Integrating behavioral interventions into a Holistic Approach to Metabolic Dysfunction-Associated Steatotic liver disease

ABSTRACT

Introduction

The therapeutic landscape of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is rapidly evolving with the FDA approval of resmetirom, the first authorized molecule to treat metabolic dysfunction-associated steatohepatitis. Clinical trials are investigating other promising molecules. However, this focus on pharmacotherapy may overshadow lifestyle interventions, which remain the cornerstone of MASLD management. A significant percentage of patients with MASLD struggle with an underlying eating disorder, often a precursor to obesity. The obesity pandemic, exacerbated by the increasing prevalence of binge eating, underscores the need for a psychological approach to address their common roots.

Areas covered

We reviewed the current evidence on behavioral interventions for MASLD. Interventions such as self-monitoring, goal setting, and frequent counseling, have proven effective in achieving at least 5% weight loss. Cognitive behavioral therapy is the first-line treatment for eating disorders and has shown efficacy in treating binge eating and obesity. Further research is needed to establish the optimal behavioral therapy for MASLD, focusing on enhancing compliance and achieving sustained weight loss through diet and physical exercise.

Expert opinion

The treatment of MASLD should not rely solely on pharmacotherapy targeting a single-organ manifestation. Instead, we must consider behavioral interventions, emphasizing the pivotal role of a holistic approach to this multifaceted disorder.

GRAPHICAL ABSTRACT

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Article highlights

• The therapeutic landscape of MASLD is evolving, marked by the FDA approval of resmetirom, the first targeted therapy for metabolic dysfunction-associated steatohepatitis.

• Despite advances in pharmacotherapy, lifestyle interventions remain essential and effective in managing MASLD.

• MASLD patients often present with multiple comorbidities, necessitating a holistic, multidisciplinary approach for effective management.

• Behavioral interventions targeting eating disorders, particularly binge eating disorder, are crucial for addressing the underlying causes of obesity and improving MASLD outcomes.

• Cognitive Behavioral Therapy is a highly effective treatment for binge eating and has shown promise in treating associated metabolic disorders.

• Effective behavioral interventions include self-monitoring, goal setting, frequent counseling, and fostering a supportive social network.

• More research is needed to identify the optimal behavioral therapy for MASLD, focusing on enhancing compliance and achieving sustained weight loss.

• Integrating behavioral and lifestyle interventions with pharmacotherapy should be pursued to provide a comprehensive treatment strategy for MASLD.

Declaration of Interests

Giada Sebastiani has acted as speaker for Merck, Gilead, Abbvie, Novo Nordisk, Pfizer, served as an advisory board member for Pfizer, Merck, Novo Nordisk, Gilead, and has received unrestricted research funding from Theratecnologies Inc. Giada Sebastiani is supported by a Senior Salary Award from Fonds de Recherche du Quebec – Sante (FRQS) (#296306). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper is not funded.