Objective: To evaluate obesity-related costs and body mass index (BMI) as a cost predictor among privately insured employees by industry.

Methods: Individuals with/without obesity were identified using the Optum Health Reporting and Insights employer claims database (January 2010 to March 2017). Direct/indirect costs were reported per-patient-per-year (PPPY). Multivariate models were used to estimate the association between obesity and high costs (more than or equal to 80th percentile) by industry.

Results: Overall (N = 86,221), direct and absenteeism/disability cost differences between class I obesity (BMI 30.0 to 34.9) and reference were $1,775 and $617 PPPY, respectively (P < 0.05). Among employees with obesity (BMI more than or equal to 30), the highest total costs were observed in the government/education/religious services, food/entertainment services, and technology industries. Class, I obesity increased the odds of high costs (more than or equal to 80th percentile) within each industry (odds ratios vs reference = 1.09–5.17).

Conclusions: Obesity (BMI more than or equal to 30) was associated with high costs among employees of major US industries.