Although overweight and obesity have long been recognised as major risk factors for a number of chronic diseases, lifestyle developments have led to substantial increases in bodyweight worldwide. In addition to their negative effects on health and quality of life, obesity and associated comorbidities may have a considerable impact on healthcare expenditures. The aim of this systematic review was to summarise cost estimates and compare costs attributable to obesity across different European countries. A structured search in MEDLINE, EMBASE, and all EBM Reviews was conducted to identify relevant literature. Two researchers independently assessed publications according to pre-defined inclusion criteria and with regard to study methodology. Costs attributable to obesity were extracted from the included studies and calculated relative to country-specific gross domestic income. Out of 797 publications that met our search criteria, 13 studies investigating 10 Western European countries were determined to be relevant and included in our review. Obesity-related healthcare burdens of up to 10.4 billion euros were found. Reported relative economic burdens ranged from 0.09% to 0.61% of each country's gross domestic product (GDP). Obesity appears to be responsible for a substantial economic burden in many European countries, and the costs identified in the available studies presumably reflect conservative estimates. There remains a great need for prospective and standardised studies to provide more accurate estimates of costs for all European countries.