Non-alcoholic fatty liver disease (NAFLD), now called MASH (Metabolic Dysfunction-Associated Steatohepatitis), isn’t just about a fatty liver-it’s a sign your body’s metabolism is out of balance. And the good news? The most powerful tool you have isn’t a pill. It’s your daily choices: what you eat, how you move, and whether you get the right medical support when needed.
Why Weight Loss Matters More Than You Think
Most people with MASH don’t feel sick until it’s too late. No pain. No jaundice. Just silent damage. But studies show that losing even 5% of your body weight can cut liver fat by nearly half. Lose 10% or more, and you might actually reverse scarring-something doctors once thought was permanent.
The science is clear: weight loss is the only treatment proven to improve liver tissue. Not just lower enzymes. Not just shrink fat. Actually heal the liver. That’s why every major guideline-from the American Association for the Study of Liver Diseases to the FDA-starts with weight loss before even talking about drugs.
What to Eat: The Mediterranean Diet Works
Forget fad diets. You don’t need to cut out carbs completely or buy expensive superfoods. The Mediterranean diet, backed by solid research, is the gold standard for MASH.
Here’s what it looks like in real life:
- Vegetables at every meal-broccoli, spinach, carrots, peppers
- Fruits like berries, apples, and oranges, not juice
- Whole grains: brown rice, oats, quinoa instead of white bread or pasta
- Healthy fats: olive oil, avocados, nuts (a small handful a day)
- Fish twice a week: salmon, sardines, mackerel
- Lean protein: chicken, tofu, legumes
- Avoid: sugary drinks, fried food, processed snacks, white bread, and added sugars
A 2022 meta-analysis found people on this diet had significant drops in liver enzymes, fat buildup, and even liver stiffness-all measured by scans and blood tests. The key? It’s not about counting every calorie. It’s about swapping out bad options for ones that actually help your liver.
Exercise: Move More, Even If You Can’t Run
You don’t need to join a gym or run marathons. The goal is 150 minutes of moderate activity a week-that’s 30 minutes, five days a week. Walking counts. Gardening counts. Dancing in your kitchen counts.
Studies show that even without weight loss, regular movement reduces liver fat. But when you combine exercise with diet? The results are stronger. People who walked 10,000 steps a day and ate better lost more liver fat than those who only dieted.
Here’s a simple plan:
- Start with walking 20 minutes after dinner, five days a week
- Gradually add two days of light strength training-bodyweight squats, wall push-ups, resistance bands
- Move more throughout the day: take the stairs, park farther away, stand while talking on the phone
It’s not about intensity. It’s about consistency. And yes, it’s okay to start slow. Most people with MASH are overweight, have joint pain, or feel tired. That’s normal. Progress isn’t linear. Just keep showing up.
Medications: Semaglutide (Wegovy) Is a Game-Changer-But Not a Magic Bullet
In August 2025, the FDA approved semaglutide (Wegovy) specifically for MASH with moderate-to-advanced liver scarring. This was a big deal-it’s the first drug approved not just for weight loss, but for healing the liver itself.
Semaglutide works by mimicking a hormone that tells your brain you’re full. It slows digestion, reduces hunger, and helps your body use insulin better. In clinical trials:
- Nearly 90% of people stayed on it for over a year
- Two-thirds saw less liver inflammation
- More than one-third had reduced scarring
But here’s the catch: it’s expensive. Without insurance, it costs about $1,350 a month. Generic metformin, which some doctors still prescribe, costs $4-$40 a month-but it doesn’t do much for the liver. Other weight-loss drugs like orlistat or SGLT2 inhibitors show hints of benefit, but not enough proof yet.
Experts agree: semaglutide is the best drug option if you qualify. But it’s not a replacement for diet and exercise. It’s a tool to help you stick with them. Many people who start semaglutide say the reduced hunger makes it easier to eat less and move more. That’s the real win.
Why Most People Fail-And How to Beat the Odds
Here’s the hard truth: fewer than one in three people with MASH lose 5% of their weight. And only one in four keep it off after three years.
Why? Plateaus. Cravings. Stress. Time. Life gets in the way. You’re not weak. You’re human.
Here’s what actually works:
- Track your food for just two weeks-not to obsess, but to see where calories sneak in. A soda? That’s 150 calories. A snack bag of chips? Another 200. You don’t need to count forever, just long enough to notice patterns.
- Get support. Talk to a dietitian. Join a group. Find one friend who’s also trying to lose weight. You’re not alone.
- Plan for slip-ups. If you eat pizza on Friday, don’t quit Monday. Just get back on track with your next meal.
- Focus on health, not just the scale. Your energy, sleep, blood pressure, and liver enzymes matter more than a number.
Most people who succeed don’t do it alone. They work with their doctor, their dietitian, and their own patience.
What to Avoid
Some things make MASH worse-and you might not realize it.
- Alcohol: Even one drink a day can speed up liver damage. Zero is best.
- High-fructose corn syrup: Found in sodas, candy, and even "healthy" granola bars. It’s metabolized by the liver-and turns straight into fat.
- Fast food: High in trans fats, salt, and hidden sugars. It’s not just unhealthy-it’s designed to keep you eating more.
- Unsupervised weight-loss supplements: No pill, powder, or tea has been proven to reverse MASH. Some can even harm your liver.
The Bottom Line: You Have More Power Than You Think
MASH isn’t a life sentence. It’s a warning sign-and a chance to reset your health. You don’t need to lose 50 pounds. You don’t need to run a marathon. You just need to make a few changes, stick with them, and get the right help when you need it.
Start with one meal. One walk. One conversation with your doctor about semaglutide if you’re eligible. Small steps add up. The liver is one of the few organs that can heal itself-if you give it the chance.
And if you’ve tried before and failed? That’s not failure. That’s data. What didn’t work? Why? Adjust. Try again. You’re not starting over. You’re learning.
Can you reverse MASH without losing weight?
No. Weight loss is the only proven way to reduce liver fat and reverse scarring in MASH. Even small losses-5% of body weight-can improve liver health. While exercise and diet help, they work best when they lead to weight loss. There are no shortcuts.
Is semaglutide (Wegovy) covered by insurance for MASH?
Coverage is still inconsistent. Most insurance plans cover Wegovy for obesity (BMI ≥30), but not yet for MASH specifically. Some patients get approval by showing liver biopsy results or fibrosis scans. Ask your doctor to help you appeal or apply for patient assistance programs.
How long does it take to see results from diet and exercise?
You may notice more energy and better sleep in 2-4 weeks. Liver enzyme levels (ALT) often drop within 3 months. Significant fat reduction and fibrosis improvement usually take 6-12 months of consistent effort. Patience is key-this isn’t a quick fix.
Can I take metformin for MASH?
Metformin is often prescribed for people with MASH who also have type 2 diabetes, but it doesn’t reliably reduce liver fat or scarring. It helps with insulin control, which is helpful, but it’s not a substitute for weight loss. Semaglutide or lifestyle changes are far more effective for the liver itself.
What if I can’t afford semaglutide or a dietitian?
Start with free resources: use the USDA MyPlate guidelines, walk daily, cook meals at home with whole foods, and cut out sugary drinks. Many community health centers offer free nutrition counseling. Even small changes-like swapping soda for water or walking 15 minutes a day-can make a difference. Progress beats perfection.
Does losing weight help even if I’m only slightly overweight?
Yes. Even people with a BMI in the "overweight" range (25-29.9) can have MASH. Losing just 3-5% of body weight can reduce liver fat and lower inflammation. You don’t need to be obese to benefit from weight loss. The liver responds to metabolic improvements, no matter your starting point.
What’s Next?
If you have MASH, your next step isn’t a new supplement or a miracle cure. It’s a conversation-with your doctor, with a dietitian, with yourself.
Ask: What’s one change I can make this week? Maybe it’s swapping out soda for sparkling water. Maybe it’s walking after dinner. Maybe it’s asking about semaglutide if you’re eligible.
The liver doesn’t care about perfection. It cares about consistency. And you? You’re already ahead just by reading this.
