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Liver Disease is a 'Public Health Emergency': MPs

The Government must do more to tackle obesity levels and address the risk to public health from non-alcohol related fatty liver disease, MPs have urged. 

The call came during the first-ever parliamentary debate on preventing obesity and fatty liver disease, which was held at Westminster Hall on Thursday. It coincided with international NASH day – an initiative aimed at raising awareness of non-alcohol related steatohepatitis.

Opening the debate, Wayne David (Lab. Caerphilly) suggested that fatty liver disease was "a clear barometer of the nation's health" and that the "obesity crisis" was exacerbating health inequalities, as well as "resulting in a significant cost to the NHS and having a hugely detrimental economic impact".

'Public Health Emergency'

According to Virendra Sharma (Lab. Ealing, Southall), fatty liver disease was a "public health emergency", but it had "not been appropriately prioritised by the Government and was overlooked in the major conditions strategy".

Maggie Throup (Con. Erewash), past chair of the All-Party Parliamentary Group on Obesity and a former public health minister, pointed out that "up to 1 in 5 people in the UK have non-alcoholic related fatty liver disease". Obesity was "getting out of control", she said, quoting research from the House of Commons library that showed that since 1993, the proportion of adults in England who were obese had risen from 14.9% to 28%. Overall, the proportion of overweight or obese adults in England had surged from 52.9% in the early 90s to 64.3% today.

Deprivation and Levelling Up

Wayne David said the situation underlined the need to level up healthcare and life expectancy. "If you look at fatty liver disease deaths in England which are non-alcohol related, the North West of England, for example, has a far higher mortality rate than the West Midlands," whilst, "Generally, liver disease mortality rates are four times higher in the most deprived areas."

In 2021, "chronic liver disease mortality rates in Scotland were 5.8 times higher in the most deprived areas than in the most affluent," according to Martyn Day (SNP. Linlithgow and East Falkirk).

Mr Sharma pointed out that inequalities also had an ethnic dimension, since "ethnic minorities have higher obesity rates than the national average, and south Asian populations are particularly vulnerable to developing fatty liver diseases due to a combination of genetic and societal risk factors".

Several members urged action on the role of diet and, in particular, how to curb consumption of unhealthy foods. Among them Mr David, who said: "We're still waiting – waiting patiently – for the Government to implement the 9 pm watershed plans to protect children from junk food advertising on television and online".

Ms Throup suggested "there's an addiction in this country to ultra-processed food". "We have tackled the smoking addiction by intervention. It's now time to tackle the ultra-processed food addiction by intervention too".

For Karin Smyth (Lab. Bristol South), tackling obesity required input from "every cog in the Government machine", since the causes of obesity were multifaceted. "It is about what we eat, but also about our access to green spaces, our genetics, the money in our pocket, our access to community care, and so much more," she suggested to colleagues.

Early Diagnosis of Liver Disease

Several contributors to the debate emphasised that liver disease was a "silent killer" and that many for many people diagnosed with cirrhosis it was already too late for effective treatment. "Risk can be drastically reduced through early detection, through diet, through exercise, through drinking in moderation," said Mr Shannon.

MPs welcomed the decision earlier this week by the National Institute for Health and Care Excellence (NICE) to recommend FibroScan as an option for assessing liver fibrosis or cirrhosis in primary care. Ms Throup said, "this could result in thousands of people being made aware of the poor condition of their liver, which still could be reversible".

Mr David said he also welcomed expansion in the use of FibroScan (Echosens, Paris) as an option for assessing liver damage, but urged the Government "to place a real emphasis on early diagnosis by adopting a new pathology pathway and to ensure that every community diagnostic centre has a facility to make an assessment for fibrosis".

Ms Throup called for "an expansion of liver testing in areas where obesity levels are higher and the risk of fatty liver disease is more extreme".

Government Response

Replying in the debate for the Government, Will Quince, minister for health and secondary care, who acknowledged recent weight loss since tipping the scales at 19.5 stone during the 2019 general election, acknowledged that obesity rates remained "stubbornly high" and that he was particularly concerned by rates of childhood obesity.

The Government had "announced plans for a 2-year pilot, backed by £40 million, to look at ways of expanding access to new weight loss drugs outside of a hospital setting through primary care that more eligible patients will be able to benefit from", he told MPs. The move followed a decision by NICE earlier this year to recommend semaglutide (Wegovy) for adults with a body mass index of at least 35 and one weight-related health condition, such as diabetes or high blood pressure. Similar drugs were "coming on stream" and they would be "part of our arsenal and one of our tools to help people tackle obesity and make healthier life choices", Mr Quince promised.

The minister acknowledged that ultra-processed foods "are an issue about which the public are concerned" and that there was "more to do on food labelling".

On early diagnosis of liver disease, Mr Quince said there was a current commitment to provide the service at 100 community diagnostic centres by March 2025, and that "if we can accelerate that, we will".