Hepatocellular carcinoma (HCC) has seen a dramatic increase in incidence over the last 4 decades.1 This increase in incidence has mirrored an increase in end-stage hepatitis C infection, and has also mirrored worsening of the obesity epidemic that has plagued the United States and the rest of the world.1,2 Prior studies have shown an association with obesity and HCC, but have not controlled consistently for well-known risk factors.3 A pathophysiologic relationship between obesity, the presence of nonalcoholic steatohepatitis (NASH), and HCC has also been hypothesized previously.