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Background: The changing patterns of obesity have had a significant impact on the epidemiology of esophageal cancer (EC). Aims: This study aimed to investigate the specific burden of EC associated with high body mass index (BMI) across different geographical and Sociodemographic Index (SDI) regions, using data from the Global Burden of Disease Study 2019. Methods: Mortality, age-standardized death rates (ASDR), and disability-adjusted life-years (DALYs) from 1990 to 2019 were analyzed for 204 countries and territories. Decomposition analysis, frontier and health inequality analyses, and age-period-cohort models were employed to examine the factors driving disease burden and to predict future trends. Results: High BMI contributed to 89,903.9 [95% uncertainty interval (UI): 27,878.9–171,254.6] EC-related deaths, an ASDR of 1.1 (95% UI 0.3–2.1) per 100,000 population, and 2,202,314.1 (681,901.4–4,173,080.3) DALYs in 2019. There was an increasing trend in these figures over the 29-year period. The middle SDI region (31,023.8, 95% UI 9,180.4–62,631.5) and East Asia (36,939.9, 95% UI 9,620.5–81,495) carried the highest burden of EC-related deaths. Disease burden increased across all age groups and genders globally. Population growth was a major factor driving EC deaths across all SDI quintiles. Disparities in disease burden were observed across countries at all development levels. Predictive models indicated a continued increase in EC-related deaths in the next decade. Conclusions: The study provided a comprehensive understanding of the global burden of EC associated with high BMI over the past decades. Opportunities exist to reduce this burden at all SDI levels through targeted interventions and policies. [ABSTRACT FROM AUTHOR]