Obesity is known to approximately double health care costs for people in the U.S. compared to those with a healthy weight. A series of five studies presented at this year’s European Congress of Obesity (ECO2022), in Maastricht, Netherlands and online from 4–7 May, now shows that around three-quarters of the total obesity costs to the health care system among people living with obesity in the U.S. are accounted for by the 20% highest-cost cases.