{"doi":"10.1111/bjd.18595","title":"The need for strategies to address obesity and psoriatic arthritis prevention in psoriasis","abstract":"Linked Article: Green et al. Br J Dermatol 2020; 182:714–720. A handful of studies have now identified obesity as a risk factor for development of psoriatic arthritis (PsA).1 However, establishing a causative role of any particular risk factor is challenging. While randomized controlled trials are the gold standard for establishing causation, observational studies are often the first step in supporting causation by demonstrating a temporal association and a dose effect, reflecting that a change in the level of the exposure leads to a difference in outcome.2 In this issue of the BJD, Green et al. found that, among obese or overweight individuals with psoriasis, reductions in body mass index were associated with a reduced risk for PsA. In demonstrating that changing the level of the risk factor (i.e. body mass index) changes the outcome, this study provides further supporting obesity as a causal risk factor for PsA.3 Now comes the hard work: putting this knowledge into action. This new evidence supports two important future needs: (i) the need for mechanisms to help our patients to lose weight and (ii) the need for PsA prevention trials in psoriasis. Obesity is a common problem in psoriasis and PsA.4-6 Patients with PsA and/or psoriasis are more obese than the general population across multiple cohorts. Obesity has not only been demonstrated to be a risk factor for both psoriasis and PsA, but it is also associated with having more severe disease, diminished response to therapy and increased adverse outcomes with methotrexate.5, 7 Furthermore, obesity is associated with diabetes, hyperlipidaemia, hypertension, metabolic syndrome, nonalcoholic fatty liver disease and increased risk for cardiovascular events.4-6, 8-10 Clearly, there is ample evidence to demonstrate that obesity is bad. Increasingly, there is also a body of evidence supporting weight loss as an effective treatment for patients with psoriasis, as reviewed recently by Mahil et al.11, 12 And, for further fodder, we now also know from Green et al. that weight loss is associated with a lower risk for PsA. So, we have the evidence to tell our patients why they should lose weight but we still lack the tools to help them actually achieve and maintain weight loss. Dermatologists and rheumatologists are generally not trained in supporting weight loss. Even primary care physicians struggle with helping patients through weight loss. While referral to a nutritionist is an option, accessibility and insurance/healthcare coverage remain an important problem across multiple health systems. Alternatively, patients can be referred to an existing programme like Weight Watchers, or a similar online program or mobile app can be helpful (there are now many that can help track calories such as MyFitnessPal and Lose It!). However, most often, if the importance of weight loss is discussed, the patient is left to figure out how to accomplish this goal on their own. This is an opportunity lost and one that can be harnessed through development of resources specific to psoriatic disease. If we simply tell a patient why they need to lose weight without giving them the tools, most people will not act. Present bias, a concept addressed by behavioural economics, explains that people are primarily concerned with short-term rewards.13 Rewards in the future are ‘discounted’ and mean less to the individual than a short-term win. In fact, sometimes the short-term ‘win’ is sitting on the couch to watch another show and waiting for tomorrow to start the diet or physical activity programme. In other words, educating the patient about the long-term benefits of weight loss (i.e. decreasing the risk for PsA or cardiovascular outcomes) is only so helpful, because the rewards are so far off in the future that they are heavily discounted. Present bias can be overcome through a variety of interventions including short-term incentives, commitment contracts and other methods that provide support for starting now and","journal":"British Journal of Dermatology","year":2020,"id":110924,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9484,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":408498,"name":"Lihi Eder","orcid":"0000-0002-1473-1715","position":1,"is_corresponding":false},{"id":270384,"name":"Alexis Ogdie","orcid":"0000-0002-4639-0775","position":0,"is_corresponding":true}],"reference_count":14,"raw_metadata":null,"created_at":"2026-07-18T23:13:01.914939Z","pmid":"32107778","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}