Author information
1 Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT., USA.
2 VA Connecticut Healthcare System, West Haven, CT., USA.
Abstract
There is an urgent need for practical approaches to patients with non-alcoholic steatohepatitis (NASH). Total body weight loss (TBWL) is an important approach because its effects are amplified in the liver, with 10% TBWL resulting in a 50% loss of liver triglycerides, and improvement in all aspects of NASH histology. Lifestyle changes are the first step in addressing TBWL, but uncommonly result in the range (7-10%) required to improve liver histology in NASH. Weight loss medications (WLM) are an effective additional tool because they can provide TBWL in the 7-10% range, have a well characterized clinical profile, have clear guidelines, and meet approved criteria for their use (body mass index greater than 27 kg/m2 ) for most NASH patients. Use of WLM requires shared decision-making with the patient which hepatologists, due to their understanding of the natural history of NASH, are uniquely positioned to provide. WLM do present the challenge of incorporating new medications into the hepatology clinic, but this will be necessary with all medications to manage NASH. Overall, WLM provide a practical intervention that can be incorporated into hepatology clinics and can be offered to most NASH patients. NASH specific medicines in clinical trials offer partial histological responses, and TBWL will likely enhance this. WLM provide hepatologist with effective and welcome clinical intervention beyond diagnosis and staging of NASH, and provide patients a sense of empowerment about the treatment of their liver disease.