OnDemand: January 2026 Grand Rounds - MASLD in Obesity: Not All Fat Was Created Equal

Primary care providers and obesity specialists play a critical role in the early identification of metabolic dysfunction–associated steatotic liver disease (MASLD) and liver fibrosis, including appropriate treatment and timely referral to hepatology when indicated. This presentation will review practical strategies for screening patients with overweight, obesity, or type 2 diabetes for liver disease and will discuss evidence-based management approaches for patients with significant liver disease.

1. Explain the pathogenesis and systemic nature of metabolic dysfunction–associated steatotic liver disease (MASLD) and its association with obesity, type 2 diabetes, and cardiometabolic risk.
2. Apply evidence-based screening and noninvasive diagnostic strategies to identify liver disease and assess fibrosis risk in patients with overweight, obesity, and/or type 2 diabetes, including appropriate indications for hepatology referral.
3. Evaluate current and emerging management approaches for MASLD, including lifestyle and pharmacologic therapies, to support individualized, guideline-concordant patient care.

Fernando Bril, MD

Assistant Professor, University of Alabama Birmingham

Dr. Bril completed medical school and 4 years of internal medicine residency at Instituto Universitario CEMIC in Buenos Aires, Argentina. Before redoing clinical training in the US, he joined the University of Florida (UF) in Gainesville, FL to complete a research fellowship/post-doc in the Division of Endocrinology, Diabetes and Metabolism. He then completed internal medicine residency and endocrinology fellowship at University of Alabama at Birmingham (UAB). He is currently an Assistant Professor and Associate Scientist in the Division of Endocrinology, Diabetes and Metabolism at UAB. His main research interest has been to understand the metabolic mechanisms that promote the progression of MASLD in obesity and diabetes, identify markers for early diagnosis, and assess pharmacological approaches that may be able to change the natural history of the disease. He has >90 publications in the field of MASLD, obesity, and type 2 diabetes. He was awarded the Early Career Award from The Obesity Society and from Endocrine Society.

The Obesity Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Obesity Society designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ACCME Activity ID

Date of Release: February 15, 2026
Date of Termination: December 31, 2028

No commercial support was received for this activity.

Fernando Bril, MD: Advisor and Consultant relationship with NovoNordisk (Pharmaceuticals); Advisor and Consultant relationship with Madrigal (Pharmaceuticals); Advisor and Consultant relationship with Boehringer-Ingelheim (Pharmaceuticals)

Monica Agarwal, MD, MEHP, FACE: No relevant financial relationships

No members of the TOS CME Oversight Committee, charged with the resolution of all relevant conflicts of interest, had any relevant financial relationships while serving on the committee.

1. Bril F, Bolla P, Huynh K, et al. Prevalence of MASLD in People With Diabetes Has Decreased in the US, but Rates of Liver Fibrosis Are Still on the Rise. Journal of the Endocrine Society. 2025;9(8): bvaf110.

2. Bril F, Godinez Leiva E, Lomonaco R, Shrestha S, Kalavalapalli S, Gray M, Cusi K. Assessing strategies to target screening for advanced liver fibrosis among overweight and obese patients. Metab Target Organ Damage. 2022;2:11. doi: 10.20517/mtod.2022.08. Epub 2022 Jul 18.

3. Bril F, Gray M. Noninvasive tests to identify liver fibrosis in metabolic dysfunction-associated steatotic liver disease are affected by race. Obesity (Silver Spring). 2024 Mar;32(3):612-622. doi: 10.1002/oby.23960. Epub 2023 Dec 27. PMID: 38151987; PMCID: PMC10922543.