Photo Credit: Natali_Mis

Liver health is a public issue that PCPs can address. Non-invasive liver tests should be routine, especially for patients struggling with obesity.

A CDC report that highlights the rise of severe obesity in the United States begins, “Obesity is a chronic condition that increases the risk for hypertension, type 2 diabetes, coronary heart disease, stroke, and certain cancers.” Unfortunately, it’s not surprising that liver disease is not mentioned, despite its undeniable link to obesity and significant impact on health. It’s a disease that doesn’t get enough attention. Ironically, metabolic dysfunction-associated steatotic liver disease (MASLD) is often called a “silent disease,” but this is because it doesn’t have any symptoms until it progresses.

MASLD, defined by fat accumulation in the liver, is more common than many people realize. One in four Americans has MASLD, and 70% of people with type 2 diabetes have it, yet only 5% are diagnosed because it’s undetectable without screening.

The gap between those affected by MASLD and those diagnosed highlights the urgent need for change in how we approach liver health. Primary care professionals (PCPs) are key—they must be the first line of defense in detecting and managing liver disease before it progresses. According to recent clinical guidelines from leading associations like the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver, screening for patients with high-risk liver disease is strongly encouraged. However, liver screening is not yet a part of routine primary care.

This can and must change with advancements in non-invasive tests for liver disease. Non-invasive liver health tests have never been simpler, faster, or more precise, even for patients with obesity.

Why PCPs Must Lead the Charge

PCPs are often the first—and sometimes only—healthcare professionals patients see. Given the rise of obesity and related conditions like type 2 diabetes, PCPs are in a unique position to intervene early and help curb the growing rates of MASLD. The silent nature of liver disease means that without routine screening, many patients will continue to live undiagnosed until more serious—and often irreversible—liver damage has occurred.

Many primary care practices do not prioritize liver function tests due to a lack of awareness, time constraints, or because liver disease is often seen as a specialist’s domain (eg, hepatologists, endocrinologists, or gastroenterologists). However, with increased access to non-invasive tests that are safe, cost-effective, and easy to use, there is no reason for liver screening not to be a routine part of primary care, especially for at-risk patients.

The Role of Non-Invasive Testing in Routine Care

Thanks to technological advancements, liver screening no longer needs to rely on invasive, painful, and risky methods like biopsies. Tools that include transient elastography, which measures liver stiffness via ultrasound, offer fast, precise, and painless liver health assessments, providing critical insights into whether a patient shows signs of MASLD or more advanced liver damage. Transient elastography is a valuable diagnostic tool that can be safely repeated every 6 to 12 months to monitor changes in liver stiffness over time, ensuring patients are consistently evaluated for disease progression or improvement. Furthermore, such non-invasive tests can be integrated into primary care settings without requiring referrals to specialists, making it easier for physicians and patients to act.

Prioritizing Prevention & Early Detection

Incorporating routine liver screenings into primary care aids in early detection and creates opportunities to have meaningful conversations with patients about lifestyle changes. Preventive measures such as weight management, healthier diets, and increased physical activity can significantly slow or even reverse the progression of MASLD. However, these interventions are most effective when the disease is diagnosed in its early stages. By diagnosing MASLD before it progresses, PCPs can empower patients to take control of their health and prevent long-term liver damage.

The reality is clear: liver health is no longer just a specialist’s domain. It’s a growing public health issue that PCPs are uniquely positioned to address. Non-invasive liver tests should be as common as screenings for diabetes, hypertension, and cholesterol, especially for patients struggling with obesity. Together, we can help people love their livers.