Changing Behaviors, Changing Outcomes
Laura Hale is one of the millions of Americans diagnosed annually with metabolic dysfunction-associated steatotic liver disease (MASLD).
Now 71, Hale grew up in the Torrance/Redondo Beach area and earned her degree in physical education from California State University, Northridge. The former physical education teacher spent nearly four decades with the Los Angeles Unified School District while also serving her community beyond the school walls. She was director of the Gay and Lesbian Education Commission, training police departments, businesses and government entities on sensitivity issues.
Professionally, Hale followed an administrative career track and became a high school principal, a position from which she later retired.
Despite being very athletic - she played international softball for nearly 40 years - she says she had long struggled with her weight.
“I tried every diet, every protocol you could possibly imagine,” she says.
Then, “as I became more sedentary as an administrator, I started to have health-related issues,” she says, including elevated blood sugar. Eventually, she was diagnosed with Type 2 diabetes. About 30 years ago she learned she had fibromyalgia, a chronic condition that often results in fatigue, pain and sleep difficulties.
Now retired, Hale lives in Palm Desert. She continues to stay active, playing golf several times each week despite experiencing the low energy levels that come with fibromyalgia.
During a checkup, her primary care physician ordered a liver scan and then a colonoscopy, sending her to Ulysses Rosas, MD, Board Certified Gastroenterologist with the Eisenhower Gastroenterology Specialty Clinic.
Hale was referred to Dr. Rosas in May 2024 for gastrointestinal (or GI) issues. In reviewing imaging, “a CT scan raised concern for hepatic steatosis, or fatty liver. Because of that, we ordered a FibroScan®,” he says.
Fatty liver disease is linked to metabolic issues and often develops without obvious symptoms. The condition is common in the United States - statistics show it affects 1 in 3 adults. It often is described as silent because it can be present long before symptoms appear. Risk factors include obesity, insulin resistance or Type 2 diabetes, high cholesterol and high blood pressure.
“Essentially, the term fatty liver is used to describe metabolic dysfunction-associated steatotic liver disease (MASLD),” Dr. Rosas says. With MASLD, excess fat builds up in the liver and can cause scarring and fibrosis, which can lead to cirrhosis [end-stage liver disease].”
“Identifying fatty liver early is important because lifestyle and dietary changes can make a real difference,” he says. “Once fibrosis begins to develop, management becomes more critical. While early fibrosis can be reversible, the goal is to prevent progression to cirrhosis, which is not.”
Management is multidisciplinary, Dr. Rosas says. “It involves GI doctors on the more complicated side, but also primary care physicians, who are really on the front line to identify patients who might be at risk and also provide some of the management options.”
The condition is diagnosed using various clinical scores. The most common being the FIB-4, or the Fibrosis-4 Index for liver fibrosis, which is a noninvasive score calculated by primary care physicians using lab values such as liver enzymes, age and platelet count. The physician may then send the patient for evaluation by a specialist.
“An elastography study like FibroScan is ordered in the vast majority of such patients referred by primary care,” Dr. Rosas says. “The scan measures liver stiffness and gives a score based on liver fat content and liver fibrosis.”
“That’s how we diagnose it,” he says. “The gold standard for diagnosis is liver biopsy, but that is not needed in every single patient unless there’s a question about the diagnosis or a question about whether it’s truly cirrhosis.”
Dr. Rosas describes Hale’s diabetes as well-controlled. She was already prescribed a low dosage of Ozempic® (semaglutide),
a prescription medication developed to lower blood sugar levels and aid in weight loss by mimicking GLP-1, a natural hormone the body produces to control both. Hale says the prescription medication did its job, lowering her blood sugar levels and helping her lose about 30 pounds.
“Patients are often referred to our office when there’s a mention of fatty liver or hepatic steatosis on the imaging study,” explains Rosas.
“They come to us to follow up.”
In Hale’s case, the finding suggested moderate to severe fibrosis.
“Typically, the treatment is lifestyle modification with the patient doing their best to stick to a Mediterranean-style diet,” he says. Recommendations are to get to a healthy weight and age-appropriate exercise at least 150 minutes per week.
“If they’re able healthwise, drinking one to two cups of black coffee each day has been shown to reverse fibrosis,” he says, cautioning that
it is not recommended for patients with medical comorbidities such as cardiac arrhythmia or atrial fibrillation.
Before 2024, there were no prescription treatments for liver fibrosis related to fatty liver. Promising treatments have since surfaced. Rezdiffra (resmetirom) was approved in March 2024, and in August 2025, Wegovy®, another semaglutide prescribed for diabetes and obesity, gained FDA approval for treatment of fatty liver disease with fibrosis.
Dr. Rosas says because not everyone with MASLD has advanced fibrosis, “we’re reliant on primary care doctors to still manage diabetes and obesity. These medications (GLP-1s) have become a great tool to help in that management. That’s the collaborative aspect of this disease.”
Staying on top of health maintenance is important. “We have an older population and we encourage aging well,” Dr. Rosas says.
Hale’s last scan in June 2025 showed no fibrosis.
“My liver really healed itself,” Hale says. “It’s remarkable.”
A breast cancer survivor, Hale is no stranger to Eisenhower Health’s services.
“I love Eisenhower,” she says. “I’ve had the best of care. If I get referred to anyone, I ask if (he or she is) a part of Eisenhower. I’m able to monitor my own health because of that.”
For more information on scheduling a screening with Eisenhower Health gastroenterologists,
call 760.773.2882 or visit EisenhowerHealth.org/GI.
