Objective： To investigate the correlation between total cholesterol to high-density lipoprotein cholesterol ratio（TC/HDL-C）and hepatic steatosis severity in obese patients with nonalcoholic fatty liver disease. Methods：From 2018 to 2019，a total of 98 obese patients hospitalized in our hospital were recruited. Based on the severity of hepatic steatosis diagnosed with pathological grade，patients were divided into groups with mild-grade（group A），moderate-grade（group B），and severe-grade（group C）hepatic steatosis. The correlation between general clinical characteristics and pathological grade of hepatic steatosis were analyzed by Spearman correlation analysis and logistic regression. Results：①Compared to group A，TC/HDL-C，body mass index（BMI），alanine aminotransferase（ALT），aspartate aminotransferase（AST）levels of group B and group C were significantly higher. There was no significant difference in the above indicators between group B and group C. ② Using Spearman correlation analysis，we found that TC/HDL-C was positively correlated with severity of hepatic steatosis，TC，triglyceride and other related factors，while negatively correlated with HDL-C in group A and group B（P < 0.05）. ③ Logistic regression analysis showed that there was a significant correlation between TC/HDL-C and pathological grade of hepatic steatosis in group A and group B（P < 0.05）. Conclusion：TC/HDL-C was significantly higher in patients with moderate steatosis than with mild steatosis，and was significantly correlated with the degree of hepatic steatosis.