Obesity is increasing in prevalence globally; both the World Health Organization (WHO) and the National Heart, Lung, and Blood Institute (NHLBI) of the United States. National Institutes of Health (NIH) have labeled obesity an epidemic.1,2 More than one-third (36.5%) of adults in the United States are obese and, if obesity trends continue, 22% of people around the world will be overweight or obese by 2045.3 The estimated annual medical cost of obesity in the United States in 2008 was $147 billion and the annual medical costs for people who have obesity were $1,429 higher than those of normal weight.4 The most commonly cited complications of obesity include type 2 diabetes, stroke, heart disease, nonalcoholic fatty liver disease, and several types of cancer, but obesity affects every organ system including the skin. The American Board of Obesity Medicine was established to credential physicians of various specialties in the field of obesity medicine, which is one of the fasting growing subspecialties, with more than 3,000 physicians credentialed currently. Despite the increasing numbers of physicians credentialed, there are not enough physicians trained to address and treat all the medical complications of this complex disease.
An often overlooked complication of obesity is how it affects the skin. Dermatological complications of obesity include venous stasis ulcerations and morphologic changes due to extra weight and pressure, both of which can complicate and extend hospitalizations due to wound care needs and being a nidus for infection. Up to 75% of patients with obesity are reported to have acanthosis nigricans and skin tags due to insulin resistance.5 These are changes mediated by high insulin and igf-1 levels. Young women with obesity and insulin resistance may present to the dermatologist with complaints of hyperandrogenism and acne. It benefits the patient’s psychosocial health greatly to have these conditions treated, but the underlying obesity is often overlooked due to time restraints and lack of medical education in the areas of nutrition and body weight science. Additional skin complications of obesity seen in clinical practice are striae, plantar hyperkeratosis, and intertrigo due to moisture in skin folds.
It is likely beyond the of scope of a dermatologist to treat the disease of obesity unless he or she has a particular interest, but a dermatologist or skin are professional can play a key role in raising awareness among patients and referring for obesity treatment. Having medical technicians assess height, weight, and body mass index at annual visits may alert the physician to trends in a patient’s weight that might be contributing to certain dermatologic complications. Encouraging patients to increase physical activity and follow a reduced calorie diet can be the first step. There are now several obesity and nutrition focused CME courses that dermatologists can attend to gain comfort in addressing these issues with patients.
1 James, WP. “WHO recognition of the global obesity epidemic.” International Journal of
Obesity (Lond) 32, Suppl 7 (2008): S120-6.
2 “Why Obesity is a Problem.” National Heart, Lung, and Blood Institute. February 2013.
3 Hales, Craig M., Margaret D. Carroll, Cheryl D. Fryar, and Cynthia L. Ogden. “Prevalence of
Obesity Among Adults and Youth: United States, 2015-2016.” CDC.
4 “The Healthcare Costs of Obesity.” The State of Obesity. https://stateofobesity.org/healthcare-
5 Hahler, Barbara. “An Overview of Dermatological Conditions Commonly Associated with the
Patient with Obesity.” Ostomy Wound Manage 52, no. 6 (2006): 34-47. https://www.o-
6 American Board of Obesity Medicine. https://www.abom.org.
Rekha Kumar, MD, MS, is an assistant professor of medicine at the Weill Cornell Medical College. She is an attending endocrinologist specializing in the diagnosis and treatment of various endocrinology disorders, including obesity and weight management. Kumar is board-certified in internal medicine, endocrinology, diabetes, and metabolism and is a diplomat of the American Board of Obesity Medicine (ABOM). Kumar currently serves as the medical director of ABOM and was the founding director of the obesity medicine fellowship training program at Weill Cornell. She has authored several papers and textbook chapters on the topic of obesity management and has addressed policy makers on Capitol Hill on the importance of treating obesity as a disease. Kumar has traveled abroad to India, China, and Tanzania in order to teach medicine and learn about the effects of urbanization on diabetes and metabolic health.