If you’ve been diagnosed with obesity, your health care team may have told you that you’re at higher risk for developing other health conditions. These include liver diseases like metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). Recently, these conditions were renamed from nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) to better reflect their root causes.

This article will cover what obesity is, how it’s diagnosed, its relation to liver disease, and how treatment and lifestyle changes can improve outcomes for people living with MASLD and MASH.

What Is Obesity?

Health care providers use the body mass index (BMI) to diagnose obesity. It’s calculated using a person’s height and weight. For example, someone who is 5 feet and 9 inches tall and weighs 203 pounds would have a BMI of 30. According to the Centers for Disease Control and Prevention (CDC), a BMI score of 30 or above is considered obese. A BMI of 40 or higher is classified as severe obesity.

However, a BMI score doesn’t tell the whole story. It doesn’t account for muscle mass, bone density, or your health history. Your doctor may also look at your waist size and overall health when diagnosing obesity.

Understanding the Link Between Obesity, MASLD, and MASH

Having a diagnosis of obesity is associated with a risk of other health problems, including chronic liver diseases like MASLD and MASH. When the body has higher levels of fat in the blood, some of it is stored in your liver when the liver filters the blood. A buildup of fat in the liver can prevent it from working as well as it should. This condition is called steatosis, or fatty liver, which is a hallmark symptom of MASLD.

If MASLD gets worse, it can turn into MASH. MASH is more serious because fat in the liver causes inflammation, cirrhosis (scarring), and long-term damage. If not treated properly, MASH can lead to more serious issues like liver cancer or liver failure.

Obesity is common for people living with MASLD and MASH. Studies have shown that up to 90 percent of people with a BMI score over 40 are also affected by MASLD.

Insulin resistance develops when your body can’t use insulin as effectively as it should. People with obesity are also more likely to have insulin resistance, which can increase the risk of developing MASLD. This is because higher levels of insulin and glucose in the blood can lead to more fat production and storage in the liver.

Shared Risk Factors for Obesity, MASLD, and MASH

Obesity, MASLD, and MASH share some common risk factors. These include insulin resistance, type 2 diabetes, and metabolic syndrome.

Insulin Resistance

Insulin resistance happens when the body’s cells don’t respond properly to insulin, leading to higher blood sugar levels. It’s a major risk factor for both obesity and MASLD.

Type 2 Diabetes

Type 2 diabetes is closely linked to both obesity and MASLD. It happens when the body either doesn’t produce enough insulin or can’t use insulin properly. As a result, this leads to higher blood sugar levels. Extra sugar in the blood is converted into fat, which can build up in the liver over time.

Metabolic Syndrome

Metabolic syndrome is a group of conditions that includes high blood pressure, high cholesterol levels, and a larger waist circumference. Each of these factors raises the risk of developing MASLD and MASH.

Treatment To Manage MASLD and MASH

A treatment plan is important for managing MASLD and MASH. Treatment usually involves a combination of dietary changes, more physical activity, and addressing comorbidities (co-occurring health conditions) like diabetes and high cholesterol. Your health care team may suggest one or more of the following strategies in your treatment plan.

Dietary Changes

Adopting a healthy diet is one of the most effective ways to improve your liver health. Focus on adding more lean proteins (like chicken, fish, tofu, or lentils), vegetables, fruits, and whole grains into your diet. By limiting your intake of sugary beverages and high-fat snacks, you may reduce your body fat. This will help to reduce the amount of fat stored in your liver.

Some studies suggest that drinking coffee can prevent liver fibrosis (formation of scar tissue). If you can tolerate caffeine, drinking around 2 cups of caffeinated coffee a day can help you manage MASLD.

Remember, small changes toward healthier eating over time are better than quick fixes or fad weight-loss diets. A registered dietitian can help you identify the best changes to make for your health.

Exercise

Developing a routine that includes regular physical activity is important for improving your overall health. Exercise helps to burn calories, build strength and endurance, and improve insulin sensitivity. Aim for around 150 minutes of moderate-intensity physical activity per week. This might include brisk walking, swimming, or other low-impact sports. Be sure to consult with your health care team about what exercises are safe for you.

Weight Loss

According to Cleveland Clinic, losing even 3 percent to 5 percent of your body weight can reduce fat levels in your liver. A weight loss of 5 percent to 10 percent can reduce inflammation. However, some studies have shown that losing a lot of weight too quickly may worsen MASH symptoms, so it’s important to talk to your doctor before attempting to change your weight.

If you and your health care team determine that weight loss is an appropriate goal for you, you can work together to develop a weight loss plan you can stick with. A registered dietitian can help you plan meals. In some cases, your doctor might recommend weight loss medications in addition to lifestyle changes.

Managing Other Health Conditions

If you have other health conditions such as diabetes, high cholesterol, or high blood pressure, it’s important to develop a treatment plan that manages these conditions too. Doing so can prevent MASLD, or keep MASLD from progressing to MASH. Your health care team may recommend lifestyle changes, medications, or a combination of both to help address your specific treatment goals. In some cases, weight loss medications may be considered, but they should be used in combination with lifestyle changes too.

If you have been diagnosed with obesity and MASLD or MASH, it’s important to talk to your doctor about your treatment options. They’ll work with you to come up with an individualized treatment plan that can help you manage these conditions.

By eating healthily and staying active, you can improve your liver health and overall well-being. Even small changes can make a big difference.

Talk With Others Who Understand

On MyObesityTeam, the social network for people with obesity and their loved ones, more than 53,000 members come together, ask questions, give advice, and share their stories with others who understand life with obesity.

Are you or a family member living with MASLD or MASH? What steps have you taken to manage your condition? Share your tips and experiences in a comment below or on your Activities page.