Fatty Liver Disease – An Underappreciated Concern in the Obese Population

Dr. Jacobs’ 4 Key Points

1. Fatty liver disease is prevalent (about 66%) in patients with excess weight and obesity.
2. While most primary care physicians discuss cholesterol and blood pressure regularly, fatty liver disease represents an underappreciated but very real and potentially chronic problem for patients carrying excess weight.
3. Bariatric surgery is an effective way to improve or eliminate fatty liver disease.
4. The number one cause of cirrhosis today is fatty liver due to obesity.

As bariatric surgeons, we see the liver in every procedure we perform.

While we think of fatty liver and cirrhosis of the liver as issues that affect those who drink alcohol excessively, these liver disorders are often caused by excess weight and obesity. Approximately 66% of overweight or obese patients suffer from fatty liver. As people gain weight, they put additional strain on the liver, which develops fatty deposits in response. These deposits, if left unresolved, eventually cause damage to the sensitive tissue and can ultimately begin to scar. The scarring is known as cirrhosis, turning the liver from soft and supple to hard and nodular, visibly unhealthy. Eventually, the liver cannot regulate chemical levels in the blood, and so begin the varying levels of nonalcoholic fatty liver disease. In the worst-case scenario, this condition can require a liver transplant to avoid long-term disability and even death.

We often discuss the consequences of excess weight and obesity in terms of high cholesterol, high blood pressure, diabetes, sleep apnea, and reflux, but we often ignore or underappreciate the effects of fatty liver at our peril.

How Do I Know I Have a Fatty Liver?

Unfortunately, a fatty liver does not show immediate and obvious effects until damage begins. When liver enzymes appear elevated in blood work or liver function tests show deficiencies, some damage has already been done.

While radiological tests such as MRIs and ultrasounds can spot scarring on the liver, the only way to definitively diagnose fatty liver is through a liver biopsy, which we often perform in conjunction with a bariatric surgical procedure, especially if liver function tests or laparoscopic visualization show concern.

However, we don’t want to wait that long to find liver issues. Therefore, we must stratify your risk. Do you have high cholesterol? Are you carrying a significant amount of excess weight? At some point, we must consider the possibility of fatty liver disease.

While we do not believe in alarming our patients, anyone carrying excess weight must be aware of the possible consequences of and potential treatment options or remedies for fatty liver disease. While we always consider surgery a last resort, we also know it to be an excellent option, especially for patients with obesity and uncontrolled comorbidities associated with metabolic disease. As such, we encourage patients to visit a weight loss specialist to take steps to improve their health.