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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. A doctor can explain results, assess your risk and plan treatment by video; blood tests, liver scans and specialist care for scarring are in person.
- What it is: a build-up of fat in the liver linked to excess weight, type 2 diabetes, high blood pressure or high cholesterol, now called MASLD.
- How common: about 1 in 5 people in the UK have it. Most only have the first stage, which does not usually cause problems.
- Reversible: often. Losing 5% of your body weight reduces liver fat, and 10% or more can improve scarring.
- Emergency: call 112 for vomiting blood, very dark or black poo, or sudden confusion or slurred speech.
Fatty liver disease is rarely urgent. Call 112 or go to an emergency department if you are vomiting blood, have very dark or black poo, or suddenly become confused or have slurred speech. Yellow skin or eyes, or a swollen tummy or legs, need urgent medical help in person.
Can an online doctor treat fatty liver disease?
Partly. Fatty liver disease is usually found on blood tests or a scan done for another reason, and most of its treatment is lifestyle change, which a doctor can plan and follow up by video. The doctor explains your results, looks at your risk factors, checks whether you need tests for liver scarring, and treats related problems such as weight, blood pressure and cholesterol. Blood tests, liver scans such as a liver stiffness scan, and specialist care for scarring or cirrhosis are done in person.
How an online consultation helps with fatty liver disease
- Your results explained: What raised liver enzymes or fat on a scan mean, and what they do not.
- Your scarring risk checked: Which blood score or scan shows whether the liver is scarred.
- A plan you can keep: Weight, diet, activity and alcohol targets in line with the European guideline.
- Heart and diabetes risks: Blood pressure, cholesterol and blood sugar, which often come with a fatty liver.
What the doctor checks in an online fatty liver consultation
The doctor checks for signs of advanced liver disease first. The doctor asks about:
- Warning signs: yellow skin or eyes, vomiting blood, black poo, a swollen tummy or legs, or confusion.
- Your results: liver blood tests, any ultrasound or liver stiffness scan, and when they were done.
- Risk factors: weight and waist size, type 2 diabetes, blood pressure, cholesterol, polycystic ovary syndrome, and age over 50.
- Alcohol: how much you drink in a typical week, because it changes the diagnosis and the advice.
- Medicines: some, such as steroids, sodium valproate, methotrexate, tamoxifen and amiodarone, can cause a fatty liver.
- Symptoms: tiredness, feeling unwell, or discomfort under the right ribs.
Before the call, have your latest blood test and scan results to hand, and weigh yourself and measure your waist if you can.
What is fatty liver disease?
Fatty liver disease is a build-up of fat in the liver. Its full name is now metabolic dysfunction-associated steatotic liver disease (MASLD): a fatty liver with at least one cardiometabolic risk factor, such as excess weight around the waist, type 2 diabetes, high blood pressure or high cholesterol, in someone who drinks little or no alcohol. It replaced the old name, non-alcoholic fatty liver disease (NAFLD).
- MASH, previously NASH, means the fat has caused inflammation.
- MetALD means a fatty liver with risk factors in someone who also drinks moderately: 20 to 50 g of alcohol a day for women and 30 to 60 g for men.
- Above those amounts, it counts as alcohol-related liver disease.
How common is fatty liver disease?
It is the most common long-term liver disease. About 1 in 5 people in the UK have it, and the UK charity Guts UK estimates that 1 in 3 people may have its early stages.
Which side is your liver on?
The liver sits on the right side of the upper tummy, under the ribs. That is where people with a fatty liver sometimes feel discomfort.
What are the stages of fatty liver disease?
Fatty liver disease has four stages. Most people only ever have the first:
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| Stage | What happens | What it means |
|---|---|---|
| 1. Fatty liver (steatosis) | Fat builds up in the liver, with no damage | Does not usually cause problems |
| 2. MASH (previously NASH) | The fat causes inflammation | A risk of getting worse |
| 3. Fibrosis | Scarring, while the liver usually still works well | Needs regular checks with a specialist |
| 4. Cirrhosis | Severe scarring that affects how the liver works | Can lead to internal bleeding, liver failure, liver cancer or sepsis |
Is fatty liver dangerous?
Usually not on its own: the first stage does not usually cause problems. The risk lies in inflammation and scarring, which can lead to cirrhosis, and in the heart: MASLD is linked to a higher risk of heart and blood vessel disease and kidney disease. That is why the next step after a diagnosis is a check for scarring, and why blood pressure, cholesterol and blood sugar matter.
What are the symptoms of fatty liver?
Fatty liver disease does not usually cause any symptoms, and many people have it without knowing. Some people feel very tired or generally unwell, or have discomfort under the right ribs. Symptoms of advanced scarring (cirrhosis) are different:
- yellow skin and whites of the eyes (jaundice), and itchy skin
- a swollen tummy, legs, ankles or feet
- confusion or trouble concentrating
- vomiting blood, or very dark or black poo
How to ease fatty liver pain
Fatty liver rarely causes pain. Discomfort under the right ribs should be checked for other causes, such as gallstones, and the treatment for the liver itself is the same: reducing liver fat through weight loss and activity.
What causes fatty liver?
Fatty liver is closely linked to weight and metabolism. You are more likely to get it if you:
- are overweight, especially with fat around the waist
- have type 2 diabetes, high blood pressure or high cholesterol
- have polycystic ovary syndrome
- eat an unhealthy diet or are not very active
- are over 50
Genes play a part too, and some medicines, such as steroids, sodium valproate, methotrexate, tamoxifen and amiodarone, can cause a fatty liver. Drinking alcohol adds to the damage, which is why it changes the name of the condition.
How is fatty liver diagnosed and checked for scarring?
Fatty liver is usually found after blood tests or a scan done for another reason. The 2024 European guideline then checks for scarring in two steps, starting with people who have type 2 diabetes, or excess weight around the waist with another risk factor, or abnormal liver tests:
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| Test | What it shows | What the result means |
|---|---|---|
| Liver blood tests | Liver enzymes and how the liver is working | Raised enzymes need a cause found |
| Ultrasound scan | Fat in the liver | Confirms a fatty liver; scarring needs the tests below |
| FIB-4 score | A scarring score calculated from routine blood tests and your age | Below 1.3 rules out advanced scarring (below 2.0 if you are over 65); above 2.67 makes it likely |
| Liver stiffness scan (elastography) | Liver stiffness, which reflects scarring | Used when FIB-4 is in between; 8 kPa or more suggests scarring that needs a specialist |
| Liver biopsy | A small sample of liver | The most accurate test of damage, used only in some people |
Can fatty liver be reversed?
Yes, often. Weight loss is the main treatment, and the liver responds to it. The 2024 European guideline sets clear targets for weight loss that is kept off:
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| Weight loss kept off | What improves | Example for someone weighing 90 kg |
|---|---|---|
| 5% or more | Liver fat | 4.5 kg |
| 7 to 10% | Inflammation | 6.3 to 9 kg |
| 10% or more | Scarring (fibrosis) | 9 kg |
Diet, activity, alcohol and coffee
- Diet: a Mediterranean-style diet, with less ultra-processed food and fewer sugary drinks.
- Activity: more than 150 minutes of moderate activity a week, or 75 minutes of vigorous activity.
- Alcohol: cut down; the European guideline discourages drinking with a fatty liver. With advanced scarring or cirrhosis, stop completely and permanently.
- Coffee: in studies, people who drink coffee have less liver damage, although this does not prove that coffee causes the benefit.
- Smoking: do not smoke.
How long does it take to reverse fatty liver?
It depends on the stage and on how much weight you lose and keep off. Liver fat starts to fall with a sustained loss of 5% of body weight, while scarring needs 10% or more, so gradual, lasting change matters more than speed.
Which fatty liver treatment might the doctor recommend?
Treatment depends on the amount of scarring and on your other risk factors. This is the framework the doctors use, in line with the EASL–EASD–EASO guideline:
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Fatty liver on a scan, normal liver tests | A lifestyle plan and a FIB-4 score | Yes | For the blood test |
| Raised liver enzymes | Repeat tests, and a check for other causes, including alcohol | Partly | For blood tests |
| Type 2 diabetes, or excess weight with another risk factor | A check for scarring: FIB-4, then a liver stiffness scan if needed | Yes, to plan | For the tests |
| A high FIB-4 score or a stiff liver on the stiffness scan | Referral to a liver specialist | Partly | For specialist care |
| Finding it hard to lose weight | A structured plan, and weight-loss medicine or surgery when suitable | Yes | For a surgery assessment |
| Cirrhosis with yellow skin or a swollen tummy | Urgent assessment | No | Urgently, in person |
| Vomiting blood, black poo or sudden confusion | Emergency care | No | Call 112 now |
Told you have a fatty liver and not sure what it means? A doctor can explain your results in one consultation.
See available times →Treatment options for fatty liver disease
What you can do yourself
- Lose weight gradually and keep it off: 5% first, then 7 to 10%.
- Move more, aiming for at least 150 minutes of moderate activity a week.
- Eat a Mediterranean-style diet, and cut down on ultra-processed food and sugary drinks.
- Cut down on alcohol, or stop if your liver is scarred.
- Keep up with check-ups: at least once a year, with tests every 2 to 3 years.
Prescription treatment
A prescription is never issued without a consultation. No medicine treats a simple fatty liver: weight loss is the treatment. The doctor may prescribe medicines for related conditions, such as blood pressure, cholesterol and type 2 diabetes, or, when suitable, medical weight loss. For MASH with moderate to advanced scarring, a liver specialist may consider resmetirom, which received a conditional marketing authorisation in the EU in August 2025. In the UK, specialists sometimes use pioglitazone or vitamin E, although the European guideline does not recommend them as liver treatments. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Vitamin E or other supplements taken without advice: they are not recommended as a treatment for the liver. Drinking ‘within limits’ once the liver is scarred: with advanced scarring or cirrhosis, all alcohol should stop. Waiting for symptoms: fatty liver rarely causes any until the damage is advanced.
Special situations
Type 2 diabetes
People with type 2 diabetes are among the first who should be checked for liver scarring. Diabetes medicines that also help weight are safe with a fatty liver.
Obesity and weight-loss surgery
When surgery for obesity is suitable, it is worth considering, because it can have long-term benefits for the liver. The obesity and medical weight loss pages cover the options.
Cirrhosis
Cirrhosis cannot be cured, but treatment can slow it down or stop it getting worse: stopping alcohol, keeping to a healthy weight, medicines for complications and, if it is very severe, a liver transplant. It needs a liver specialist.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When fatty liver disease is treated online, and when you need in-person care
Treated online: explaining results, assessing risk factors, planning tests for scarring, weight, diet, activity and alcohol plans, related conditions such as blood pressure and cholesterol, and follow-up.
In-person care: blood tests, ultrasound and liver stiffness scans, liver specialist care for scarring or cirrhosis, weight-loss surgery, and any sign of advanced liver disease.
When to get in-person care
Call 112 or go to an emergency department now for:
- vomiting blood
- very dark or black poo
- sudden confusion or slurred speech
Get medical advice the same day for:
- yellow skin or whites of the eyes
- being more short of breath than usual
- a swollen tummy, legs, ankles or feet
Tiredness, loss of appetite or weight loss you cannot explain, or liver blood tests that stay raised, need a doctor to review them soon.
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your liver: share your blood test and scan results, and say how much you weigh, how active you are and how much alcohol you drink.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s fatty liver disease? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
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Similar symptoms, different condition? Nutrition and metabolism disorders can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about fatty liver disease
What is fatty liver disease?
A build-up of fat in the liver, now called metabolic dysfunction-associated steatotic liver disease (MASLD). It is linked to excess weight, type 2 diabetes, high blood pressure and high cholesterol, and it usually causes no symptoms.
What causes fatty liver?
Fatty liver is caused by being overweight, especially around the waist, type 2 diabetes, high blood pressure or cholesterol, an unhealthy diet, too little activity and being over 50. Genes, some medicines and alcohol add to the risk.
Is fatty liver dangerous?
Usually not on its own: most people only have the first stage, which does not usually cause problems. Inflammation and scarring can lead to cirrhosis, and fatty liver is linked to a higher risk of heart disease.
Can fatty liver disease be prevented?
Largely, yes. Fatty liver disease follows the same risks as type 2 diabetes and heart disease, so keeping a healthy waist, eating a Mediterranean-style diet low in sugar and ultra-processed food, avoiding sugary drinks, exercising regularly, limiting alcohol, not smoking, and treating high blood pressure, cholesterol and blood sugar early prevent most cases; people with a strong family history, polycystic ovary syndrome or long-term steroid use benefit from a periodic liver blood test so a fatty liver is caught while it is reversible.
Can fatty liver be reversed?
Often, yes. Losing 5% of your body weight and keeping it off reduces liver fat, 7 to 10% improves inflammation, and 10% or more can improve scarring.
How long does it take to reverse fatty liver?
It depends on the stage and on how much weight you lose and keep off. Liver fat starts to fall with a sustained loss of 5% of body weight, while scarring needs 10% or more.
How do I reverse a fatty liver at home?
Lose weight gradually, 0.5 to 1 kg a week, aiming for 5% of your body weight to reduce liver fat and 10% to improve inflammation and scarring; eat a Mediterranean-style diet with vegetables, fruit, wholegrains, olive oil, fish and legumes and little sugar or processed food; exercise for at least 2.5 hours a week, with some strength work; cut alcohol; drink coffee, which is linked to less scarring; and keep diabetes, blood pressure and cholesterol treated. Fatty liver disease responds to this.
What are the symptoms of fatty liver?
Usually none. Some people feel tired or unwell, or have discomfort under the right ribs. Yellow skin, a swollen tummy or vomiting blood are signs of advanced liver disease.
Which side is the liver on?
The liver sits on the right side of the upper tummy, under the lower ribs, with a smaller lobe reaching across to the left, so discomfort from a fatty liver, when there is any, is a dull ache or fullness under the right ribs rather than sharp pain; sharp pain there is more likely gallstones, and a fatty liver is painless in most people.
Is coffee good for a fatty liver?
In studies, people who drink coffee have less liver damage, but this does not prove that coffee causes the benefit. Avoid adding lots of sugar: the European guideline advises cutting down on sugary drinks.
Can I drink alcohol with a fatty liver?
The European guideline discourages alcohol with a fatty liver, because even moderate drinking adds to the fat and inflammation and speeds up scarring, and there is no safe amount once fibrosis has started; if your liver is scarred or you have cirrhosis, stop drinking completely. For an early fatty liver, cutting right back, with several alcohol-free days a week and no binges, is the minimum, and stopping is better.
What is the difference between NAFLD and MASLD?
They describe the same condition. MASLD, metabolic dysfunction-associated steatotic liver disease, is the newer name and requires at least one cardiometabolic risk factor, such as type 2 diabetes or excess weight.
Can an online doctor help with fatty liver disease?
Partly. A doctor can explain your fatty liver results, assess your risk, plan tests for scarring and agree a treatment plan by video. Blood tests, scans and specialist care are in person.
- Non-alcoholic fatty liver disease (NAFLD), NHS, National Health Service (UK), reviewed 31 July 2025.
- EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD): executive summary, European Association for the Study of the Liver, of Diabetes and of Obesity, Diabetologia, 2024.
- Metabolic dysfunction associated steatotic liver disease (MASLD), Cambridge University Hospitals NHS Foundation Trust, approved 7 November 2025.
- Cirrhosis, NHS, National Health Service (UK), reviewed 10 February 2025.
- Resmetirom: European public assessment report (EPAR), European Medicines Agency, updated 27 May 2026.
- What is non-alcoholic fatty liver disease?, Guts UK, updated 11 November 2019.
- Gallstones, NHS, National Health Service (UK), reviewed 11 August 2025.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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