Obesity and high cholesterol: what's the connection?

Written on May 22, 2023 by Theresa Vuskovich, DMD. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• Understanding high cholesterol
• Measuring cholesterol levels
• Treating and preventing high cholesterol
• Related content

Obesity increases your risk of type 2 diabetes (T2D), heart disease, high blood pressure, and high cholesterol.[1] Approximately 94 million Americans have high cholesterol, many of whom are unaware they have it.[2] This article explains the connection between obesity and high cholesterol.

Understanding high cholesterol

Cholesterol is a waxy, fatty substance produced by the liver to digest food and create hormones.[3] High cholesterol occurs when your blood contains an excessive amount of cholesterol.[3] Hyperlipidemia and dyslipidemia are other terms used to describe high cholesterol and abnormal lipid levels.[4]

Cholesterol is present in your cell membranes and is essential for your body to function optimally.[6] Your liver makes all the cholesterol your body needs.[5] However, you also absorb cholesterol when you eat meat and dairy products (i.e., dietary cholesterol).[5] High cholesterol can occur if you consume too much cholesterol or have a disorder affecting your cholesterol levels, high cholesterol can occur.[4-6]

A diet high in cholesterol can also lead to obesity.[6] Obesity and high cholesterol are both associated with excessive cholesterol consumption.[6] According to the U.S. Department of Agriculture (USDA) 2020-2025 Dietary Guidelines for Americans, a diet as low in cholesterol as possible is recommended.[6]

High cholesterol can lead to atherosclerosis, a condition in which the arteries harden and thicken.[6] Atherosclerosis increases your risk of high blood pressure, heart disease, and stroke.[3]

Types of cholesterol

Not all cholesterol is created equal.[3,5] There are different forms of cholesterol, some of which are beneficial. The following are the types of cholesterol [3,5]:

• High-density lipoprotein (HDL): HDL carries cholesterol from the blood to the liver. Taking cholesterol out of the blood reduces the risk of plaque buildup in the arteries. HDL is a "good form" of cholesterol.
• Low-density lipoprotein (LDL): LDL carries cholesterol to the arteries, increasing the risk of plaque buildup in the arteries. LDL is the "bad form" of cholesterol.
• Very low-density lipoprotein (VLDL): VLDL carries triglycerides which can damage arteries. VLDL is also considered a "bad form" of cholesterol.

High cholesterol typically has no symptoms, making regular monitoring of your cholesterol levels essential.[5] Everlywell offers a cholesterol and lipid test that you can complete from the comfort of your own home.

The test measures total cholesterol, calculated LDL, HDL, and triglycerides. If you are monitoring your cholesterol levels or are interested in learning what they are, this cholesterol test is for you. Results are provided online in an easy-to-understand format.

Causes of high cholesterol

The causes of high cholesterol are classified as primary (genetic) or secondary (lifestyle).[4] Individuals with obesity may have both primary and secondary causes contributing to their high cholesterol.[4] Genetic mutations can lead to either excess production of LDL or abnormal clearance of HDL.[4] High cholesterol is also associated with age, with women after menopause having an increased risk.[7]

Secondary causes are the most common cause of high cholesterol.[4] A sedentary lifestyle and a high-calorie diet with excessive amounts of saturated fat, cholesterol, and trans fat can lead to high cholesterol and obesity.[4] Other secondary causes of high cholesterol include hypothyroidism, medications, cigarette smoking, alcohol overuse, and HIV.[4]

Risk factors

Risk factors for high cholesterol include [3]:

• A family history of high cholesterol
• Drinking too much alcohol
• High blood pressure
• Smoking
• Obesity
• Advanced age
• Medical conditions, including T2D and hypothyroidism
• Poor diet
• Medications

While obesity is a risk factor for high cholesterol, individuals who are normal or underweight can also have high cholesterol.[7] However, being overweight or having obesity raises LDL levels and lowers HDL, resulting in dyslipidemia and an increased risk of heart disease.[7,8]

Measuring cholesterol levels

A blood test measures your cholesterol levels.[2] According to the Cleveland Clinic, the following are optimal values of cholesterol [3]:

• Total cholesterol: Less than 200 mg/dL is ideal; high cholesterol is when levels are greater than 200 mg/dL
• LDL: Less than 100 mg/dL
• HDL: At least 60 mg/dL

According to the Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA), healthy adults need a lipid panel every 4-6 years.[2,7] You may need to take cholesterol tests more frequently, depending on your age and medical conditions.[2]

You should consult a healthcare provider about testing your cholesterol levels. Virtual care visits offered through EverlyWell allow you to talk to a healthcare provider wherever you are. A cholesterol test is recommended for anyone with one of these risk factors:

• Family history of heart disease before age 50 in male relatives, or age 60 in female relatives
• Personal history of coronary heart disease or non-coronary atherosclerosis (e.g., abdominal aortic aneurysm, peripheral artery disease, carotid artery stenosis)
• Personal history of diabetes
• Personal history of high blood pressure
• BMI > 30
• Active use of tobacco products

Treating and preventing high cholesterol

Obesity-associated high cholesterol is treatable with weight loss, physical activity, and a healthy diet.[8,10] However, factors such as your genetics and age may contribute to high cholesterol and are beyond your control.[4] Medications are available to treat high cholesterol.[10] Consult a healthcare provider to discuss your options.

According to the Cleveland Clinic, you can reduce your risk of obesity and high cholesterol by doing the following [3]:

• Exercising
• Quitting cigarette smoking
• Sleeping at least seven hours each night
• Managing your stress level
• Choosing healthier foods
• Drinking alcohol in moderation

To help manage weight and weight loss, you can book an appointment with a healthcare provider via Everlywell's telehealth for weight loss option.

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References

1. Know your risk for high cholesterol. Centers for Disease Control and Prevention. https://www.cdc.gov/cholesterol/risk_factors.htm. Published March 23, 2023. Accessed May 16, 2023.
2. Get a cholesterol test. Centers for Disease Control and Prevention. https://www.cdc.gov/cholesterol/cholesterol_screening.htm. Published December 6, 2022. Accessed May 16, 2023.
3. Hyperlipidemia. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21656-hyperlipidemia. Accessed May 16, 2023.
4. Davidson MH, Pulipati VP. Dyslipidemia. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/lipid-disorders/dyslipidemia. Accessed May 16, 2023.
5. About cholesterol. Centers for Disease Control and Prevention. https://www.cdc.gov/cholesterol/about.htm. Published March 20, 2023. Accessed May 16, 2023.
6. USDA 2020-2025 Dietary Guidelines for Americans. Dietaryguidelines.gov. Accessed May 16, 2023. URL
7. The American Heart Association. Common misconceptions about cholesterol. www.heart.org. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/common-misconceptions-about-cholesterol. Accessed May 16, 2023.
8. Klop B, Elte JW, Cabezas MC. Dyslipidemia in obesity: mechanisms and potential targets. Nutrients. 2013;5(4):1218-1240. Published 2013 Apr 12. doi:10.3390/nu5041218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705344/.
9. Stadler JT, Marsche G. Obesity-Related Changes in High-Density Lipoprotein Metabolism and Function. Int J Mol Sci. 2020;21(23):8985. Published 2020 Nov 26. doi:10.3390/ijms21238985. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731239/.
10. Cholesterol medications: Consider the options. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/cholesterol-medications/art-20050958. Published November 3, 2022. Accessed May 17, 2023.