Human Liver Cell

NASH: The Invisible Complication of Untreated Obesity

When most people think about obesity, the only complication they think of is type 2 diabetes. Quite a few people (but not a majority) think of heart disease. But few people think about liver disease. Unfortunately, Nonalcoholic steatohepatitis (NASH) can be one of the most serious complications a person with obesity will face. NASH is an advanced stage of fatty liver disease.

When it progresses, fibrosis can lead to cirrhosis, liver failure, and death. By 2020, NASH will be the number one reason for liver transplantation. NASH is on the rise, because about 80% of it occurs in people with obesity. As obesity is rising, so is NASH.

Commonly Undiagnosed

Most people with obesity (about 70%) have some signs of fatty liver disease. In contrast, most people with obesity do not have diabetes, and 30% will never develop diabetes. Nonetheless, diabetes is the number one complication that people associate with obesity. In comparison, only 15% of people think liver disease is a complication of obesity.

Even among people who are actively engaged in seeking out obesity care, we find very low awareness of liver disease and NASH. That’s surprising because bariatric surgery patients follow a “liver-shrinking diet” before their surgery. But it seems that the subject of liver disease rarely comes up.

And according to hepatologist Stephen Harrison, it mostly slips by without a diagnosis. He says that’s because most primary care providers are unaware of the disease. On top of that, the only hard and fast diagnosis is a liver biopsy.

Better Awareness Needed

The picture is pretty clear. We have a tremendous knowledge gap. Patients are unaware of the risks of NASH. Providers are missing the diagnosis. Bariatric surgery and other forms of obesity care can be helpful for NASH, but not if people are overlooking the problem.

Likewise, new therapies may be on the way, but they won’t help patients who don’t know they have a problem. We have much work to do.

Click here for more on NASH from Newsweek, here for more from the New England Journal of Medicine, and here for more from the Washington Post.

Human Liver Cell, photograph by Donna Beer Stolz / NIH / flickr

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November 28, 2017

3 Responses to “NASH: The Invisible Complication of Untreated Obesity”

  1. November 28, 2017 at 8:26 am, Gretta said:

    Very important article about a serious consequence of obesity. I was diagnosed with primary liver cancer in 2010 without a history of alcohol use, hepatitis, or other common risk factors except for NASH. A very thorough endocrinologist noted a small change in my liver enzymes while checking bloodwork for my poorly controlled diabetes… with no symptoms or history. I am grateful for good health insurance and excellent medical care and here I am, healthier and stable almost 8 years later. I have since addressed my obesity by having RNY and have maintained a healthy weight since 2013. My diabetes is now well controlled, though it never went into remission. NASH is serious-awareness of your risk is critical. It can happen to anyone. I believe that obesity is a disease, and we know without a doubt that it increases risks for many serious illnesses and chronic diseases. Do all that you can to manage your weight and all your health risks and conditions-a life well-lived is worth the effort.

    • November 28, 2017 at 8:57 am, Ted said:

      Gretta, thanks for sharing your very important story. I’m heartened to hear about the excellent care you received.

  2. November 28, 2017 at 5:43 pm, Michael said:

    In Sydney Australia in mid 1998 a GP failed to refer Luis Almario with refractory severe obesity for bariatric surgery. Luis later developed liver cancer and was awarded $364,000 in damages after suing his GP for negligence. This judgement was overturned on appeal because i) bariatric surgery was not a standard of care in 1998 and ii) Luis failed to act on a referral to a weight loss clinic from another doctor.

    The first reason no longer applies. The second reason was just luck (for the GP).

    Given all the prevalent and drastic consequences of obesity (incl. toe, foot and leg amputations) it is interesting that no subsequent cases have been brought before the courts. Is this because affected patients have been conditioned by the stigma of obesity to believe that they only have themselves to blame for their disease and hence its ghastly consequences as well?