The impact of Americans’ growing waistlines extends well beyond obesity-related diseases like heart disease, cancer and type 2 diabetes. Because of the wide range of health conditions associated with obesity, medical costs are higher for obese people—an extra $1,152 for men and $3,613 for women. This adds up to $190 billion a year in additional spending in the U.S., exceeding the costs associated with smoking. This financial burden doesn’t fall only on the obese, but is picked up by the rest of the population as increased health insurance premiums and taxes to support programs like Medicaid. In the workplace, obese people are more likely to miss work—5.9 more sick days a year for men, and 9.4 more for women—at a cost of $6.4 billion a year in lost productivity. Even while at work, obese workers lose a month of productive work a year due to their extra weight. Obesity is also altering much of the nation’s infrastructure. Hospitals are replacing toilets attached to the wall with ones built into the floor to support heavier people. Trains are being built with wider seats that can hold up to 400 pounds. In addition, more money is spent on gasoline, since it takes more energy to move the extra weight around. An extra 938 million gallons of gasoline are used each year due to people being overweight or obese—at a cost of $4 billion dollars. Some advocacy groups claim that the increased focus on the costs of obesity adds up to size discrimination. Public health officials, though, emphasize that knowing the overall impact of obesity—both in terms of health and dollars—will help us know which health programs are effective at stemming the rise of obesity.