What Is Fatty Liver Stigma?
A stigma is a negative belief about someone or something. Stigma is often related to something that makes people uncomfortable, such as poverty, or certain illnesses like nonalcoholic fatty liver disease and alcohol-induced fatty liver disease.
When someone hears you have fatty liver disease, they may think that you brought it upon yourself. The word “fatty” in there could imply it’s related to food or obesity. The fact that it’s a liver disease could imply it was caused by alcohol – even if it is called “nonalcohol-related.” And then if the name actually says “alcohol” in it, like alcohol-induced fatty liver disease, this can help some people believe they’re justified in thinking someone caused their illness by drinking.
Professionals in the health care system can also have negative feelings towards patients with fatty liver disease since they may believe that patients brought the condition upon themselves. This is one of the reasons why the medical community changed the name of nonalcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease (MASLD). The hope is that people will see past the original name and treat the disease like any other.
Why Is Fatty Liver Disease Stigmatized?
Stigmas develop when people don’t understand something or they only know part of the story and they fill in the blanks with what they’ve heard or believe. The stigma surrounding any type of liver disease, especially ones that can lead to cirrhosis, is that it’s your fault you’re ill. And sadly, sometimes it’s the people with the disease who lay the blame on themselves. They self-stigmatize. Up to 69% of people with MASLD feel that they are at least partly to blame for their situation.
There are several things wrong with these assumptions, including that sometimes MASLD just happens and it can also run in families. And even if some of the things in your life did contribute to the disease, it doesn’t mean you deserve it.
Here are some of the most common reasons why people may be stigmatized for having fatty liver disease. They believe it’s caused by:
- Alcohol consumption
- Drug use
- Obesity and unhealthy diets – having the word “fatty” in the name can promote this idea
What can also add to the stigma is that liver disease is:
- A silent disease without obvious symptoms, so people may believe you can’t be as sick as you say you are
- A chronic disease, and people with chronic diseases who don’t get better can make people uncomfortable
Liver disease stigma is such a problem that one study showed almost 30% of people with the disease didn’t tell their friends and family members about it. Another study said it was over 50% who didn’t share that information. Many who do share information about their liver disease feel they must clarify that their disease wasn’t caused by alcohol.
How Common Is the Stigma of Liver Diseases?
The stigma of liver disease is all too common, whether it’s MASLD or other ones, like cirrhosis. One study published in 2022 found that 69% of patients with MASLD said they were stigmatized in several ways. If they had cirrhosis, this number was higher (72%). And almost everyone (89%) said they were stigmatized in at least one way.
The stigmas that people with liver disease face are global. Another study from 2024 looked at patients from 23 countries, including countries in Europe, the Middle East, North Africa, and Asia. Although there were some slight differences in numbers, no matter where the people were, there was a stigma related to having MASLD.
Fatty Liver Disease Stigma in Health Care
Unfortunately, some health care providers can’t see past a disease or condition and their own belief that it’s your own fault. It can be hard to ask for help knowing that this might come across someone in the health system who feels this way. A survey from the United Kingdom found that 1 in 3 people with a liver disease didn’t look for or get the medical help they needed because of this, and almost half felt that the stigmas held by health care providers had an impact on their care.
Sometimes, patients with MASLD might be accused of being drinkers but refuse to admit it. Or a provider may write someone off as being “noncompliant," a patient who doesn’t follow instructions because they haven’t lost weight after the doctors told them they should.
If you need a liver transplant, you might also face barriers related to your liver disease. For many years, you could only get a liver transplant if you drank no alcohol at all for six months. The belief was based on the idea that you wouldn’t do as well with the liver as someone whose disease might not be related to alcohol use. This has been proven wrong – people who drink alcohol don’t have worse survival rates or need new organs more than other transplant recipients. But the stigma remains and in many cases, it’s expected that patients take personal responsibility for their health, which means abstaining from alcohol.
Effects of Stigmatizing Fatty Liver Disease
The stigma of liver disease can have a strong impact on you and your quality of life.
If you have a condition that others blame on alcohol, street drugs, or overeating, your family, friends, and co-workers may pull away from you. The more they pull away or pass judgment on you, the more you become lonely and isolated. This means that you have less access to social support when you may need it most.
It’s also been proven that social isolation can lead to mental health issues, such as depression, for people of all ages. This, in turn, can lead to several other issues, such as:
- Malnutrition
- Insomnia
- Job loss or not being able to find employment
- Being in a more unstable economic situation
- Having difficulty staying in a relationship or having a healthy relationship
The judgment, or stigma, may stop you from going to a doctor or other health care provider for both the physical problems and any mental health issues.
According to a U.K. study, 1 in 3 people who face a stigma on top of having a serious medical condition consider suicide or self-harm.
How to Deal With Fatty Liver Stigma
If you have MASLD and are facing stigma, there are things you can do to help cope. The first thing, and perhaps the most important, is that you need to take care of yourself. This means doing things for yourself to take care of your own well-being:
Be kind to yourself. Being kind to yourself looks different for everyone, so do what makes you happy. Do you enjoy creating things? Going to a movie? Going for walks or hikes? Reading a book? Do what makes you feel good. Give yourself the same grace you’d give a friend going through a tough time. Consider what would you say to them – and say it to yourself.
Schedule your worry time. It’s easy to get overwhelmed with your health and how people respond to you. It may sound too simple, but it really can help if you schedule worry time. Rather than allowing the thoughts to crowd your head constantly, pick a time of day and length of time and for when you are going to think about these things. There’s no right time of day, but avoid doing it just before bed since the stress may make it hard for you to fall asleep.
Other strategies include:
Seek support. Whether online or in-person, support groups bring together people who understand the issues of living with liver disease. They allow you to listen to other people's experiences and to share yours. Participants share ideas of how they coped with certain issues. If you don’t know how to find a group, ask your doctor’s office or clinic if they know of any. You can look online as well. Check out the American Liver Foundation’s peer-to-peer support program.
Know your rights. While having a liver disease doesn’t automatically mean you’re disabled, the American with Disabilities Act (ADA) provides some protection if your illness is affecting your work. This can mean ensuring you have time off for doctor's appointments or you can take leave, if you need to. While your job can’t be protected if you can no longer do the work, the ADA means you can’t be fired simply for having liver disease. Another important part of the ADA is that your employer may not share your health information with other employees. Whether you tell them or not is up to you.
As a patient, you have the right to be treated with dignity and respect. If you feel that you’ve been treated unfairly by your health care provider:
Speak up. Tell your health care provider how you feel and why.
Write down what happened. Write down your experience while it’s fresh in your mind so you can refer to it later.
Switch providers or staff if possible. See if there’s another health care provider in the practice who will care for you, or switch practices altogether.
Complain. Health care facilities and systems frequently send out surveys asking about patient experiences. Tell them what happened. Write letters to the facility’s administration to share your experiences.
Takeaways
Liver disease can make someone feel stigmatized to the point that many people with the disease don’t tell anyone they have it – even their family. The stigma can affect your quality of life, as well as health care experience. It’s important that if this happens to you, you get support from family, close friends, health care providers, or other people living with liver disease. And you can – and should – get the medical help you deserve.
Fatty Liver Stigma FAQs
How common is MASLD?
MASLD is common. It’s the leading cause of liver disease across the world. About 32% of adults have it.
How do I prevent MASLD?
Not everyone can prevent fatty liver disease, but there are some things you can do to reduce the risk. They include:
- Eating a healthy diet that contain fruits, vegetables, whole grains, and healthy fats
- Losing weight if you’re overweight or have obesity
- Exercising
- Reducing or avoiding alcohol consumption
- Avoiding sugary beverages like sodas and sports drinks
What should I do if my doctor won't address my concerns about MASLD?
There are a few things you can do if you do not feel like your concerns about MASLD are being addressed:
- Get a second opinion.
- Advocate for yourself. This might mean talking to your doctor about your concerns. If that doesn't help, ask them for the name of a specialist you can see.
- Look for another doctor. If you still feel that your concerns are not being addressed, get recommendations for a new doctor from your state or local medical societies or from members of your support group.
