Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the Western world. Associated with the metabolic syndrome, NAFLD is associated with adverse cardiovascular outcomes. A subset of NAFLD patients with histologic nonalcoholic steatohepatitis (NASH) can have increased liver related mortality. Because of the prevalence and complications of this chronic liver disease, it is important that internists understand important aspects about diagnosis and management. In this article, we aim to provide an update to clinicians related to issues surrounding prognosis, monitoring, and treatment.