Obesity has undeniably become the top health issue of our time, with its prevalence and impact on our bodies making headlines across health care and popular media.
This isn’t merely a matter of carrying extra pounds; it’s about the multitude of serious health complications that come in its wake. The conversation around obesity often gravitates towards heart disease, diabetes, and certain cancers.
Still, another critical aspect frequently slips under the radar – the detrimental impact on one of our most vital organs, the liver.
As a gastroenterologist, I see the direct impact that our diets and lifestyles have on our livers. Liver disease leads to 2 million deaths per year, worldwide. One in 4 adults globally have metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as nonalcoholic fatty liver disease or NAFLD) – many of which have no symptoms. One hundred million Americans have some form of liver disease, but less than 2 percent are officially diagnosed.
With liver disease on the rise at staggering rates, we must have conversations about liver health with our patients now to help redirect our current trajectory.
The projected rates of liver disease for both MASLD and metabolic dysfunction-associated steatohepatitis (MASH, formerly known as nonalcoholic steatohepatitis or NASH) will become unmanageable for our health care providers and also carry an increasingly hefty price tag for our health care system. MASLD alone costs the United States nearly $32 billion dollars annually, nearly the same cost strokes have on our health care system.
The liver is one of the most critical indicators of one’s health, responsible for over 500 vital functions. It plays a role in nearly every organ system in the body, aiding in detoxification, synthesis, and storage.
It’s also the “canary in the coal mine” of poor diet and lifestyle choices. However, the liver is so resilient that we can’t hear or see its cry for help. We might not know until it’s too late and we receive a diagnosis of cirrhosis or cancer.
The good thing about a resilient organ is that early-stage damage can often be reversed. In fact, patients can do little things to make a big difference – small amounts of weight loss combined with low-impact physical activity multiple times a week can help increase overall liver health, possibly reversing liver damage significantly.
The bad thing is that because the liver tolerates more—the disease progression is largely asymptomatic, even in patients with advanced disease.
More people die of liver disease than breast and colon cancers combined. And, thanks to the successful public health initiatives and media attention, we are all aware that annual mammograms are recommended to start at age 40 and annual colonoscopies at age 45.
With liver disease, no sign or symptom prompts patients to see a doctor about their liver health. Where is the public health campaign to elevate the importance of liver disease and detection? Why aren’t liver scans included as part of our annual checkups?
The alarm bells have been sounding across the globe. This year alone, the American Diabetes Association, American Association for the Study of Liver Disease, and American Gastroenterological Association have all made guidance suggestions for earlier liver screenings – to find liver disease at those early stages, when therapies and interventions can aid in reducing, and even reversing the damage.
Early detection is crucial to help curb the rising liver disease burden. Advances in technology have made earlier screenings more accessible than ever. Endocrinologists and gastroenterologists can noninvasively test a patient’s liver in their own clinics within 10 minutes. The scans provide a point-of-care exam with results in minutes at a doctor’s office – no operation or hospital stay needed. Liver scans not only help with initial diagnosis, but also can be used to monitor progression of disease or even provide proof of reversed damage. I have had countless patients see progress after intervention, which has effectively encouraged them to continue adopting and maintaining healthier lifestyles and dietary habits.
As a physician, I don’t want my patients to go undiagnosed with this mostly asymptomatic condition. As providers and patients, we must work to change the current trajectory of America’s liver health. We need more people to be aware of the risks of liver disease, more providers to utilize and recommend liver scans, and we need the media to help raise awareness of the importance of liver health.
Darryn Potosky is a gastroenterologist.