Abstract Introduction: Fatty liver has become a pandemic with potential of progression to liver cirrhosis and hepatocellular carcinoma. Till date lifestyle modification remains the mainstay of management of fatty liver. Materials & Methods: We included 68 fatty liver patients in this prospective, real-life study. They were randomized into two groups. One group (case group’) included 48 patients who were prescribed generic obeticholic acid 20 mg orally, daily plus lifestyle modification. The other group (control’) included 20 fatty liver patients. They were advised only lifestyle modification. Patients were followed up at 6 months. Serum alanine aminotransferase and aspertate aminotransferase levels, in addition to ultrasonography of hepatobiliary system and fibroscan were done at baseline and at 6 months. Results: We observed significant reduction in hepatic fat content in the case group compared to the control group. Conclusion: Our real-life study shows promising results with generic obeticholic acid in fatty liver management. Larger clinical trials in the future will be needed to validate our findings.