What to watch with HDL and weight loss?

HDL (high-density lipoprotein) is often called 'good cholesterol,' but its relationship with weight loss is nuanced. During active weight loss, HDL can temporarily drop, especially with very low-calorie diets. Long-term, regular exercise, weight loss, and a Mediterranean diet tend to raise HDL. Genetic variants (e.g., in APOA1, CETP, LPL) can influence baseline HDL and response to diet, but effect sizes are small. An HDL level below 40 mg/dL (men) or 50 mg/dL (women) is considered a risk factor. Importantly, HDL alone is not a perfect protective marker; newer research highlights HDL function (e.g., cholesterol efflux capacity) as more relevant. DNA tests for HDL are currently not well-validated for personalized recommendations. Focus should be on healthy diet, exercise, and avoiding trans fats. Caveat: No randomized trials show that raising HDL alone reduces cardiovascular risk.