As a Gastroenterologist trained at a very busy liver transplant center, it was almost a daily occurrence to hear someone's liver being transplanted due to cirrhosis secondary to fatty liver. When I mention this to my patients, almost 90% are totally surprised. The answer I get all the time is that they were not at all aware that this could happen!!
Fatty liver in most cases is due to excess calories and overweight/obesity and could cause scarring in the liver over time (10-20years) and lead to complete scarring of the liver when it is called 'cirrhosis'. Once cirrhosis sets in, one may need a liver transplant if it becomes serious enough. There are other manifestations of cirrhosis like swelling of the legs and feet, swelling of the belly with fluid, excess daytime sleepiness, bloody vomitings or black stools etc. Those could become problematic to manage even if one does not need a liver transplant. Lifespan is reduced as well.
From my practice experience, it seems to me that a great majority of patients are totally unaware of this serious issue.
Once I was in the hallway of a hospital when I was rounding and a patient with whom I had a discussion the day before about fatty liver (she was cirrhotic and I went into the causes etc), stopped me and started me in the eye and said, "Why was I not told about this long ago?" and tears welled up in her eyes and they did in mine as well. I had no answer as I did not know the circumstances under which she got that information. She was told that she had a fatty liver about 10 years ago.
It was a deeply touching moment reminding me of my humble responsibility as a specialist to educate the patient about the consequences of fatty liver and urge them to lose the weight and thereby reverse the fatty liver (in most cases).
There are other causes of fatty liver like alcohol use, diabetes, medications etc. which can get confusing when they happen in the setting of obesity. So, do not take it lightly and talk to your Gastroenterologist.