Maintaining a healthy liver health is important, especially as the rate of obesity rises. Current research suggests that liver diseases such as Metabolic Dysfunction-Associated Steatotic Liver Disease (or more simply referred to as MASLD) is present in up to 75% of people who live with overweight and in more than 90% of people living with obesity. This article explores the link between obesity and MASLD, and the weight management strategies that can be taken to support a healthy liver. 

MASLD affects 38% of adults worldwide, making it one of the most common chronic (long- lasting) liver diseases in the world. You may have also seen MASLD called NAFLD or fatty liver disease –these are all names for the same condition. MASLD is caused by too much fat being stored in the liver. If left unmanaged, MASLD can lead to metabolic dysfunction-associated steatohepatitis (MASH), which is a more severe stage of MASLD. If MASH is left unmanaged, this can progress to liver cancer or eventually, liver failure. Early diagnosis can help to identify the signs of MASLD and therefore, the most appropriate interventions to slow or prevent a decline in liver health.
 

There are several complex processes by which living with obesity can increase the risk of developing MASLD. Let’s take a look:

• In obesity, fat cells (adipocytes) become overloaded and swell up. Eventually, the cells can't store any more fat and it is released into the blood as free fatty acids
• The free fatty acids are taken up and stored by other organs, including the liver.
• This leads to fat accumulation in liver cells, an indicator of MASLD.
• Excess fat accumulation in liver cells can cause them to become damaged and/or die.
• When liver cells are damaged and/or die, they trigger several processes which attract and activate immune cells.
• Immune cell activation can lead to inflammation of the liver. 
• Long-term inflammation can lead to MASLD.

People living with obesity and MASLD can be at an increased risk for cardiovascular risk disease. Calculating your Waist-to-Height Ratio can be a good way to understand the risk of developing cardiovascular risk factors associated with MASLD.

Reducing risk factors associated with MASLD, such as living with obesity, aims to prevent the condition from getting worse.

Weight reduction of at least 5% of total body weight can improve MASLD and weight reduction of 7–10% of total body weight can improve advanced MASLD and fibrosis. Your doctor can help you to understand the types of weight management options that can work best for you. 
 

Some options include:*

• Diet: Your doctor can work with you to create a personalised nutrition plan to help reduce the levels of fat that sit around the liver. Each plan will look different depending on your individual needs but typically includes limiting the intake of fats, sugary foods and drinks and increasing the intake of low-glycemic index foods such as fruits and whole grains
• Physical activity: Your doctor can work with you to work out a realistic physical activity routine based on exercises you enjoy and best fit into your day-to-day routine
• Pharmacological interventions: Alongside diet and physical activity, your doctor can help to assess whether medications are a suitable option
• Surgery: If the stage of MASLD is particularly advanced, sometimes surgery or transplant may be required

* This information is intended for people living with obesity and should not be substituted for medical advice from your doctor.

MASLD is a serious but often silent liver disease that is becoming increasingly common alongside rising obesity rates. While there is no single treatment for MASLD, many effective strategies exist, such as weight management options. Early diagnosis and  timely weight management can help to improve MASLD and slow or prevent progression to more serious liver health conditions. If you're concerned about your liver health or your weight, talk to your doctor.