Background: Obesity is major health hazard in the western world, however studies on skin manifestations in obese patients are limited. Most common co-morbid conditions associated with obesity are hypertension, Type 2 Diabetes Mellitus, dyslipidaemia, degenerative joint diseases etc. Skin conditions such as acrochordons, acanthosis Nigricans can be easily made out on inspection and seen most commonly with obesity. It is important for the clinicians to routinely screen patients for obesity and co-morbid conditions.The aims were to study the prevalence of various skin disorders in obese patients and the frequency of skin changes in various obesity classes and to study the presence of metabolic syndrome and its association with leptin and insulin levels in those patients with acanthosis Nigricans and skin tags.Methods: Cross-sectional descriptive study done on 100 patients with a BMI >30 and waist circumference >90 cm (in males) and >80 cm (in females).Results: Acanthosis Nigricans was the most prevalent skin condition (65%) and the association statistically was significant (p=0.012). Association of Skin tags (second commonest, in 42%) with p=0.012. Acanthosis Nigricans and skin tags among the various skin conditions studied like psoriasis, striae-distensae, fissure-feet, pyoderma, intertrigo, varicose veins, seborrheic dermatitis, Hand-feet eczema, osteoarthritis, candiasis was significantly associated with obesity. Conclusions: Acanthosis Nigricans and skin tags among the various skin conditions studied had a strong correlation with obesity and metabolic syndrome which may be a marker for atherosclerosis and cardiovascular risk. It was also noted that in patients with Acanthosis Nigricans and skin tags, who had metabolic syndrome, there was an elevation of the plasma leptin levels and fasting plasma insulin levels but not significant with a p=0.25.