Objective This study utilized the 2021 Global Burden of Disease database to systematically analyze global liver cancer mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALY) from 1990 to 2021. It focuses on differences across genders and age groups to reveal epidemiological patterns of liver cancer attributable to high BMI, providing reference for global liver cancer prevention and control. MethodBased on the 2021 Global Burden of Disease database, the Global Health Data Exchange query tool was used to extract the total number of global liver cancer deaths, DALY, age-standardized mortality rate (ASMR), and age-standardized DALY rate from 1990 to 2021. These metrics were assessed using estimated annual percentage change. Joinpoint regression analysis was employed to calculate annual percentage change and average annual percentage change , comparing differences in subtype composition from 1990 to 2021. Smooth curve regression analysis was applied to assess the correlation between liver cancer mortality and DALY rates attributable to high BMI and the socio-demographic index (SDI). ResultsFrom 1990 to 2021, the cumulative number of liver cancer deaths attributable to high BMI increased from 10 282.12 cases in 1990 ［95%UI (4 196.72, 16 721.85)］ to 46 200.88 cases［95%UI (38 606.14, 77 983.02)］ in 2021, representing a 3.5-fold increase. DALYs attributable to high BMI-related liver cancer increased from 292,696.35 years in 1990［95%UI (119 094.56, 475 962.67)］ to 1 273 312.58 years［95%UI (504 391.1, 2,101,957.87)］ in 2021, representing a 3.2-fold increase.② Cumulative deaths attributable to high BMI: For males, deaths increased from 5,913.45 cases [95% UI (2,479.64, 9,717.69)] in 1990 to 28,511.99 cases［95%UI (11 721.81, 49 277.60)］ in 2021, representing a 3.8-fold increase. For women, the cumulative number increased from 4,368.66 cases［95%UI (1 707.64, 7 078.83)］in 1990 to 17 691.88 cases［95%UI (7 169.44, 29 573.18)］in 2021, representing a threefold increase.③ Cumulative mortality values increased across all SDI income regions to varying degrees. ASMR and death counts steadily rose with increasing age, mirroring the growth trend in DALYs attributable to liver cancer associated with high BMI. Correlation analysis and slope index results demonstrated a significant positive correlation between SDI and both death counts and DALYs. The mortality concentration index rose from –0.277 (1990) to –0.258 (2021), while the DALY concentration index increased from –0.222 (1990) to –0.208 (2021). The mortality slope index increased from 0.284 (1990) to 0.881 (2021), while the DALY rate slope index rose from 7.002 (1990) to 19.244 (2021). ConclusionsThe burden of liver cancer associated with high BMI remains substantial and varies significantly across different age groups, genders, and geographic locations worldwide. The global disease burden of liver cancer linked to high BMI is projected to remain severe in the future, necessitating sustained attention and the development of more targeted prevention and control measures tailored to current circumstances.