A recent article published in Metabolism discussed that the obesity epidemic is closely associated with the rising prevalence and severity of nonalcoholic fatty liver disease (NAFLD). Obesity is not only linked to simple steatosis (SS), but also with advanced disease; vis, NASH, NASH-related cirrhosis, as well as hepatocellular carcinoma. Thus, apart from increasing the all-cause mortality, obesity tends to increase liver-specific mortality among NAFLD patients.

Owing to limited approved pharmacological interventions for NAFLD, targeting obesity is a rational option for its management. In the first-line, lifestyle modification—diet and exercise—is recommended. However, weight loss may be difficult to achieve and sustain; therefore, adding pharmacotherapy is recommended in cases where lifestyle modifications seem inadequate. Several anti-obesity medications have been investigated in NAFLD, for instance orlistat and glucagon-like peptide-1 analogs. Anti-obesity medications that have not been investigated are lorcaserin, phentermine hydrochloric, phentermine/topiramate and naltrexone/bupropion. On the other hand, some medications with weight-lowering efficacy have not been approved for obesity, such as sodium-glucose cotransporter-2 inhibitors and farnesoid X receptor ligands.

It was stated that in cases where the combination of lifestyle modification and pharmacotherapy also fails, bariatric surgery must be considered in selected morbidly obese individuals.

Source: Polyzos SA, Kountouras J, Mantzoros CS. Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics. Metabolism. 2019;92:82-97.