, HDL, tends to drop.
But the problem isn't how much weight you're carrying. It's where. Visceral fat, the kind that wraps around your organs, drives your cholesterol out of control.3 It floods your blood with harmful fats, making it harder for your body to process them, and consequently increases your risk of heart disease and stroke.2,3 Essentially, your cholesterol levels become a reflection of the damage that excess fat is doing internally, even if the scales aren’t moving as fast as you’d like.
Why cholesterol is a good weight loss metric
Cholesterol levels give you a direct insight into the health of your heart, which is especially important if you’re carrying extra weight. Too much cholesterol in your blood leads to fatty deposits building up in your arteries, which over time, can harden and break off, potentially triggering a heart attack or stroke.
Regular cholesterol checks are an early warning system for heart disease. As you shed pounds, your cholesterol levels should start improving too, with the bad LDL cholesterol dropping and the good HDL cholesterol rising. But if those numbers aren’t budging, it’s a sign that your heart might still be in trouble, no matter how much the scales are shifting.
It's important to know what to look for when you’re getting your cholesterol levels tested. So here’s a breakdown of what’s considered healthy:4
Total cholesterol: Should be 5 mmol/L or below. Higher levels increase your risk of heart disease.
LDL cholesterol (bad cholesterol): Should be 3 mmol/L or below. High LDL levels lead to fatty build-up in arteries, which can cause blockages.
HDL cholesterol (good cholesterol): Should be 1 mmol/L or above. Higher levels are protective, helping to clear LDL from your bloodstream.
Non-HDL cholesterol: Should be 4 mmol/L or below. This includes all the “bad” types of cholesterol and is a useful marker for understanding your overall heart health.
Triglycerides: Should be 1.7 mmol/L or below. High levels of these fats in the blood can increase your risk of cardiovascular disease.
Total cholesterol to HDL ratio: Should be 6 or below. A higher ratio means you have more harmful cholesterol compared to the protective kind, which increases your heart disease risk.
Managing cholesterol in obesity
Thankfully, higher cholesterol levels can be managed using lifestyle intervention and, if needed, medication.
First off, weight loss has been shown to reduce triglycerides, which are often elevated in obese individuals. This happens because losing weight boosts the activity of enzymes like lipoprotein lipase (LPL), which helps break down fat in the blood, reducing triglyceride levels.2 Even moderate weight loss, say 4–10 kg, can make a big difference—reducing harmful LDL cholesterol by 12% and boosting your body’s ability to clear out bad cholesterol.5
But it’s not just about the amount of weight you lose—it’s also about what you eat. Diets rich in saturated fats can worsen post-meal fat levels, increasing the risk of heart disease. In contrast, a diet low in saturated fat and high in monounsaturated fats (like olive oil) can cut down post-meal triglyceride spikes by nearly half, slashing the inflammatory damage caused by unhealthy fats.2
But what about exercise? Regular movement increases LPL activity, helping your body process fats more efficiently.2 Exercise has a double benefit: it lowers triglycerides and can reduce fat around your liver (intrahepatic). And even if the pounds don’t immediately fall off, exercise alone can lower dangerous intrahepatic fat and improve cholesterol balance, providing a heart-health boost.
However, lifestyle changes alone sometimes aren’t enough, and that’s where interventions like weight loss medications come into play. These medicines can support weight loss efforts, which in turn helps improve cholesterol.
The numan take
Cholesterol is a key marker in weight management, showing how fat affects your heart. While weight loss helps, tracking cholesterol reveals if you need extra tweaks to optimise health. Focus on both to protect your heart and achieve lasting improvements.
References
Wadden TA, Anderson DA, Foster GD. Two‐year changes in L ipids and lipoproteins associated with the maintenance of a 5 % to 10% reduction in initial weight: Some findings and some questions. Obes Res [Internet]. 1999;7(2):170–8. Available from: http://dx.doi.org/10.1002/j.1550-8528.1999.tb00699.x
Klop B, Elte JWF, Cabezas MC. Dyslipidemia in obesity: mechanisms and potential targets. Nutrients [Internet]. 2013;5(4):1218–40. Available from: http://dx.doi.org/10.3390/nu5041218
Hoenig MR, Cowin G, Buckley R, McHenery C, Coulthard A. Low density lipoprotein cholesterol is inversely correlated with abdominal visceral fat area: a magnetic resonance imaging study. Lipids Health Dis [Internet]. 2011;10:12. Available from: http://dx.doi.org/10.1186/1476-511X-10-12
Patalay M, Lofgren IE, Freake HC, Koo SI, Fernandez ML. The lowering of plasma lipids following a weight reduction program is related to increased expression of the LDL receptor and lipoprotein lipase. J Nutr [Internet]. 2005;135(4):735–9. Available from: http://dx.doi.org/10.1093/jn/135.4.735
