Novo says Wegovy normalized liver fat in about 9 of 10 adults with excess liver fat in STEP UP sub-analysis

Novo Nordisk on October 1, 2026 presented a post hoc analysis from its STEP UP obesity trial program showing that semaglutide — sold as Wegovy — sharply cut liver fat in a small group of adults with obesity and no diabetes. In the 55 participants whose liver fat was measured directly by MRI, mean liver fat fell from 8.8% at the start to 3.1% at week 72 on pooled semaglutide 7.2 mg and 2.4 mg ^[1]. The findings were presented at the European Association for the Study of Diabetes (EASD) Annual Meeting 2026 in Milan, Italy ^[1].

The headline number comes from a smaller slice of that group. Of the 55 people with MRI measurements, 26 entered the trial with liver fat above 5% — the usual cutoff for excess fat in the liver. By week 72, 23 of them, or 88.5%, had dropped below 5% ^[1]. Liver fat was quantified using MRI–proton density fat fraction (MRI-PDFF), which the company describes as the gold-standard imaging method for measuring fat in the liver and which avoids the need for a biopsy ^[1].

What the broader analysis covered

The liver imaging sits inside a larger exploratory analysis that pooled 1,919 adults from STEP UP and STEP UP T2D. Of those, 1,312 received semaglutide 7.2 mg, 304 received semaglutide 2.4 mg and 303 received placebo ^[1]. At baseline, more than 94% of participants in every group were classified as high risk for fatty liver by the Fatty Liver Index, a score built from BMI, waist circumference, triglycerides and GGT ^[1]. Fewer than 1% met criteria for advanced fibrosis risk using the FIB-4 index ^[1]. In other words, this was a population at high metabolic risk but with little advanced liver scarring at the outset.

It is important to be precise about what this is. STEP UP and STEP UP T2D were phase 3b randomized, double-blind, placebo-controlled trials of once-weekly semaglutide 7.2 mg versus semaglutide 2.4 mg and placebo for weight management, with primary endpoints of body weight change and the share of participants losing at least 5% of body weight at week 72 ^[1]. The liver analysis was post hoc and exploratory, and was not a pre-specified primary or secondary endpoint of the parent trials ^[1]. The company's own release describes all 55 imaged participants as having excess liver fat while also reporting that only 26 started above the 5% threshold, so the exact composition of that subgroup is not fully clear from what has been released ^[1]. How placebo recipients fared on MRI-PDFF, and whether the differences were statistically significant, have not been reported.

"This analysis showed that semaglutide reduced liver fat and was linked to better overall liver health in adults with obesity," said Eric Lawitz, MD, of the Texas Liver Institute and University of Texas Health San Antonio, who added that "as many as three in four people with obesity may have excess liver fat" ^[1].

Why it matters for patients

Excess liver fat, known as MASLD, is strongly tied to obesity and type 2 diabetes and can progress to MASH, fibrosis and cirrhosis if it goes unaddressed ^[1]. Many people with obesity have it without knowing, since it usually causes no symptoms.

For people already taking or considering semaglutide for weight, this adds a data point suggesting the drug's effects extend to the liver — but it does not change what is approved or how the drug is prescribed. Semaglutide 2.4 mg is already approved for MASH under the Wegovy brand in the United States, Canada, the United Kingdom, China and several other markets, based on the dedicated ESSENCE trial ^[1]. Semaglutide 7.2 mg is not being investigated for MASH ^[1]. A 55-person imaging subgroup from a weight-loss trial is far smaller and less rigorous than a dedicated liver study, and it cannot establish long-term liver outcomes.

What happens next

ESSENCE continues. The trial randomized 1,197 participants with MASH and stage F2 or F3 fibrosis 2:1 to semaglutide 2.4 mg or placebo on top of standard care for 240 weeks ^[1]. Part 1, based on biopsies from the first 800 randomized patients at 72 weeks, showed superior improvement in fibrosis without worsening steatohepatitis, and resolution of steatohepatitis without worsening fibrosis, versus placebo ^[1]. Part 2 results are expected in 2029 ^[1].