Does stigma reduce hazardous health behaviors contributing to steatotic liver disease?

Abstract

Hazardous health behaviors increasingly contribute to end-stage liver diseases. To address surges in alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease, clinicians in hepatology and liver transplantation must increasingly understand factors that influence eating and alcohol behaviors and consider ways to therapeutically influence patients' health choices. Stigma is a prominent influence on patient behavior, but is overused as a sweeping explanatory factor as to why difficulties arise, behavior change does not occur, or when outcomes are suboptimal. With more awareness of behavioral influences, clinicians may wonder if, for all its adverse effects, stigma exerts some therapeutic effects on patients considering altering habits. While stigma is less likely to yield desired outcomes, other co-occurring systemic, social, and interpersonal influences can favorably affect health choices (ie, structural nudging, social norms and consequences, and motivational interviewing, respectively). In this article, we analyze these related yet distinct constructs in ways pertinent to liver disease and transplantation, indicating where they might be applied and further studied.