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The health associated costs of obesity can represent between 2% and 9% of the total health costs of a given country. To assess the impact of obesity on health care costs and absenteeism in a cohort of mine workers. Prospective study of 4.673 men, employees of a mining company, aged 49±7 years that were followed for 24±11 months. Total health care cost and days of sick leave were recorded for each individual. The association between obesity and these variables was analyzed by logistic regression adjusting for co-morbidities, age and other variables. Mean annual health care costs for obese workers were 17% higher (p< 0.001) compared to workers with normal weight and 58% higher (p< 0.001) for workers with severe and morbid obesity. Mean annual days of sick leave increased by 25% in the obese (p= 0.002) and by 57% in subjects with severe and morbid obesity (p< 0.001). For health care costs the most significant predictors were: presence of diabetes mellitus (Odds ratio (OR) 6.21, 95% confidence intervals (95% CI) 4.9 to 7.9), hypertension (OR 3.99; 95% CI 3.4 to 4.6) and severe and morbid obesity (OR 2.55, 95% CI 1.9 to 3.4). For absenteeism the most significant predictors were: presence of diabetes mellitus (OR 1.58, 95% CI 1.2 to 2.0), hypertension (OR 1, 34, 95% CI 1.2 to 1.6) and severe and morbid obesity (OR 1.50, 95% CI 1.1 to 2.1). Obesity increases significantly health care costs and absenteeism (Rev Méd Chile 2009; 137: 337-44).(Key words: Comorbidity; Health expenditures; Obesity)