# Patients’ Experience of Stigma as the Hidden Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease: A Descriptive Qualitative Study with Thematic Analysis

## TL;DR

This study explores how people with MASLD experience stigma from healthcare, social, and personal sources, highlighting the need for better support and care.

## Contribution

The study provides new qualitative insights into the psychosocial burden of MASLD stigma through thematic analysis of patient experiences.

## Key findings

- Patients reported feeling blamed for lifestyle choices and receiving limited or conflicting medical guidance.
- Stigma led to anxiety, depression, and social withdrawal, showing the impact of structural, public, and self-stigma.
- Participants emphasized the need for holistic care and professional support to manage lifestyle changes and stigma.

## Abstract

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally, closely associated with obesity and metabolic syndrome. Despite its clinical significance, patients frequently experience stigmatization from society, healthcare professionals, and family, which may exacerbate psychological distress and hinder effective care. This study aims to explore how patients living with MASLD experience and interpret different dimensions of stigma. By examining stigma across healthcare, social, and personal contexts, the study offers insights into the hidden psychosocial burden of MASLD and may inform approaches to reduce stigmatization and promote more patient-centered and equitable care. Methods: Between 19 November 2024 and 6 February 2025, 23 adults diagnosed with MASLD (21 women, aged 35–70+ years) completed an anonymous online questionnaire comprising 4 demographic questions and 11 open-ended questions regarding their experiences of stigma, its emotional and social impact, and strategies for managing these experiences. Responses were analyzed thematically using Braun and Clarke’s six-phase framework to identify key domains. Results: Three overarching themes emerged: (1) Diagnosis, Symptoms, and Medical Experiences; (2) Emotional and Social Impact; and (3) Coping Strategies and Advocacy. Most participants reported incidental diagnosis, limited or conflicting medical guidance, and feeling blamed for lifestyle choices. Several participants described anxiety and depressive symptoms, while many reported social withdrawal and self-blame, illustrating the interplay of structural, public, and self-stigma. Coping strategies included peer support, self-education, and advocacy, yet participants emphasized that lifestyle changes remained challenging without professional guidance. Many expressed a need for holistic care addressing both medical and psychosocial needs. Conclusions: Stigma profoundly affects patients with MASLD, influencing healthcare experiences, emotional well-being, and social interactions. Interventions should target multiple levels of stigma, incorporating education for healthcare professionals, holistic care models, and accessible support systems. Further research is needed to identify effective strategies for reducing stigmatization and improving equity of care.