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Child to Adult

Ages 13-18 years, with fatty liver diseaseInclusion Criteria Ages 13-18, Tanner stage 4-5 Biopsy-documented hepatic steatosis per the steatosis grade. Grade 1-3 required for inclusion Diagnosis of NAFLD per hepatologist Sedentary- less than 3 hours of moderate (jogging, swimming, etc.) exercise a week BMI equal or greater than the 85th percentile for age and gender, this is overweight and obese categories Exclusion Criteria Use of medications known to affect insulin sensitivity: metformin, oral glucocorticoids within 10 days, atypical antipsychotics, immunosuppressant agents, HIV medications. Currently pregnant or breastfeeding women. Development of pregnancy during the study period will necessitate withdrawal from the study Severe illness requiring hospitalization within 60 days Diabetes, defined as Hemoglobin A1C > 6.4% BMI percentile less than the 85th percentile for age and sex. Waist circumference >200 cm. Anemia, defined as Hemoglobin < 11 mg/dL Diagnosed major psychiatric or developmental disorder limiting informed consent Implanted metal devices that are not compatible with MRI Use of blood pressure medications. Some blood pressure medications, in particular beta- blockers, have direct effects on concentrations of hepatic fat, and this could confound results. Known liver disease other than NAFLD or AST or ALT >150 IU/L.