Fatty Liver Disease and Weight Loss: How MASLD Is Treated
Dr. Hecham Harb
Consultant Endocrinologist & Medical Director
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Weight loss is the main focus of treatment for fatty liver disease. The condition previously called non-alcoholic fatty liver disease (NAFLD) is now generally termed metabolic dysfunction-associated steatotic liver disease (MASLD) when metabolic risk criteria are met. Losing around 10% of body weight can substantially reduce liver fat and may improve inflammation and scarring. At Endocare, our endocrinologists assess the metabolic risk factors linked to MASLD at our Dubai clinic.
- The condition previously called non-alcoholic fatty liver disease (NAFLD) is now generally termed MASLD when metabolic risk criteria are met, a name announced in June 2023 after an international consensus process.
- A review published in 2022 put the global prevalence of MASLD at 32% of adults.
- Cleveland Clinic notes that fatty liver disease often causes no symptoms in its early stages.
- NHS Highland guidance advises that people with type 2 diabetes are at particular risk of MASLD and should be considered for liver screening.
- Bradford Teaching Hospitals NHS Foundation Trust advises people living with overweight to aim for a weight loss of 7% to 10% to help reverse liver damage.
- In the United States, the FDA label for the Wegovy injection includes adults with MASH and moderate to advanced liver fibrosis, under accelerated approval.
- Our endocrinologists assess weight, blood sugar, cholesterol and liver enzymes at our Dubai clinic, with body composition analysis at every consultation.
01 What is fatty liver disease (MASLD)?
Fatty liver disease is a build-up of fat in the liver. The American Association for the Study of Liver Diseases (AASLD) describes MASLD as hepatic steatosis together with at least one of five cardiometabolic risk factors.
MASLD replaced the older name non-alcoholic fatty liver disease (NAFLD). Metabolic dysfunction-associated steatohepatitis (MASH) replaced non-alcoholic steatohepatitis (NASH). The AASLD reports that the new names were announced in June 2023 after a consensus process with more than 200 participants.
A 2022 review in Clinical and Molecular Hepatology estimated that NAFLD, now MASLD, affects 32% of adults worldwide. Where alcohol intake is higher, the AASLD uses a separate category called MetALD. It applies to people with MASLD who drink more than 140 g of alcohol a week for women, or more than 210 g a week for men.
02 The stages of fatty liver disease
Fatty liver disease can range from a build-up of fat alone to permanent scarring. The table below summarises the stages, using the AASLD terms.
| Stage | What it means |
|---|---|
| Steatosis (MASLD) | Fat builds up in the liver |
| Steatohepatitis (MASH) | Fat is accompanied by inflammation and injury to liver cells |
| Fibrosis | Scar tissue forms in the liver |
| Cirrhosis | Severe scarring that permanently damages the liver |
Not everyone with MASLD progresses to the later stages. Assessing the risk of scarring is therefore part of the diagnosis.
03 Symptoms of fatty liver disease
In its early stages, fatty liver disease often causes no symptoms. Many people find out from a blood test or a scan done for another reason.
As the disease progresses, the Cleveland Clinic guide to steatotic liver disease lists symptoms such as yellowing of the skin and eyes, swelling of the abdomen and confusion. We recommend seeking medical advice promptly if you notice any of these.
04 Who is at risk of fatty liver disease?
The NHS Highland guidance on MASLD lists these cardiometabolic features alongside overweight or obesity:
- prediabetes or type 2 diabetes
- blood pressure above 130/85 mmHg, or treatment for it
- raised triglycerides, or treatment for them
- low HDL cholesterol
Having one of these features does not mean that you have MASLD. It is a reason to ask your doctor about your liver health.
People with type 2 diabetes are at particular risk. The NHS Highland guidance recommends considering them for screening with the FIB-4 score.
These risk factors are common in the UAE. The UAE National Health Survey 2017 to 2018, published by the Ministry of Health and Prevention, found obesity in 27.8% of adults aged 18 to 69. The International Diabetes Federation puts adult diabetes prevalence in the UAE at 20.7%.
05 How fatty liver disease is diagnosed
Fatty liver disease is often first suspected from raised liver enzymes on a blood test or from an ultrasound scan. Cleveland Clinic lists blood tests, imaging such as ultrasound, CT or MRI, and elastography among the tests used.
The FIB-4 score combines your age with routine blood test results to estimate the risk of liver scarring. Elastography, such as a FibroScan, measures the stiffness of the liver, which reflects scarring. A liver biopsy may be needed in some cases.
At Endocare, your endocrinologist will review your liver enzymes alongside your blood sugar, cholesterol and other markers in your blood tests. If further assessment is needed, your endocrinologist can arrange imaging or refer you to a hepatologist, a doctor who specialises in the liver.
06 How weight loss helps fatty liver disease
The NHS Highland guidance associates losing around 10% of body weight with a substantial reduction in liver fat in MASLD. It adds that this level of weight loss can prevent fibrosis from worsening and may improve it.
For people with a healthy weight, the Bradford Teaching Hospitals NHS Foundation Trust recommends a weight loss of 3% to 5%. Your endocrinologist will set a target with you, based on your starting weight and the stage of the disease.
The NHS describes reducing daily calorie intake by around 600 calories as a safe and sustainable approach to weight loss. The NHS Highland guidance suggests the same deficit for MASLD, with a target of 90% of your current weight.
Nutrition, activity and alcohol
Our clinical nutritionist works towards a Mediterranean-style pattern: vegetables, legumes, whole grains, fish, nuts and olive oil, with refined carbohydrates and sugar-sweetened drinks reduced rather than banned. The US Physical Activity Guidelines set the target at 150 to 300 minutes a week of moderate-intensity aerobic activity, plus muscle-strengthening work on at least two days.
Endocare’s lifestyle coaches will build these recommendations into a plan that fits your routine. Adequate protein and resistance training can help preserve muscle while you lose weight.
For MASLD, the NHS Highland guidance recommends stopping or minimising alcohol. Where the risk of scarring is raised, it recommends stopping completely.
07 Medication for fatty liver disease
Weight loss medication can help some patients reach the weight loss that benefits the liver. Options available in the UAE include Mounjaro (tirzepatide), the Wegovy injection (semaglutide), the Wegovy pill and Foundayo (orforglipron).
Weight loss medication is generally considered for patients with a BMI of 30 or above, or 27 or above when weight-related health conditions are present. Eligibility also depends on the approved use of each medication. Your endocrinologist can assess whether weight loss medication is suitable for you and discuss the benefits and risks.
In the United States, the prescribing information for the Wegovy injection includes the treatment of adults with MASH and moderate to advanced liver fibrosis, without cirrhosis. This indication was granted under accelerated approval. For patients with type 2 diabetes, the NHS Highland guidance supports considering GLP-1 receptor agonists.
08 Complications of fatty liver disease
Without treatment, fatty liver disease can progress to cirrhosis, in which the liver becomes permanently damaged. Cleveland Clinic also links fatty liver disease to a higher risk of heart disease and liver cancer.
The NHS Highland guidance notes that people with MASLD are at high risk of premature death from cardiovascular disease. For this reason, treatment also covers blood pressure, cholesterol and blood sugar.
09 Preventing fatty liver disease
Our endocrinologists recommend a few steps to help prevent fatty liver disease:
- maintaining a healthy weight
- exercising regularly
- eating a balanced, whole-food diet
- staying hydrated
- getting enough sleep
- managing stress, with support where needed
- not smoking
These steps can also support healthy blood sugar, blood pressure and cholesterol.
10 How Endocare supports patients with fatty liver disease in Dubai
Your first appointment is a full medical assessment, not simply a prescription visit. Your endocrinologist will review your medical history, your blood tests and your metabolic risk factors. They will then discuss a plan with you.
Visceral fat, the fat stored around the organs, is often associated with fatty liver disease and insulin resistance. At Endocare, body composition analysis is included free of charge at every consultation. Body composition analysis estimates body fat, muscle mass and body water. Repeated measurements help your endocrinologist understand how your body is changing beyond the number on the scale. A body composition analysis can estimate visceral fat and provide a visceral fat rating that can be tracked over time.
Where possible, your first appointment takes place in person at Endocare’s Dubai clinic, as the physical examination and body composition analysis cannot be completed remotely. Monthly follow-up appointments can be held in person at the clinic or online.
Our pages on metabolic syndrome, prediabetes and PCOS cover related conditions. Insurance coverage for weight loss treatment in the UAE varies by policy and is often limited, so we recommend checking your individual coverage before starting treatment. Our care coordinators can also help you in this process.
11 FAQ
Can fatty liver disease be reversed?
In its early stages, often yes. Losing weight can reduce liver fat and inflammation, and fibrosis can also improve. Cirrhosis causes permanent damage, which is why early assessment matters.
How much weight do I need to lose for fatty liver disease?
It depends on your starting weight and the stage of the disease. For people living with overweight, NHS guidance describes a loss of 7% to 10% as helping to reverse liver damage. Your endocrinologist will agree a target with you.
Is fatty liver disease dangerous?
It can be. Early MASLD often causes no symptoms, but it can progress to scarring and cirrhosis in some people. It is also linked to a higher risk of heart disease.
Can I drink alcohol if I have fatty liver disease?
We recommend avoiding alcohol or keeping it to a minimum. Alcohol can add to liver damage, and complete avoidance is advised where scarring is a concern.
Can I take statins if I have fatty liver disease?
For most patients, yes. The NHS Highland guidance states that statins are safe in chronic liver disease, including compensated cirrhosis. Your endocrinologist will review your cholesterol treatment with you.
Which doctor treats fatty liver disease?
Hepatologists and gastroenterologists treat the liver itself, while endocrinologists treat the metabolic conditions linked to it, such as obesity, insulin resistance and type 2 diabetes. Many patients can benefit from both.
Do I need a referral to see an endocrinologist in Dubai?
No. In the UAE, you can see an endocrinologist directly, with no GP referral needed, for concerns related to hormones, weight, metabolism or blood sugar. If you plan to use health insurance, we recommend checking your policy before you book, because some insurers require a referral or pre-approval.
At our Dubai clinic, your endocrinologist will assess you, review your blood tests and body composition, and discuss a plan to support your liver health. You can book a weight loss consultation with one of our endocrinologists on +971 4 285 3885 or send us a message on WhatsApp.
Book Your Consultation
- Specialist consultation
- Personalized Coaching
- Body Composition Analysis