Author(s): William G. Simpson, Trung TruongThe metabolic multi-system disorder that is non-alcoholic fatty liver disease can be associated with hepatic inflammation and fibrosis, and result in the development of chronic liver disease. Effective pharmacologic therapy for NASH remains in development. Data indicate that weight loss and increased physical activity reduced hepatic fat content and fibrosis. The impact of physician counseling and support on weight loss in a patient population with documented NASH was reviewed. Seventy-three patients with liver biopsy confirmed NASH and varying stages of fibrosis were reviewed 12 months after receiving detailed dietary and exercise counseling from a physician with close clinical follow-up. The primary end point was weight loss achieved. Neither weight nor body mass index changed significantly. In patients with Stage II and III fibrosis on liver biopsy at diagnosis no significant change in body weight or body mass index resulted. These data provide real world documentation that physician counseling failed to effect even modest weight loss in patients with NASH, especially in those with advanced fibrosis who are are greatest risk of progressing to cirrhosis.