SA Alqahtani et al. remind us of the burden of non-alcoholic fatty liver disease (NAFLD). In the USA, it is the most common cause of chronic liver disease and the prevalence is estimated to be about 25% and will increase in future years. For the management of patients with NAFLD, the determination of the fibrosis is essential. Liver biopsy is the gold standard but is invasive. The authors aimed to assess the performance of three non-invasive tests for the detection of advanced fibrosis (NAFLD fibrosis score, NFS, fibrosis-4 index, FIB-4, and aspartate aminotransferase-to-platelet ratio, APRI), in the identification of advanced fibrosis among morbidly obese patients. In this study, these 3 tests (NFS, FIB-4, and APRI) showed important limitations: they fell short to detect advanced fibrosis but proved valuable for excluding advanced fibrosis. Combinations of the tests did not improve their performance. Therefore, more research is needed to develop new non-invasive tests with high positive predictive value.