Obesity and Liver Health: Two sides of the same coin
You may have recently read about NFL legend Dan Marino opening up about his liver disease diagnosis in Forbes and People Magazine.
The articles offer a clear and relatable explanation of metabolic dysfunction–associated steatotic liver disease (MASLD) and its more advanced form, metabolic dysfunction–associated steatohepatitis (MASH) - conditions that many people may still recognise by their previous names, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).
MASLD/MASH are not isolated liver problems. They are closely tied to obesity and other metabolic conditions, including cardiovascular disease and diabetes, representing two sides of the same (and growing) public health threat. Addressing them together can help prevent and manage both conditions more effectively - while also strengthening the broader fight against other metabolic-based non-communicable diseases (NCDs).
Shared roots, shared risks
Both obesity and MASLD are becoming more common worldwide. In 2022, around 1 in 8 people were living with obesity, and 1 in 3 adults were estimated to have MASLD - with even higher rates among those living with obesity.
These high and rising numbers don’t come down to individual choices alone. They reflect the environments that shape our daily lives:
- Easy access to ultra-processed, calorie-dense foods,
- Cities and routines that make it harder to stay active, and
- Limited preventive healthcare, which often misses early warning signs.
This “obesogenic environment” makes healthy living harder for everyone, and their effects are felt most strongly in disadvantaged communities.
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The weight of stigma
Despite clear scientific evidence, both obesity and MASLD are still often seen as the result of poor choices or lack of willpower. This view fuels stigma and discrimination - from society, and sometimes even within healthcare, shifting political and social responsibility.
For those affected, stigma can delay diagnosis, discourage seeking help, and make treatment harder to follow. For healthcare providers, unconscious bias can lead to less empathy and reduced quality of care.
To move forward, we must treat obesity and MASLD as medical conditions, not personal failings. Addressing the social and commercial determinants- such as food marketing, limited healthcare access, and inequitable environments - is just as important as supporting individuals to make healthy changes.
Gaps in health systems
Despite their scale, obesity and MASLD are still under-recognised in national and regional health plans. Many clinicians aren’t trained to screen and manage MASLD, and most health systems don’t offer clear pathways for diagnosis or long-term management.
While obesity is at least part of many policy discussions, liver disease has often been left out entirely, leaving millions of people undiagnosed until the disease is advanced - when treatment options are fewer and more expensive, and outcomes are worse.
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Shared solutions
Because these diseases share causes, they can share solutions too.
- Put liver health on the map.
Integrate MASLD/MASH into national and global obesity and broader NCD strategies, including screening, policy, and funding. - Focus on prevention.
Measures like taxing sugar-sweetened drinks, designing cities that support active living, and ensuring access to affordable, healthy food options can make a powerful difference. - Strengthen primary care.
Routine check-ups, simple blood tests, and non-invasive imaging can help detect problems early. A coordinated, multidisciplinary, person-centred approach can prevent progression while easing pressure on health systems. - Guarantee fair access to new treatments.
New medications, such as GLP-1 receptor agonists, are indicated for both obesity and MASH with fibrosis. But they must be made affordable and accessible to all, not just a few. - Expand universal health coverage.
Everyone should have access to preventive care, diagnostics, and treatment for metabolic conditions, regardless of income level, geographical location or migration status.
A shared opportunity
The numbers ahead are daunting: by 2035, almost 4 billion people could be living with obesity, and millions more could develop advanced liver disease. But this story isn’t fixed - and the future can look very different if we act together now.
We already know what works: prevention, early detection, and fair access to care. By combining efforts against obesity and MASLD, we can protect lives, ease the strain on health systems, and create healthier environments for generations to come.
Hope lies in integration and equity - in policies that see the whole person, not just the disease. By moving beyond blame and working collectively, we can turn these twin epidemics into a catalyst for stronger, fairer, and more compassionate health systems worldwide.
Together, we can rewrite the future of metabolic health - one where prevention is prioritised, care is accessible, and everyone has the opportunity to live well.
Watch the recording
If you’re interested in learning more about liver health and other metabolic conditions like obesity, diabetes and cardiovascular disease, please view this recording from a recent policy side-event during the United Nations General Assembly in New York City (September 2025).
Hear from a high-level panel of experts who unpacked integrated policy approaches to NCDs and the need to strengthen health systems to move toward prevention, early detection, and treatment.
WATCH HERE