NAFLD on the Rise: Why Southern Utah Needs Bold Action on Fatty Liver Disease
By Richard Berk, Utah Channel 3 Health Analyst September 3, 2025
BRIAN HEAD, Utah — Non-alcoholic fatty liver disease (NAFLD), once a niche concern for hepatologists, is now a silent epidemic sweeping through southern Utah. With our high rates of obesity and diabetes—fueled by processed diets and sedentary winters—NAFLD affects up to 30% of adults in Iron County, mirroring Utah’s statewide prevalence of 25-30%, per the latest Utah Department of Health data. As a health journalist who’s covered digestive disorders for over a decade, I’ve reported on countless cases where patients progress from reversible fat buildup to irreversible cirrhosis, often without warning. The good news? Emerging management strategies offer hope. But without policy shifts and better screening, we’re failing rural communities like Brian Head.
NAFLD, now increasingly called metabolic dysfunction-associated steatotic liver disease (MASLD) to reflect its metabolic roots, occurs when excess fat infiltrates the liver, unrelated to alcohol. It’s not just a “fatty liver”—it’s a precursor to inflammation (NASH), fibrosis, and even liver cancer. A 2024 meta-analysis in Hepatology estimates that 20% of NAFLD cases progress to NASH annually, with southern Utah’s demographics amplifying the risk. Our region’s love for high-calorie comfort foods during ski season, combined with limited access to fresh produce in rural stores, creates a perfect storm. Add in the 15% diabetes rate in Iron County—double the national average for some subgroups—and it’s clear: NAFLD isn’t a lifestyle footnote; it’s a public health crisis.
Recent advances in management are promising, but they demand a critical eye. First, pharmacotherapy: Semaglutide (Ozempic) and tirzepatide (Mounjaro), originally for diabetes, have shown liver fat reductions of 30-50% in 2024 trials (New England Journal of Medicine). These GLP-1 agonists don’t just aid weight loss; they improve insulin sensitivity, a key NAFLD driver. Yet, as I review the data, access barriers loom large. In Brian Head, where patients drive two hours to St. George for specialists, prescribing these meds requires coordinated care that’s often absent. Insurance coverage is spotty, and side effects like nausea can deter adherence in our active population.
Lifestyle interventions remain the cornerstone, but evidence gaps persist. The 2023 ACG guidelines emphasize a Mediterranean diet—rich in olive oil, nuts, and fish—paired with 150 minutes of weekly exercise. A southern Utah twist? Incorporate local hikes and farm-fresh veggies from St. George markets to make it sustainable. But randomized trials, like the 2024 LOOK-AHEAD follow-up, reveal only 10-15% sustained weight loss long-term. Why? Rural isolation: No on-site nutritionists, and telehealth glitches during snowstorms. We need community programs, like those piloted by the Southwest Utah Health Department, expanded to include NAFLD-specific coaching.
Non-invasive diagnostics are another bright spot, reducing reliance on costly biopsies. FibroScan, an ultrasound-based tool measuring liver stiffness, is now available at Intermountain clinics in St. George. Paired with blood tests like FIB-4 scores, it identifies high-risk patients with 85% accuracy (Journal of Hepatology, 2024). In my reporting, this has shifted care upstream—screening diabetics routinely catches NAFLD early. But here’s the critique: Adoption in rural Brian Head is lagging. Only 40% of primary care providers in Iron County use these tools, per a recent Utah survey, due to equipment costs and training shortages.
Policy must step up. Utah’s 2025 legislative session missed a chance to fund NAFLD awareness campaigns, unlike states like Texas with state-backed screening mandates. I advocate for integrating NAFLD into the Utah Cancer Registry—it’s a cancer risk factor—and subsidizing FibroScan for rural clinics. Federally, expanding Medicare coverage for GLP-1s in NAFLD could save billions in downstream cirrhosis costs, estimated at $10,000 per patient annually.
Looking ahead, precision medicine holds transformative potential. Genetic markers like PNPLA3 variants, prevalent in 20% of Utahns of Hispanic descent, predict progression risk. 2024 pharmacogenomics studies suggest tailoring drugs based on these—e.g., resmetirom, the first FDA-approved NASH drug, works best in certain genotypes. For Brian Head, this means partnering with the Huntsman Cancer Institute for equitable trials, ensuring mountain communities aren’t left behind.
In southern Utah, NAFLD isn’t inevitable—it’s addressable with smarter strategies. Providers: Prioritize screening in at-risk groups (diabetics, obese adults over 40). Policymakers: Invest in rural infrastructure. And residents: Swap sugary sodas for herbal teas and lace up those boots for a trail walk. As I’ve witnessed through years of coverage, early action reverses the tide. Let’s make Brian Head a model for NAFLD management, not a cautionary tale.
Richard Berk is a health analyst and long-time contributor to Utah Channel 3, specializing in gastroenterology and digestive health for southern Utah communities.