Someone came to see me last year for weight loss surgery and was found on further investigation to have a severe form of deposition of fat within the liver otherwise known as NASH (non-alcoholic steato-hepatosis). Fat deposition within the liver is very common, although more severe in obese individuals, the condition is called NAFLD (non-alcoholic fatty liver disease) and can then progress to NASH. Individuals with this condition can be more prone to bleeding and carry a higher risk for surgery and anaesthesia. Luckily, evidence from previous studies shows that weight loss surgery has a beneficial effect on the fatty liver and can reverse some of the changes caused by fat deposition. I am pleased to say following the operation, this individual’s liver function tests have begun to normalize. Recently the evidence has been mounting that surgery is one of the best ways of treating this condition.