Been diagnosed with fatty liver disease and wondering if weight loss surgery may help? Learn all about the condition, and the potential benefits of bariatric surgery for treating the disease when it co-exists with obesity.
Understanding fatty liver disease (NAFLD / MAFLD)
Non-alcoholic fatty liver disease (NAFLD) is a common condition where excess fat builds up in the liver, not caused by alcohol. It affects up to 1 in 3 adults in Australia, especially those with obesity, type 2 diabetes, high cholesterol, or insulin resistance. In 2023, the preferred name for the condition was changed to ‘metabolic dysfunction–associated fatty liver disease’ (MAFLD), although NAFLD is still widely used to refer to the condition. The name change reflects the strong correlation between metabolic syndrome and the condition, with an increased risk for those who already have another condition such as hypertension, high cholesterol or insulin resistance.
Why fatty liver is so dangerous
While early stages of fatty liver may be silent, it can progress to non-alcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis, and even liver failure or liver cancer if left untreated. The liver is a vital organ that processes nutrients, filters toxins, and helps regulate metabolism. When fat infiltrates the liver, it causes inflammation and scarring.
NAFLD / MAFLD is now one of the leading causes of liver transplants worldwide. The good news is, the condition is reversible, especially when addressed early.
How does it happen?
Your risk of developing MAFLD/NAFLD increases with poor lifestyle habits. Physical inactivity, a poor diet and smoking are all significant risk factors. According to a census statement on primary care published in the Medical Journal of Australia, those who already have diabetes, or have two or more metabolic risk factors should be tested for the condition. Importantly, people with obesity are at a significantly increased risk. It is estimated that NAFLD is prevalent in 55-75% of people with obesity, although some studies suggest it could be as high as 80%.
The role of weight loss in treating NAFLD / MAFLD
Clinical studies show that weight loss and lifestyle improvements are the mainstay of treatment for fatty liver. Even a modest reduction in weight can dramatically improve liver health.
- 3% weight loss can reduce liver fat in your cells.
- 5% weight loss can improve liver inflammation
- 7–10% weight loss can reverse inflammation and fibrosis in many patients.
The Royal College of Australian General Practitioners (RACGP) guidelines for fatty liver disease reiterates the importance of weight loss:
“The cornerstone for management of fatty liver is achieving weight control and reduction in cardiovascular risk factors,” RACGP considers that where weight reduction is unsuccessful through diet and exercise “bariatric surgery may be considered.”
Weight loss surgery as a treatment for fatty liver disease
For many people, achieving and sustaining the required level of weight loss through diet and exercise alone can be extremely challenging. This is where metabolic (bariatric) surgery can play a transformative role.
Bariatric surgery isn’t just about reducing stomach size, it also leads to hormonal changes that improve insulin sensitivity, reduce inflammation, and promote long-term weight loss. These effects directly benefit the liver. Several high-quality studies and international guidelines support the use of weight loss surgery to improve or even reverse MASLD / NAFLD.
A 2022 systematic review and meta-analysis of 37 studies found that bariatric procedures significantly improved liver steatosis, inflammation, and fibrosis, suggesting surgery should be considered a treatment option for NAFLD.
The well-cited BRAVES randomised controlled trial examined bariatric surgery for NASH, an advanced stage of NAFLD, and found it was significantly more effective than lifestyle intervention and medical therapy alone in achieving disease resolution at 1 year in people with obesity.
Australian evidence also supports these findings. A 2017 clinical trial of 84 patients showed that NAFLD improvements occurred rapidly after bariatric surgery and were closely linked to weight loss, with a 10–15% reduction in body weight associated with substantial benefit.
Long-term outcomes appear durable, with a five-year observational study reporting NASH resolution in 84% of patients following bariatric surgery.
What this means for you
If you have been diagnosed with NAFLD / MAFLD and are struggling with obesity, weight loss surgery may offer more than just weight loss, it could help restore your liver health and reduce the long-term risk of liver-related complications.
At Mackay & McLeod Weight Loss Surgeons, we take a holistic, evidence-based approach to your care. We work closely with hepatologists, dietitians, and your GP to ensure that your liver health is closely monitored before and after surgery.
What to expect after bariatric surgery
If you’ve already had weight loss surgery, you’re likely already experiencing the benefits for your liver. Most patients see:
- Reduced liver enzymes on blood tests
- Improved imaging (e.g. ultrasound or shearwave elastography)
- Less liver inflammation and fat
- A better overall metabolic profile
We encourage all post-op patients with NAFLD to stay engaged in long-term follow-up care. Maintaining a healthy lifestyle, avoiding excess alcohol, and keeping up with regular blood tests are all crucial to protect your liver for life.
Take the next step
If you have NAFLD and are considering surgery, or if you’ve already had surgery and want to better understand how it helps your liver, we’re here to support you. Contact Mackay & McLeod Weight Loss Surgeons today to book a consultation or learn more about how we can help you on your journey to better liver and overall health.
Disclaimer: This blog post is for informational purposes only and does not substitute professional medical advice. Always consult a healthcare provider for personal medical guidance.
