Liver disease is a silent epidemic that affects millions of Americans and imposes a significant financial burden on employers. As a matter of fact, 22% of Americans have non-alcoholic fatty liver disease (NAFLD) and for those with obesity, 80-90% are affected. Because there often are no symptoms, NAFLD can progress to cirrhosis and liver failure with few warning signs. The good news is that early detection and lifestyle modification can reduce the progression of this disease. Employers should be aware of new testing options and treatments to mitigate the high cost of treating advanced liver disease.