OBJECTIVES: To evaluate how abdominal obesity (AO) measured by waist circumference (WC) affects productivity and indirect costs over 3 months in a population of overweight and obese (25≤BMI ≤35 kg/m2) subjects in the US and Germany. METHODS: Subjects were recruited by the internet; 5410 (US) and 5406 (Germany) eligible and consented subjects were stratified by BMI and gender into normal weight (BMI 20-24.9, n=404), overweight (BMI 25-29.9, n=8009), and obese (BMI 30-35 kg/m2, n=1403) groups. Weight, height and WC were self reported and validated. In overweight and obese groups, subjects were further classified into high and low WC groups using the observed gender-specific median WC. Impairment at work among employed respondents (presenteeism) was assessed using the validated questionnaire WPAI, General Health version. Absenteeism was assessed based on self-reported number of days missed from work due to a health problem in the past 3 months. Indirect costs were calculated by adding cost of absenteeism and presenteeism (both monetized by using country specific estimated quarterly earnings).RESULTS: The percentage of subjects in each group working for pay (low/high WC respectively) were 70%/62% (overweight), 64%/55% (obese) in the US; and 73%/66% (overweight), 67%/56% (obese) in Germany. In both countries and overweight/obese groups, subjects above median WC had a significantly higher mean percent of overall impairment while working than subjects with low WC. In both countries, except for obese German, subjects with high WC had a significantly higher mean indirect cost than subjects with low WC (low, high WC, respectively); in US: $804, $1070 in overweight subjects and $958, $1391 in obese subjects; in Germany: €907, €1095 in overweight subjects and €1178, €1352 in obese subjects.CONCLUSIONS:Within each overweight and obese group, subjects with high WC had a 7% to 11% lower employment rate, significant overall impairment at work and consequently higher indirect costs.