Can you have fatty liver without being overweight?

Insulin resistance, visceral fat distribution, genetics (for example PNPLA3 variants), diet pattern and low muscle mass can all contribute at a normal BMI.

Some people store relatively little fat under the skin and more around the organs.

Lean individuals are less likely to be screened, so diagnosis can be delayed.

Management focuses on metabolic health, muscle mass and dietary pattern rather than weight loss alone, and should be individualised by a clinician — weight loss advice is not appropriate for everyone.

Lean MASLD is recognised in international guidance, with outcomes that are not uniformly milder than in people with obesity.

Studies in Indian and other Asian cohorts report meaningful prevalence of fatty liver among people with normal BMI; exact figures vary by population and diagnostic method.