The liver is one of the most important organs in the body. It cleans toxins out of our blood, helps break down food, regulates blood flow, and metabolizes proteins and carbs so that our bodies can use them. 

 As CEO of Global Liver Institute, I’ve spent time educating communities on the importance of the liver and the dangers of liver disease. Yet, I continue to see how many, from policymakers to patients, routinely ignore this silent killer.

Liver disease is often underdiagnosed, stigmatized and linked to alcohol because its causes may be hidden and symptoms are slow progressing. In reality, liver disease has many forms and causes.      

That’s the case with the condition Metabolic Dysfunction-Associated Steatohepatitis (MASH), the most advanced stage of nonalcoholic fatty liver disease that develops when fat cells build up in the liver, causing inflammation. An estimated 30.2% of the global population now lives with MASLD, with a rate soaring 57.5% among adults with obesity.

 When left untreated, it can lead to serious liver scarring, inflammation, and even liver cancer. While obesity is a risk factor for MASH, the common assumption that only those suffering from obesity can be diagnosed with fatty liver disease couldn’t be further from the truth. 

Recent studies have shown that among those who have MASH, there’s a growing population that are considered lean based on their body mass index (BMI). This is why solely focusing on weight as an indicator for MASH ends up doing more harm than good. It ignores the countless patients already struggling with the disease and makes it harder for patients to recognize when they are experiencing symptoms and need to get checked out. 

Fortunately, there’s new evidence around MASH and obesity, as well as treatment options that can change things for the better. 

Recently, there have been new innovations with GLP-1 medications and how they can be used to treat MASH. For the first time in August, the FDA approved a GLP-1 for use with MASH patients. 

The study that led to this approval showed the medication’s usage resulted in significant decreases in liver inflammation and helped stall or improve liver scarring. Importantly, roughly 13 percent of the participants who were considered lean showed signs of liver improvement.

This study showed the impact that the treatment can have on patients with MASH regardless of weight. Now, it’s about ensuring that all those with the disease can access it.

As insurers and state Medicaid programs develop coverage policies around this new use case, we stand at a critical crossroads. Across states, FDA-approved GLP-1s have largely been used for weight loss and cardiovascular risk reduction in obese or overweight adults. In most cases, coverage for them is dependent on being above a certain BMI threshold. 

But given that studies around GLP-1s and MASH show clear signs that improvement can happen independently of the patient’s current weight, we cannot let insurance companies or state Medicaid programs get in the way of life-saving care. 

Implementing BMI requirements for coverage would deny access to the full battery of treatments for MASH to lean patients, both ignoring FDA guidance that does not specify BMI requirements and running contrary to the most up-to-date medical guidance from organizations like the American Gastroenterological Association and the American Association for the Study of Liver Diseases, who both highlight the benefits of minor weight loss even in lean MASH patients. 

As insurers develop coverage criteria, they must look comprehensively at the evidence. Including BMI requirements around these new treatments for MASH throws out the data about the effectiveness of the treatment across body types and also puts outdated stigmas in the way of quality care.

Insurance companies and state Medicaid programs must align their coverage policies to reflect the current evidence. This means covering treatments for MASH based on medical necessity, not arbitrary BMI requirements. 

The liver doesn’t discriminate based on body size when disease strikes. Neither should our healthcare coverage policies. Patients with MASH deserve access to effective treatment regardless of their weight. Their livers and their lives depend on it.