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Policy, Prevention, and Progress: Fatty Liver & Obesity

Dr. Kelly Brownell, Dean Emeritus of the Sanford School of Public Policy at Duke University, has over 35 years of experience studying food systems and obesity. After initially focusing on obesity treatments, he found that weight loss often led to rapid regain, suggesting a harmful metabolic change. Consequently, Dr. Brownell shifted his focus to prevention and policy solutions, emphasizing the importance of addressing the root causes of obesity. Read on, and listen to his recent appearance on GLI LIVE, to explore his insights on the causes, consequences, and solutions for obesity, as well as the connections between obesity and fatty liver disease.

Food Systems and Chronic Diseases

There is a close link between obesity, fatty liver disease, and the food system. The state of agriculture and food production has shifted dramatically over the decades. In the 1950s, American farmers grew a variety of fruits and vegetables. However, since then, farming policies have incentivized the growth of corn and soybeans – which feature predominantly in processed foods – to the detriment of other crops. The federally subsidized, low cost of these commodity crops has contributed to the proliferation and staying power of processed foods, which are designed to be highly palatable and maximize consumption. This shift has contributed significantly to the obesity epidemic by transforming the options available to shoppers at the supermarket. Though this trend might be slowly reversed through the passage of policies that subsidize the production of fresh produce rather than the commodity crops common in processed foods, both political will and substantial infrastructure changes would be necessary to support this change.

Processed foods, often rich in sugar and additives, create cravings, withdrawal, and tolerance similar to addictive substances – and an estimated 73% of food available at grocery stores can be considered ultra-processed. This raises concerns about the food industry’s role in creating and promoting foods that have damaged their customer’s health for their own financial profit. Ultra-processed foods, ubiquitous in modern diets, have been linked to metabolic and other health issues, including fatty liver disease, obesity, and type 2 diabetes. The food industry’s resources for both marketing and development far exceed those of public health institutions, allowing those for-profit businesses to dominate the market and influence consumer behavior. Aggressive marketing, especially to children, overshadows educational efforts to promote healthy eating.

Obesity, Stigma, and Mental Health

Obesity and fatty liver disease are not just physical health issues; they are also linked to mental health conditions such as depression. The stigma associated with obesity can impact family relationships, interactions with healthcare providers, and overall mental health. Dr. Brownell emphasizes that shaming individuals into losing weight is counterproductive and harmful. However, behavioral health interventions, such as coaching and counseling, can help manage obesity by addressing the psychological aspects of eating and promoting healthier behaviors. Still, sustained change at-scale will require the creation of  food environments supportive of healthy choices and the resolution of systemic issues within food systems.

Anti-Obesity Medications and Policy Challenges and Opportunities 

Anti-obesity medications have recently emerged as a transformative development in obesity treatment. These drugs have shown remarkable effectiveness, leading to substantial weight loss and sustained results if used long-term. However, they are expensive, not always covered by insurance, and have faced shortages – raising equity concerns. Moreover, relying solely on these medications without addressing the root causes of obesity could lead to complacency regarding unhealthy food environments and an over-reliance on a pharmaceutical solution rather than a robust, multifaceted response.

Policy interventions, such as front-of-package labeling, have been implemented in various places, including Mexico and Chile in efforts to reduce the consumption of sugary foods and drinks. However, these measures have been often seen as band-aid solutions rather than comprehensive approaches to addressing systemic issues. To make a significant impact, a combination of policies (similar to the multifaceted approach used in tobacco control) is needed.

Addressing obesity and fatty liver disease requires prevention, policy reforms, and support networks. Anti-obesity medications should be part of a broader strategy to improve food systems, reduce stigma, and enhance mental and physical health through the reduction of obesity and fatty liver disease. Dr. Brownwell finds in his role as a professor that there is an increasing youth interest in healthier diets and activism for strengthened, reformed food systems. Engaging legislators, media, and communities is driving social change. Comprehensive policies, public awareness, and community empowerment are essential to reduce obesity and related liver disease.



FLD – Fatty Liver Disease

SLD – Steatotic Liver Disease 

NAFLD – Nonalcoholic Fatty Liver Disease 

  1. MASLD – Metabolic Dysfunction-Associated Liver Disease
  2. MetALD – MASLD + Increased alcohol consumption (MetALD)
NASH – Nonalcoholic Steatohepatitis

MASH – Metabolic Dysfunction-Associated Steatohepatitis