After Wegovy’s Historic MASH Approval, What’s Next?

On Friday, August 15, the FDA approved Wegovy (semaglutide) as the first-ever GLP-1 therapy for the treatment of metabolic dysfunction-associated steatohepatitis (MASH) — a pivotal moment in the fight against steatotic liver disease. It’s a breakthrough years in the making and one that could transform how we care for millions of Americans living with this silent, progressive, and deadly disease.

But approval is only the beginning. Now comes the harder part: identifying the right patients, detecting the disease earlier, and monitoring outcomes so that this promising treatment is effective at scale.

We’re standing at the edge of a new era in liver health. The question is whether our healthcare system is ready to meet the moment.

The stealth threat of MASH

MASH, a more severe form of metabolic dysfunction-associated steatotic liver disease (MASLD), affects approximately 1 in 20 adults — yet 9 out of 10 people living with it remain undiagnosed. The early stages are often asymptomatic, so most patients don’t know they have the disease until serious damage has already occurred.

Left untreated, MASH can lead to cirrhosis, liver failure, and liver-related mortality. However, its impact isn’t limited to the liver. Steatotic liver disease doubles the risk of heart attack or stroke and triples the risk of developing type 2 diabetes.

While Wegovy is not the first drug approved to treat MASH, it is the first GLP-1 therapy to gain this indication—an especially important milestone given its broader benefits in managing metabolic disease. Still, a therapy is only as impactful as our ability to identify the patients who need it.

Liver health is metabolic health

For decades, liver disease has been siloed as a hepatology issue. But that view is outdated. The liver is not just collateral damage in metabolic disease—it’s an active driver of it. 

The liver is one of the first organs to show signs of dysfunction, but it does so silently. Liver fat and early signs of damage can develop before patients show obvious metabolic symptoms; even those with a normal body mass index (BMI) may be on a trajectory toward more serious disease. 

Yet many clinicians prioritize A1C, blood pressure, and lipid panels, overlooking liver health entirely. This disconnect is no longer tenable. 

We can’t treat what we don’t diagnose

The liver assessment tools clinicians have traditionally relied on — blood tests like ALT and AST, and ultrasounds — are simply not enough. Up to 80% of patients with MASLD and nearly 60% with MASH will have normal ALT levels. Conventional ultrasounds miss almost 40% of mild cases, especially in patients with lower BMI or fewer metabolic risk factors.

This is why precise, scalable, non-invasive diagnostic tools are critical. These point-of-care technologies are quick, painless, and accurate, allowing clinicians to assess liver fat and fibrosis in real time—without needing a referral to a hepatologist. 

This kind of early detection can change the entire trajectory of care. It allows primary care physicians, endocrinologists, gastroenterologists, and other providers to catch issues before they become crises and gives patients a clear, motivating picture of their health.

Early identification and non-invasive liver assessment tools also support personalized interventions. Clinicians can adjust care plans, introduce a GLP-1 or other therapy, and track liver health over time to understand whether changes are having the desired effect.

It’s time to bring liver health to the frontlines

Wegovy’s approval for MASH is more than a regulatory milestone — it’s a wake-up call for how we manage metabolic health. Liver disease must become part of routine metabolic health conversations, not something deferred to a specialist after noticeable symptoms arise.

This means:

• Making liver health a frontline concern in cardiometabolic care.
• Normalizing non-invasive liver assessments for patients with metabolic risk factors.
• Educating providers and patients about the link between steatotic liver disease and cardiovascular and type 2 diabetes risks.
• Investing in scalable, cost-effective tools that deliver instant, actionable data at the point of care.

The path forward isn’t complicated, but it does require commitment. We have the tools. We have the evidence. And now, we have the first in a promising new class of therapies, offering a real chance to change the trajectory of this disease – if we can get it to the people who need it most.

A new standard for metabolic care

This isn’t just about liver disease. It’s about transforming how we think about metabolic risk as a whole. With Wegovy’s new indication, we’ve taken a meaningful step toward better outcomes for patients with MASH. Now, let’s take the next step by making liver health a routine part of how we manage metabolic health.

Photo: eranicle, Getty Images

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