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HS and Weight: Is There a Connection With Obesity?

Medically reviewed by Raj Chovatiya, MD, PhD, MSCI
Posted on April 15, 2024

If you’re living with hidradenitis suppurativa (HS), you may have heard that losing weight can improve your symptoms. One myHSteam member commented, “I can’t tell you how many times a doctor or nurse has suggested weight loss as a cure.”

HS — also known as acne inversa — is a skin condition that causes painful lumps to form under your skin. While there’s not yet a cure for HS, you may be wondering if there is a connection between body weight and HS.

What Is Obesity?

The Centers for Disease Control and Prevention (CDC) defines overweight or obesity as “weight that is higher than what is considered healthy for a given height.” Obesity is also a specific measurement on the body mass index (BMI).

Health care providers use your current body weight and height to calculate your BMI score. The BMI doesn’t directly measure body fat, but a higher BMI score is associated with higher body fat. It’s important to note that the BMI, while used by many health care professionals, does not account for physical differences between people of different genders, ethnicities, and ages. It is not always a direct measure of health.

BMI scores indicate a weight status as follows:

  • Underweight — BMI less than 18.5
  • Healthy weight — BMI 18.5 to 24.9
  • Overweight — BMI 25 to 29.9
  • Obese — BMI 30 or higher

More than 40 percent of people in the U.S. have a BMI that is classified as obese.

What Causes Obesity?

Your body weight is influenced by many different factors, including the food you eat, the amount of physical activity you get, your sleep routine, your medical history and your access to health care, your environment, and your genetics.

According to the CDC, having a BMI in the obese range is more common in the U.S. among different groups: It affects around 50 percent of non-Hispanic Black adults, 46 percent of Hispanic adults, and 41 percent of non-Hispanic white adults, compared to around 16 percent of non-Hispanic Asian adults. African American and Hispanic people in the U.S. are more likely to develop HS than white people.

Some aspects of living with HS may affect your body weight. For example, it may be more difficult to get the right amount of physical activity each day if painful lesions (sores) restrict your movement. Additionally, pain caused by HS may make it more difficult to get quality sleep.

How Does Body Weight Affect Your Overall Health?

Research has linked high body weight to an increased risk of several health problems, including:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Liver problems
  • Joint problems
  • Sleep problems
  • Some types of cancer

Increasing rates of obesity in the U.S. are also linked to an increase in people with metabolic syndrome — a cluster of risk factors that increase your risk for heart disease. Metabolic syndrome has also been linked to HS.

In addition to being linked to HS, higher body weight has been linked to other skin diseases, such as psoriasis. People with psoriasis are also at an increased risk of developing HS.

How Does Body Weight Affect HS?

Having a BMI in the obese range is a risk factor for developing HS in both adults and children. It’s estimated that between 1 percent and 4 percent of the population has been diagnosed with HS. One small study on people with obesity found that 18 percent also had HS.

Additionally, people with HS and high body weight may be more likely to have more severe HS symptoms compared to people with lower body weights. Researchers don’t know why HS develops in some people and not others. However, there are several ways that weight may affect HS symptoms.

People with higher body weights may have more skin folds, which can increase friction. HS lumps may be more likely to form in areas with more friction, such as the stomach, thighs, and buttocks.

Having a higher body weight can cause people to sweat more. Sweat, along with the protein keratin, is one of the components that build up in hair follicles. More sweat may cause the hair follicle to burst and become swollen and painful.

People with obesity may have changes in their hormones that lead to increased androgen levels. Higher-than-normal androgen levels are associated with HS. In fact, blocking androgen is a potential HS treatment.

Both having HS and a higher body weight are associated with long-term inflammation, which may affect the immune system. Because HS is an inflammatory disorder, increased inflammation associated with obesity may contribute to the condition.

Can Weight Loss Help HS?

Some people with HS notice their symptoms improve when they lose weight. A 2023 review of 15 studies on the subject concluded the evidence for improving HS with weight loss was “significant but weak” and more research is needed.

A 2014 study found that 35 percent of people with obesity and HS had symptom improvement following weight loss from bariatric surgery (weight loss surgery). However, some people may experience worsening HS symptoms if dramatic weight loss results in excess skin that creates more skin folds.

Diet interventions that promote weight loss may also improve HS symptoms for some people. Avoiding certain foods considered HS triggers may also decrease your HS symptoms. These include:

  • Dairy products
  • Sugary foods
  • White bread
  • Brewer’s yeast
  • High-fat foods

An example of a diet that may benefit people with HS is the Mediterranean diet. This diet emphasizes fresh fruits and vegetables, whole grains, and healthy fats while minimizing sugar and processed carbohydrates. A Mediterranean diet may contribute to weight loss for some people.

It’s important to know that weight loss may not improve HS disease severity for everyone. A myHSteam member shared, “I’ve lost 60 pounds with absolutely no improvement.”

Talk to your dermatologist or primary care provider before starting a new diet or weight loss program.

It’s also important to note that there are many treatment options for HS that are available to you, unrelated to your body size. Be sure to talk to your doctor about treatments that can help you to feel better.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 40,000 members come together to ask questions, give advice, and share their stories with others who understand.

Have you noticed that your weight affects HS? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on April 15, 2024
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    Raj Chovatiya, MD, PhD, MSCI is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Learn more about him here.
    Amanda Jacot, PharmD earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014. Learn more about her here.

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