Hidradenitis suppurative is a chronic inflammatory skin condition. It is characterized by recurrent, painful inflammatory nodules and abscess in the intertriginous parts of the body, leading to extensive scarring and disfigurement. The exact pathogenesis of HS is unknown. The primary defect in HS is believed to cause occlusion and subsequent inflammation of the pilosebaceous unit under the influence of genetic, hormonal, immune, smoking, obesity, and mechanical frictional factors. A sizeable body of research demonstrates obesity as one of the most common comorbidities associated with HS. Moreover, obesity is considered to be one of the risk factors for the development of metabolic syndrome and cardiovascular abnormalities, which are commonly associated with HS. Presently, there is a lack of data on there being a direct association between HS and obesity and none data available showing a cause and effect relationship between weight or BMI and the disease severity. Therapeutic studies in HS have shown a decreased efficacy of patients towards various treatment modalities, including biologics. Studies evaluating the efficacy of biologics in autoinflammatory diseases have suggested obesity to have a negative impact on anti-TNF therapy. Unfortunately, at present, there are no studies conducted on HS that can verify this theory, chiefly due to imprecise knowledge linking obesity and HS. Thus, for this paper, the scientific studies surrounding the multifaceted association between HS and obesity have been reviewed, suggesting that obesity might be a severity factor of HS. Therefore, opting a different course of treatment may help in the management of overweight and obese HS.