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CBO points out that the studies we have on this topic rely on correlations between [body mass index (BMI)] and health conditions and between health conditions and health care spending, which may or may not be driven by a causal relationship. As CBO notes, there is a correlation between higher BMIs and higher health care spending

Otsuka, M., Kato, N., Ichimura, T., Abe, S., Tanaka, Y., Taniguchi, H., Hoshida, Y., Moriyama, M., Wang, Y., Shao, R., Narayan, D., Muroyama, R., Kanai, F., Kawabe, T., Isobe, T., & Omata, M