INTRODUCTION: Weight loss is the mainstay of management for patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We studied the impact of referral to MOVE!, a nationally implemented behavioral weight loss program, on weight in patients with MASLD. METHODS: This retrospective cohort study included 102,294 patients with MASLD from 125 Veterans Health Administration centers from 2008 to 2022. RESULTS: Most patients lost no significant weight or gained weight. Increased engagement with MOVE! was associated with a greater hazard of significant weight loss compared with no engagement. DISCUSSION: A minority of patients experienced significant weight loss through 5 years using lifestyle interventions alone.