OBJECTIVES: To investigate the differences in work productivity in patients with metabolic syndrome across three geographies. METHODS: Data from the 2008 National Health and Wellness Survey (NHWS), an annual internet survey of attitudes, behaviors, health status, and outcomes of adults in the US, EU (Germany, Spain, Italy, UK, and France), and Japan (JPN) were used for the analysis. Metabolic syndrome was defined as having at least three of the following: diabetes, BMI >=30, high cholesterol, or hypertension. Multiple regressions were used to determine the effect of geography on work productivity using the validated Work Productivity and Activity Impairment Questionnaire (WPAI) controlling for age, gender and total number of comorbidities. RESULTS: Of the 3,995 employed patients with metabolic syndrome in the analysis 881 (22.1%) were from Europe, 89 (2.2%) from JPN, and 3,025 (75.7%) from the US. EU patients (10.9%) had significantly higher levels of percent work missed in the past week due to health (absenteeism) than US (6.2%) and JPN (5.3%) patients.  No significant differences amongst geographies were seen for percent impairment at work (presenteeism), however, EU patients had higher levels of percent overall work impairment compared to US patients (p<0.05). For all metabolic patients (n=11,131) activity impairment was significantly lower for JPN compared with US and EU (p<0.05). After controlling for age, gender and number of comorbid conditions, the differences remained significant, with EU having higher absenteeism, overall work impairment, and activity impairment than the US, and JPN reporting less activity impairment than the  US (p<0.05). CONCLUSIONS: The effect of metabolic syndrome on work productivity differed significantly across the three geographies. Any combination of factors may explain these differences: awareness of the condition, treatment differences, cultural issues, and health systems, amongst other. Further research is needed to describe the impact metabolic syndrome may have globally.