Obesity and liver disease: Making a difference
By A.J. Hostetler, Communications Director
Stravitz-Sanyal Institute for Liver Disease and Metabolic Health
At liver clinics, many patients are dealing with obesity. This makes treating liver disease even harder. Over the last few decades, more people have become obese or developed other health issues like diabetes. This is straining health care systems and changing how doctors treat liver problems.
Obesity is closely connected to liver issues like steatotic liver disease (SLD), cirrhosis, and problems after liver transplants. It raises the chances of getting liver disease and makes the disease worse and harder to treat. But even with this, many clinics still don’t have good plans for helping patients manage their weight.
A new review article in the journal Hepatology says that has to change, and explains what liver specialists should do to help their patients with obesity. VCU transplant hepatologist Mohammad Shadab Siddiqui, M.D., and co-authors from the Mayo Clinic, the University of Chicago and the University of Western Ontario review how to treat obesity in liver patients — and why it matters.
Obesity affects the whole body
Obesity is more than appearance of gaining extra weight. It affects how the body handles sugar and causes inflammation. For people with liver disease, these problems can lead to faster liver damage and a higher chance of chronic liver failure or the need for a transplant. SLD, more specifically, metabolic dysfunction associated steatotic liver disease (MASLD), is now the leading cause of chronic liver failure requiring liver transplant in women and patients over the age of 60. People with MASLD often also have type 2 diabetes, high blood pressure, and heart disease. In many cases, these other health problems are more dangerous than the liver disease itself.
After a liver transplant, many patients gain a lot of weight. That puts them at risk for even more health problems, which can harm the new liver. This shows why treating obesity early is so important.
Hepatologists can help with weight management
Usually, weight loss advice comes from family doctors or nutritionists. But they may not feel comfortable giving certain medications to people with liver disease. That’s where hepatologists come in.
Telling someone to “just lose weight” doesn’t work. People need a plan and support that can be best achieved with a team of doctors, such as a multidisciplinary approach. Hepatologists should be ready to talk about eating fewer calories, being more active, and using medicine or surgery if needed. But the plan must be personalized. Liver patients need help losing weight without getting too weak or making their liver worse.
In some parts of the world, like in many Asian countries, people may be at risk for obesity-related liver problems even with a lower body weight. Doctors need to understand these differences and adjust treatment based on culture and biology.
A team effort that starts in the clinic
Helping liver patients with obesity takes a whole team. This includes dietitians, exercise experts, diabetes doctors, and weight-loss specialists. But the first step starts in the liver clinic, with a real conversation between the patient and the doctor.
If a patient shows signs of liver damage, such as high liver enzymes or SLD, that’s the time to talk about weight management too. Depending on the patient’s condition, treatment might include weight-loss drugs or other medicines, especially if they also have diabetes.
Doctors should build a system in their clinics to spot high-risk patients early. The sooner obesity is addressed, the better chance the patient has of avoiding serious liver problems and living a healthier life.
Beyond just the liver
Helping a patient lose weight isn’t taking focus away from liver disease—it’s targeting one of the main causes. Obesity doesn’t just affect liver test results. It affects how long someone lives, how they feel, and what other diseases they might face. “It is important for all doctors to be cognizant of the overall effect of obesity and treat the whole patient rather than the siloed approach of focusing on a single organ system,” said Siddiqui.
The authors of the article believe liver doctors must play a bigger role in the fight against obesity. They should lead tough but honest talks with patients about how their lifestyle affects their liver. Liver clinics can be key places to start solving a worldwide health problem, and help patients live better lives.