Background: To examine the relationship between waist circumference and future health care costs across a broad range of waist circumference values based on individual level data. Method: A prospective cohort of 31,840 subjects aged 50–64 years at baseline had health status, lifestyle and socio-economic aspects assessed at entry. Individual data on health care consumption and associated costs were extracted from registers for the subsequent 7 years. Participants were stratified by presence of chronic disease at entry. Results: Increased waist circumference at baseline was associated with higher future health care costs. For increased and substantially increased waist circumference health care costs rise at a rate of 1.25% in women and 2.08% in men, per added centimetre above normal waistline. Thus, as an example, a woman with a waistline of 95 cm and without co-morbidities can be expected to incur an added future cost of approximately USD 397.– per annum compared to a woman in the normal waist circumference group, corresponding to 22% higher health care costs. Conclusions: Future health care costs are higher for persons who have an increased waist circumference, which suggests that there may be a potential for significant resource savings through prevention of abdominal obesity.