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The relationship between obesity and rosacea is poorly understood.To conduct the first cohort study to determine the association between obesity and risk for incident rosacea.A total of 89,886 participants were included from the Nurses’ Health Study II (1991-2005). Information on history of clinician-diagnosed rosacea and year of diagnosis was collected in 2005. Information on obesity was collected biennially during follow-up.Over 14 years of follow-up, we identified 5249 incident cases of rosacea. The risk for rosacea was elevated for those with increased body mass index (BMI, Ptrend < .0001). Compared with a BMI of 21.0-22.9 kg/m2, the hazard ratio of rosacea was 1.48 (95% confidence interval 1.33-1.64) for BMI ≥ 35.0. There was a trend toward an increased risk for rosacea among participants who had gained weight after age 18 years (Ptrend < .0001), with a hazard ratio of 1.04 (95% confidence interval 1.03-1.05) per 10-lb weight gain. We also observed significantly increased risk for rosacea associated with higher waist circumference and hip circumference (Ptrend < .0001), and the associations appeared to be independent of BMI.This epidemiologic study did not explore underlying mechanisms of the association.Measures of obesity were significantly associated with an increased risk for incident rosacea.