Addressing liver health and obesity is crucial—ignore these areas, and risk the failure of tackling non-communicable diseases (NCDs) at their core. But here's where it gets controversial: despite the European Union’s prominent 'Healthier Together' initiative targeting NCDs from 2022 to 2027, experts caution that the program might be falling behind rapidly advancing scientific understanding of metabolic health. While this framework offers support to EU member states on issues like cardiovascular disease, diabetes, chronic respiratory conditions, mental health, and key lifestyle factors, it notably omits a direct focus on liver diseases—even though they are intimately connected with obesity and type 2 diabetes.
During an insightful recent policy discussion titled 'NCDs, obesity and liver health – can the EU turn the tide?', several leading specialists highlighted this significant oversight as a fundamental weakness in the EU’s overall approach to NCD prevention and management.
Cyrielle Caussy, a respected professor of medicine specializing in nutrition at Lyon 1 University, emphasized the importance of recognizing the liver’s role in metabolic health. She warned that neglecting liver health means ignoring one of the most critical organs driving Europe’s ongoing metabolic health crisis. The liver acts as an 'upstream' regulator—playing a pivotal role—in processes related to glucose and lipid metabolism and overall energy balance. She pointed out that the current health agenda rarely addresses this organ specifically, despite clear evidence showing that liver issues, such as non-alcoholic fatty liver disease (NAFLD), are widespread—affecting around 40% of adults globally—and are largely invisible in EU strategies, including the 'Healthier Together' initiative.
A common misconception undermines efforts to prioritize liver disease: many still misunderstand obesity itself. Dra Andreea Ciudin Mihai, an endocrinologist and obesity expert from Barcelona, explained that obesity isn't simply a matter of excess weight. Instead, it should be understood as a disorder of adipose tissue—meaning that the problem lies in the excess and dysfunctional nature of body fat. This distinction is critical because it shapes how we recognize and treat the condition.
Furthermore, she highlighted that the recognition of obesity as a serious non-communicable disease remains sluggish. Without proper acknowledgment, stigmatization persists, impeding effective intervention. Recognition is vital—not just for better treatment but also for fostering public health initiatives that can truly make a difference.
When it comes to recent medical advancements, especially the use of GLP-1 receptor-based medications, there is hope and optimism. Dra Mihai pointed out that these drugs have been hailed as 'game changers' since they demonstrate benefits for diabetes management, fatty liver conditions, and cardiovascular health. However, access to these innovations remains limited because they are often not reimbursed by health systems, leaving many who need them most unable to afford the treatment.
Prof Caussy added a sobering reminder: those who require these medications most are often the least able to pay. This stark inequality underscores a larger issue—the gap between scientific progress and equitable access.
Dr Kremlin Wickramasinghe, a WHO regional adviser, voiced concern that the focus on these medications might unintentionally divert attention from essential preventive measures. He cautioned against relying solely on drugs and emphasized that many health issues, like hypertension, go undiagnosed or are poorly controlled, largely due to insufficient early detection strategies.
Experts unanimously agreed that early detection of advanced liver disease is both feasible and cost-effective but remains underutilized. Dr Caussy explained that the initial simple screening test, called FIB-4, is quick and free, serving as a good preliminary tool. For individuals flagged at risk, more precise assessments—such as ultrasound-based elastography—are recommended, which can measure liver stiffness more accurately and guide further intervention.
Gamal Shiha, director of the European Liver Patients’ Association, emphasized the importance of public awareness and simplified pathways for diagnosis and treatment. Not everyone with obesity has liver disease, but education is key to helping patients and health professionals identify those who need specialized care.
However, prevention remains the real challenge—especially because much of the risk factors' impact occurs before screening even begins. Wickramasinghe highlighted that about 80% of deaths stem from preventable causes linked to lifestyle and risk factors, yet these issues are often not openly discussed with patients due to stigma and discrimination. Creating a health system capable of addressing these root causes is essential. This involves better integration of primary health care, creating space for honest conversations, and reducing societal barriers that hinder open discussions about weight, lifestyle, and health risks.
On the political front, critics like MEP Tomislav Sokol pointed out the slow pace of EU action regarding transparent front-of-pack nutrition labeling. He warned that prevention efforts are at risk of being sidelined in upcoming financial frameworks, obscured by industry influence and lack of political will. Sokol and WHO adviser Wickramasinghe agree: meaningful change will require overcoming political and commercial pressures that often hinder health-promoting policies. The truth is, Europe has the scientific evidence and practical solutions—what remains uncertain is whether political courage will be enough to turn the tide against these preventable and interconnected health crises.
Are we truly ready to prioritize metabolic and liver health as a cornerstone of NCD prevention? Or will industry and political biases continue to block essential reforms? Share your thoughts below—your voice could drive the change we need.
