Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the United States with a growing prevalence worldwide. Nonalcoholic steatohepatitis (NASH), progressive form of NAFLD can lead to the development of cirrhosis, hepatocellular carcinoma (HCC), and the need for liver transplantation. Treatment of NASH may decrease the risk of progressive disease. Treatment for NAFLD should center around weight loss and exercise. Pharmacotherapy with vitamin E and pioglitazone should be considered for those with NASH, especially those with fibrosis. Weight loss surgery is also an effective treatment for NASH in individuals with other indications for surgery. In this review we will discuss the currently available therapies for NASH including lifestyle, pharmacologic and surgical options.