Obesity and diabetes: The silent culprits behind liver diseases

For years, liver disease has been seen through a narrow lens—most people still believe it’s something only alcoholics suffer from. But today, doctors are sounding the alarm on an emerging crisis: people who don’t touch alcohol are being diagnosed with advanced liver disease, including cirrhosis and even liver cancer. The culprits? Two of the most common modern health concerns—obesity and diabetes.


As India grapples with surging cases of type 2 diabetes and obesity, an associated but lesser-known crisis is brewing in the background. Experts say it’s time we bring liver health into the spotlight—not just for drinkers, but for anyone with a bulging waistline or erratic blood sugar levels.


Fatty liver disease: Not just an alcohol problem anymore

"Obesity and diabetes are growing epidemics in the country. One of the lesser-known but serious complications associated with both conditions is liver disease,” says Dr. Apurva Shah, Consultant, Gastroenterology, Apollo Hospitals, Ahmedabad.


The condition he refers to is fatty liver disease, more specifically Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD). MASLD occurs when fat builds up in the liver cells—even in people who don’t drink alcohol. This fat build-up is often a result of how the body processes fat and sugar, combined with a poor lifestyle.


Dr Shah explains that fat accumulation around the belly, which is common in obesity, is a significant risk factor. This leads to insulin resistance—a key mechanism behind both type 2 diabetes and fatty liver.


From fatty liver to liver damage

Fatty liver may sound mild, but it’s just the first step on a dangerous path. If left unchecked, MASLD can progress to Metabolic dysfunction-associated steatohepatitis (MASH)—a condition in which the fat in the liver triggers inflammation and damage to liver cells.


MASH, if not managed early, can spiral into liver fibrosis (scarring), cirrhosis, and even liver cancer.


“Just as people with diabetes are at risk of developing MASLD, those with MASLD are also at high risk of developing diabetes,” Dr Shah adds. The relationship is a two-way street—each condition worsens the other.


Dr Shah notes that about 70% of diabetic patients have fatty liver, and a staggering 70–80% of people suffering from obesity also show signs of fat accumulation in the liver. This indicates a deeply concerning overlap—and possibly a future public health emergency if not addressed soon.


Dr Rajesh Dey, Associate Director – Liver Transplant and Biliary Sciences, Max Super Speciality Hospital, Vaishali, confirms the scale of the problem. “NAFLD is estimated to affect 30–40% of the adult population, with significantly higher rates in individuals with obesity or type 2 diabetes,” he says.


He highlights that most people don’t realize their liver is under attack. NAFLD and NASH (the older term for MASLD and MASH) often show no symptoms in the early stages, making it a silent but deadly condition.


Lifestyle is the root of the problem

According to Dr Dey, the core issue lies in our modern sedentary lifestyles. Prolonged sitting, lack of physical activity, consumption of processed and high-sugar foods, and irregular sleep patterns have created a perfect storm for metabolic dysfunction.


“Most people are not aware of the insidious damage to their liver until the disease is well established,” he says. By then, the liver has already endured years of fat buildup and inflammation.


Poor diet and inactivity don’t just lead to weight gain and diabetes—they also change how the liver functions. Over time, this results in fat storage in liver cells, which turns toxic when inflammation kicks in.


Why this matters right now?

Liver disease was once thought to primarily affect older people or those with alcohol use. But now, younger adults in their 30s and 40s are being diagnosed with fatty liver and even cirrhosis. This shift in demographics is alarming and calls for a public health response.


More importantly, liver damage from obesity or diabetes is reversible—if caught early. That’s why experts are urging people with these risk factors to monitor their liver health proactively.


Preventive measures

The silver lining? Unlike many chronic diseases, early-stage fatty liver disease can be reversed. Here’s what both doctors recommend:


Lose weight: Even a 5–10% reduction in body weight can significantly reduce fat in the liver and slow down disease progression.


Exercise regularly: Aim for at least 30 minutes of moderate exercise like walking, cycling, or swimming five days a week. Resistance training also helps improve insulin sensitivity.


Control blood sugar: If you have diabetes or prediabetes, work with your doctor to manage your blood sugar. This includes sticking to medications and tracking glucose levels.


Ditch the junk: Cut down on refined carbs, added sugars, and trans fats. These fuel both diabetes and fatty liver. Instead, load up on fruits, vegetables, whole grains, nuts, and lean proteins.


Avoid alcohol: Even though fatty liver can occur without alcohol, drinking worsens liver inflammation. If you already have MASLD, alcohol accelerates liver damage.


The message from experts is loud and clear: liver health is no longer just an alcohol issue. Obesity and diabetes are now among the leading causes of liver disease in India—and they’re affecting people earlier and more aggressively than ever before.


As we observe World Liver Day, it’s a reminder that your liver needs as much care as your heart or your blood sugar levels. A few lifestyle tweaks today can save you from lifelong complications tomorrow.


In Dr Shah’s words, “We advise everyone to eat healthy food, include vegetables and fruits in their diet, engage in regular exercise, take your medications and avoid alcohol to maintain a healthy liver.”


So the next time you think fatty liver isn’t your problem—think again. Your waistline and blood sugar may be silently speaking to your liver.