More than 30% of people in Appalachia are obese, and the proportion of people affected is on the rise. In addition to contributing to health risks such as heart disease, diabetes, high blood pressure and certain cancers, obesity is driving a spike in non-alcoholic fatty liver disease (NAFLD), fueling a new health crisis many are unprepared to deal with, The Herald-Dispatch reports.

According to recent reports from hospitals in West Virginia, Kentucky and Ohio between 56% and 60% of patients are at risk for NAFLD, more than twice the national average. That represents more than 130,000 individuals across the region, and health workers say almost none of them are aware of the risk.

Liver disease researchers also fear hospitals across Appalachia do not have the capacity to handle the growing liver disease epidemic. Their biggest fears revolve around non-alcoholic steatohepatitis (NASH), the advanced stage of NAFLD that can lead to life-threatening conditions, including cirrhosis, liver cancer, liver failure and the need for a liver transplant.

A liver transplant is among the most expensive surgical operation in the United States, costing on average around $600,000 per patient. The procedure requires nearly six months of aftercare, a steady supply of donated organs, high-tech operating rooms and massive quantities of blood for transfusion. Local doctors say many area hospitals lack the technology and care capabilities to handle a potential influx of new NASH transplant patients, meaning many patients would need to be transferred elsewhere to receive proper care.

What’s more, health care coverage in Appalachia is far from universal. Although West Virginia has a decent Medicaid program, Kentucky, Pennsylvania, Maryland and Ohio do not.

But health workers in Appalachia are moving to address the burgeoning crisis. A new clinical trial in Huntington, West Virginia, for example, hopes to test a new medication on local patients to help stop and reverse the effects of NASH. To learn more about that trial, click here.