Bold claim: liver health is the missing piece in Europe’s fight against obesity and metabolic disease, and ignoring it could derail the entire Non-Communicable Diseases (NCD) strategy. As EU's Healthier Together program enters its final stretch, experts warn that the approach is not keeping pace with rapidly evolving science on metabolism and liver disease.
Overview
The 2022–2027 framework supports member states in tackling cardiovascular disease, diabetes, chronic lung conditions, mental health, and key lifestyle determinants. But it does not explicitly address liver disease, a condition tightly linked to obesity and type 2 diabetes. In a recent policy discussion titled “NCDs, obesity and liver health – can the EU turn the tide?”, several specialists described this omission as a structural weakness in the EU’s NCD framework.
Liver health as a central driver
Cyrielle Caussy, a professor of nutrition medicine at Lyon 1 University, warned that overlooking liver health means overlooking a central organ that drives Europe’s metabolic illness. The liver, she explained, sits upstream in glucose and lipid metabolism and energy balance, and is directly connected to many non-communicable diseases. She called liver health the “blind spot” on the agenda, noting that current strategies fail to reflect the liver’s crucial role in metabolic disease.
The scale of the problem: fatty liver disease
Steatotic liver disease (SLD) affects roughly 40% of adults globally, yet it remains largely invisible in EU strategies, including Healthier Together. This gap means a potentially massive portion of the population is not being targeted or monitored effectively.
Misunderstood obesity hinders progress
One key reason liver disease is overlooked is a persistent misunderstanding of obesity itself. Dra Andreea Ciudin Mihai, an endocrinologist and obesity specialist, argues that obesity is not simply excess weight but an adipose tissue disorder—characterized by excess and dysfunctional body fat. She contends that recognizing obesity as a non-communicable disease is essential to reducing stigma and driving policy change.
GLP-1 medicines: promise shadowed by access gaps
Mihai described two GLP-1–based therapies as game-changers, with benefits for diabetes, fatty liver disease, and cardiovascular risk. However, access remains unequal because these drugs are often not reimbursed, leaving patients to pay out of pocket. Caussy added that those most in need are typically the least able to afford them.
Cautions about shifting focus from prevention
Dr Kremlin Wickramasinghe, an advisor for the WHO European region, warned that reliance on medicines could undermine prevention efforts. He cautioned that the belief in a miracle drug might cause policymakers to deprioritize prevention. He highlighted that a substantial portion of hypertension remains undiagnosed or inadequately controlled, underscoring the need for ongoing prevention alongside treatment.
Early detection is feasible and cost-effective
Experts agreed that detecting advanced liver disease early is both doable and affordable, yet not widely implemented. Caussy pointed to the FIB-4 score as a first-line, low-cost screening tool. If results exceed a threshold (e.g., above 1.3), a second, more accurate test—often a trans-elastography ultrasound-based assessment—should follow. She also noted the existence of additional blood tests and stressed the importance of patients knowing their liver stiffness measurements.
Education and patient pathways matter
Gamal Shiha of the European Liver Patients’ Association (ELPA) emphasized the need for simple care pathways and public awareness. He cautioned against assuming that all obesity patients have liver disease and urged better education to help patients and clinicians identify who should see a specialist.
Prevention gaps start early
Wickramasinghe pointed out that Europe’s prevention gap begins long before screening. He argued that the factors causing 80% of deaths are not adequately addressed with current strategies, and that health systems must engage patients about risk factors in a stigma-free, supportive environment. He advocated for strengthening primary care, reducing barriers to speaking about risk factors, and building capacity before investing in expensive screening technology.
Policy shortcomings in the EU
MEP Tomislav Sokol criticized the slow pace of EU action on front-of-pack nutrition labeling and warned that prevention could fall through the cracks in the next budget cycle. He noted underutilized powers in labeling, marketing, prevention, pharmaceutical reform, and health data sharing. He argued that benefits of policy changes are often not immediately visible to politicians, which dampens political will. Wickramasinghe added that policies perceived as negative to industry frequently stall.
A call to courage and coherence
Experts concluded that the EU cannot fulfill its NCD ambitions without tackling these political and commercial pressures. As Healthier Together moves into its final phase, the consensus is clear: Europe has the evidence and the tools; what’s missing is the political courage to implement them and place liver health at the forefront of metabolic disease prevention and management. The discussion ends with an invitation to readers to weigh in: Do you agree that liver health should be elevated to the core of Europe’s NCD strategy, or do you think other factors deserve priority right now? What concrete steps would you take to close the prevention gap in your country? The debate is just beginning, and your voice could influence the course of policy.
