Does Obesity Cause Pilonidal Disease?

If you search online for information about pilonidal disease, nearly every website lists obesity as a major cause. Many patients come to us feeling blamed for their condition because of their weight.

At our clinic, we do not feel that obesity is a major predisposing factor for pilonidal disease.
We routinely see thin and athletic patients with severe pilonidal problems as well as obese patients. In our experience, the anatomy of the gluteal cleft is far more important than the number on the scale.

Where weight does matter is in surgical planning. Patients with a higher BMI often have a deeper cleft and different tissue anatomy. Because of this, we slightly modify the cleft lift procedure in obese patients in order to flatten the cleft adequately and achieve reliable healing. With these modifications, our recurrence rate in obese patients has not been different from our overall results.

However, there are limits. We currently do not perform cleft lift procedures on patients over approximately 350 pounds. Depending on height, this often corresponds to a BMI in the upper 40s to low 50s. At that point, the anatomy and surgical risks become substantially more difficult, and weight reduction may improve both safety and long-term success.

We feel it is important for patients to understand that pilonidal disease is usually not simply a consequence of being overweight. More often, it is a mechanical and anatomical problem — and successful treatment depends on properly addressing that anatomy.