Simple Summary: The most prominent feature of coconut oil (CO) is that it contains over 80% saturated fatty acids and about 60% medium chain fatty acids of total fatty acids. With these characteristics, CO shows many health benefits, but concerns about the risk of cardiovascular disease still remain in dispute. So far, there has been limited research on the potential use of CO in aquafeeds, being used as an alternative to fish oil (FO), and inconsistent results were presented. Therefore, we performed an experiment to investigate the effects of CO replacing FO on the growth performance of the orange-spotted grouper (Epinephelus coioides) in an attempt to determine its potential use and pertinent lipid metabolic mechanism in the fish species. Results show that CO could completely replace FO without affecting the growth performance, but high CO feeding will compromise the liver lipid deposit and long chain polyunsaturated fatty acids reduction of fish flesh in orange-spotted groupers. In this study, we conducted an 8-week feeding trial to investigate the effects of replacing fish oil (FO) with coconut oil (CO) on the growth performance, blood components, tissue fatty acid (FA) profile, and mRNA levels of genes related to lipid metabolism in the liver of the orange-spotted grouper (Epinephelus coioides). Five isolipidic and isoproteic diets were formulated through increasing the CO levels (0, 25%, 50%, 75%, and 100%, respectively). Triplicate groups of twenty-five fish (initial wet weight of about 22.4 g/fish) were fed one of the diets twice daily to apparent satiety. The 25% CO diet had the highest growth rate and feed utilization, and the 100% CO diet exhibited a comparable growth and feed utilization with that of the control diet, indicating a suitable FO substitute. Moreover, the hepatosomatic index, intraperitoneal fat rate, liver lipid content, as well as the serum HDL-C content and ALT activity had positive linear and/or quadratic responses, but the serum TC and LDL-C contents exhibited the opposite trend, with an increasing CO inclusion level. The FA profile in the liver and muscle generally mirrored the FA profile in the feed. Furthermore, the mRNA levels of the fas, acc, g6pd, srebp-1c, and δ6fad genes in the liver had positive linear and/or quadratic responses, but the mRNA levels of elovl 4 and elovl 5 had the opposite trend, with increasing dietary CO inclusion levels. When compared with the control diet, 25% and 50% CO diets up-regulated the mRNA levels of cpt 1, while the 75% and 100% CO diets down-regulated its mRNA levels. The hsl and atgl were down-regulated through the addition of dietary CO. The mRNA level of lpl was not affected by dietary treatments. Results showed that CO could completely replace FO without affecting growth performance, but high CO will lead to the significant liver lipid deposition and lower LC-PUFAs contents of fish flesh. [ABSTRACT FROM AUTHOR]