Jul 2, 2026 By Kristin Emery 5 min read

A new study led by a researcher at UPMC in Pittsburgh found that 1 in 10 U.S. adults reports both heavy drinking and obesity. Both are on the rise across the country, and the study published this spring in JAMA Internal Medicine examines how often these risk factors overlap and how clinical care and health policy should address the issue.

The research was led by Dr. Bryant Shuey, a board-certified general internist at UPMC and a clinician-investigator at the University of Pittsburgh Center for Research on Health Care, whose work focuses on substance use, chronic diseases and access to care.

Shuey used survey data from adults across the country to examine overlapping risk factors that could lead to liver disease down the road. A key finding of the study is that about 1 in 10 adults reported both heavy drinking and a body mass index of 30 or greater in 2023.

“That’s a substantial share of the population, especially considering how strongly each of these factors contributes to liver disease risk on its own,” Shuey said.

What stood out to him most was how early this overlap appears.

“Rates were highest among young and middle-aged adults, when risk factors for serious liver disease are just beginning to build. These findings suggest that many people are entering adulthood with multiple, reinforcing risk factors for liver disease long before they ever develop symptoms.”

Shuey became interested in researching this overlap after noticing more people in their 30s and 40s coming to the hospital with advanced liver disease linked to both alcohol use and metabolic risk factors. Nationally, heavy drinking and obesity are both becoming more common, and there has been greater recognition that alcohol and metabolic disease can combine to speed liver disease progression. His goal was to investigate the overlap of risky alcohol use and obesity and what it might mean for prevention and earlier intervention.

“We can look at historical trends over the last few decades, and the reality is that people of different age groups and different cultural backgrounds drink alcohol at different levels,” says Shuey. “The Gen Z generation is consuming alcohol at much lower levels than the millennial generation, and that between the millennials and the Gen X generations, that’s where kind of we’ve seen some of this increase in liver disease presentations.”

The highest numbers in the study showed up in both men and women ages 26 through 49 with nearly 14% of men age 35 to 49 having overlapping heavy drinking and obesity and around 12% of women 26 through 34 having overlapping heavy drinking and obesity.

Liver disease generally presents in a person who has consumed large amounts of alcohol for many years.

“I’m not talking a few days, a few months … generally, many years of progressive, persistent alcohol use,” says Shuey. “It can come to a head with developing liver disease. People can present to the hospital with yellowing of their skin, swelling of their belly, which is fluid in the abdomen, and even signs of gastrointestinal bleeding, which all relate to the liver being at the end of its road, and not doing its proper job.”

Modeling studies show the number of cases may increase over the next decade due to the combination of obesity and alcohol abuse.

“There’s a lot of data that shows that the drinking that people do earlier on in their life can influence their drinking habits later down the road. And so if people are drinking more in their teenage years, then they’re more likely to drink into adulthood.”

Patients with alcohol and metabolically related liver disease are sometimes identified early by primary care doctors through discussing risk factors like alcohol use and metabolic health and ordering blood work and liver imaging. Other patients end up in the emergency room with symptoms of advanced liver disease or cirrhosis, which can include jaundice, abdominal swelling or gastrointestinal bleeding. Someone can have liver disease for years with no symptoms and not even know they have it. Left untreated, progressive liver damage can lead to cirrhosis and liver failure.

Shuey says doctors need to routinely screen for both alcohol overuse and obesity in an empathetic and non-judgmental way. “People can have a hard time talking about alcohol use or even weight with their doctors because it’s a sensitive subject,” Shuey says. “I encourage patients if they’re struggling with issues of weight or alcohol use to mention both of these issues to their doctor and ask if they have any recommendations.”

He says doctors can offer options such as dietary counseling and medications for alcohol use disorder and metabolic disease such as GLP-1s and related weight loss drugs.

“There’s growing interest in these medications because they help people reduce their metabolic risk through weight loss and reversing inflammation in metabolic liver disease,” Shuey adds. “A smaller trial last year found that GLP-1s may reduce alcohol use among people with alcohol use disorder. While these results should not be overstated, GLP-1s may emerge as an important dual-therapeutic for patients with risky alcohol use and obesity if these findings hold up in larger trials. Ultimately, addressing both risk factors together may be an important strategy to change long-term outcomes.”