Obesity is a growing global epidemic with significant economic impacts, and in North Macedonia, limited local data have hindered economic evaluations. This study presents a cost-of-illness (COI) analysis of obesity in the country. Using a top-down, population-based approach, we estimated obesity-attributable costs in 2021, applying the Population Attributable Fraction (PAF) method to stroke, ischemic heart disease, and diabetes mellitus. Direct costs were derived from healthcare expenditures, while indirect costs covered productivity losses. Obesity-related costs totaled €97.5 million, with 38.25% from healthcare and 61.74% from productivity losses. Diabetes mellitus had the highest cost sensitivity. This paper estimates the economic burden of obesity-related illness in North Macedonia to estimate its financial burden, promote rising awareness, and stimulate policy action.