The increasing prevalence of diabetes and obesity have led to the co-occurrence being labelled as “twin epidemics.” Given the high rates of comorbid diabetes and obesity, as well as the health benefits associated with lower weight among patients with type 2 diabetes, this research examines the burden of obesity associated with comorbid T2D. This U.S. administrative claims database study uses IBM® MarketScan® Explorys Claims Electronic Medical Records data from January 1, 2012 through April 30, 2019 to identify adults with T2D, two recorded body mass index (BMI) values in the same weight category, and continuous insurance coverage from 1 year prior through 1 year post index date. Patients with index 18.5 kg/m2 ≤ BMI < 30 kg/m2 (normal/overweight) were matched to patients with index BMI ≥ 30 kg/m2 (obese) using propensity score matching (PSM). Using the PSM cohort, multivariable analyses examined the association between obesity and patient comorbidities, resource utilization, and healthcare costs. In the 1:1 matched cohort (16,006 normal/overweight; 16,006 obese), multivariable analyses showed that obesity, compared to normal/overweight, was associated with increased odds of a diabetes-related comorbidity (Odds Ratio [OR] = 1.21; 95% Confidence Interval [CI] 1.14 – 1.28) and an obesity-related comorbidity (OR=1.42; 95% CI 1.29 – 1.56). Obesity was associated with increased odds of the specific obesity or diabetes-related comorbidities of hypertension, hyperlipidemia, cardiovascular disease, nephropathy, neuropathy, peripheral vascular disease, and metabolic disease (all P<0.05). Obesity was also associated with increased resource utilization as well as significantly higher annual diabetes-related ($8,987 v $8,057; P<0.0001) and all-cause total costs ($26,624 v $24,838; P<0.0001). Results increase the knowledge of how patients with T2D and obesity should be of greater concern for healthcare providers compared to T2D patients without comorbid obesity, given their worse comorbidity profile, increased resource utilization, and higher healthcare costs.