OBJECTIVES: Abdominal obesity is a major risk factor for cardiovascular disease (CVD), diabetes, and related mortality. Little information is available on the economic burden of abdominal obesity. Therefore, the objective of this study was to assess the current medical resource use in patients with abdominal obesity in Belgium. METHODS: Data on resource utilization was retrospectively (1/8/2004-31/7/2005) collected by general practitioners (GP) in patients aged ≥45 with abdominal obesity and with either a history of CVD- or diabetes, or either >=2 CVD risk factors (hypertension, dyslipidemia, impaired glucose tolerance). GPs were selected based on setting (urban-rural) and geographical region (north-south). Cost analysis was performed for the whole sample, and for 2 subpopulations: patients with a history of CVD or diabetes (64%) and patients without a CVD-history or diabetes. Both costs related and not related to obesity were included. The perspective of the health care payer was taken. RESULTS: 403 patients were studied. Mean age was 61.2 (St.Err. 0.5), females represented 65.26% of the patients. The overall cost per year for the entire sample was €1,758 (St.Err. €129) including all costs related and not related to obesity. Excluding the costs not related to obesity the yearly cost was €995 (St.Err. €90). For the group of patients with a history of CVD or diabetes these costs were €2,109 (St.Err. €182) and €1,252 (St.Err. €130) respectively. For the subgroup of patients without a history of CVD nor diabetes these costs were €1,099 (St.Err. €138) and €534 (St.Err. €82). CONCLUSIONS: This retrospective chart review shows that patients with abdominal obesity have a considerable cost, especially in the presence of CVD or diabetes but also if multiple cardiovascular and/or metabolic risk factors are present. Fifty-seven percent of the total cost of care is related to the patient's obesity.