As metabolic disease quietly overtakes hepatitis B as the leading driver of cirrhosis in Singapore, the country's Health Sciences Authority has approved semaglutide — marketed as Wegovy — as the first pharmacological treatment for metabolic dysfunction-associated steatohepatitis with liver fibrosis. The decision reflects a broader reckoning: the diseases of modern abundance are now reshaping the burden of advanced liver illness across Asia. Where fatty liver once seemed a silent inconvenience, it has become a measurable force behind cirrhosis and liver cancer, and medicine is only beginning to