Non-alcoholic fatty liver disease (NAFLD) is now the most common liver condition in the UK, affecting an estimated 1 in 3 adults. In patients who are overweight or obese, prevalence rises to 70-80%. Yet it is almost never identified through standard GP assessment, because standard blood tests are a poor predictor, and it causes no symptoms until significant damage has occurred.
What Is NAFLD and Why Does Fat Accumulate in the Liver?
The liver is the body’s primary metabolic organ, responsible for processing fats, detoxifying hormones, regulating blood glucose, and synthesising proteins. When caloric excess, insulin resistance, or metabolic dysfunction impairs normal fat processing, triglycerides accumulate within hepatocytes (liver cells). This is NAFLD.
The spectrum ranges from simple steatosis (fat accumulation without inflammation) to NASH (non-alcoholic steatohepatitis, where inflammation is present) to cirrhosis. The earlier in the spectrum it is identified, the more reversible it is, often significantly so through targeted medical intervention.
How NAFLD Directly Impairs Weight Loss
- Fat metabolism is compromised: A fatty liver cannot efficiently oxidise stored fat for energy, meaning the body resists fat mobilisation even in caloric deficit
- Insulin resistance is amplified: The liver plays a central role in glucose homeostasis; hepatic fat directly worsens systemic insulin resistance, making blood sugar control harder
- Hormonal detoxification is impaired: The liver deactivates excess oestrogen, cortisol, and other hormones. When compromised, these accumulate, contributing to oestrogen dominance, fat storage, and metabolic dysfunction
- Medication efficacy may be reduced: Some weight loss and metabolic medications are hepatically metabolised; liver dysfunction can alter their pharmacokinetics
Many of our patients who have struggled with weight loss despite genuine adherence to diet and exercise are found to have significant hepatic steatosis on FibroScan. Treating the liver first, through targeted nutrition, liver-supportive supplements, and where appropriate medication, often unlocks weight loss that had previously been impossible.
Why Standard Blood Tests Are Not Enough
Liver function tests (LFTs), specifically ALT and AST, are the standard first-line assessment. However, they are poorly sensitive for NAFLD: up to 75% of patients with histologically confirmed NAFLD have normal LFTs. By the time LFTs are elevated, significant hepatic damage is often already present.
FibroScan: The Gold Standard for Non-Invasive Liver Assessment
FibroScan (vibration-controlled transient elastography) is a non-invasive ultrasound-based technology that measures two parameters: liver stiffness (a marker of fibrosis) and the Controlled Attenuation Parameter (CAP), which quantifies hepatic fat content. It takes less than 10 minutes, requires no needles, no sedation, and no radiation.
At Harley Weight Loss Clinic, we offer FibroScan as part of our advanced diagnostic pathway. For patients with elevated BMI, metabolic syndrome, or suspected hormonal dysfunction, it is frequently a revelatory investigation, identifying a treatable condition that explains years of treatment-resistant weight.
Written by Dr Saima Ajaz, MBBS, MRCGP
Lead Clinician, Medical Director, Harley Weight Loss Clinic
