Psoriasis Skin Clearance, Body Mass Index, and Lifestyle Behaviors

Obesity is common in psoriatic patients and plays a crucial role in disease severity, therapeutic response, and cardiovascular risk [1]. Despite substantial skin clearance with biologic therapy, the body mass index (BMI) often remains unchanged [2]. Understanding patient perspectives on this issue may enhance clinical care and outcomes. Psoriasis is a chronic inflammatory disease associated with increased cardiovascular risk, including myocardial infarction and stroke [3]. This risk is particularly elevated in younger patients with severe disease [3]. Patients with psoriasis also have a higher prevalence of traditional cardiovascular risk factors, including hypertension, diabetes, hyperlipidemia, and obesity [3]. Metabolic syndrome affects around 40% of patients with psoriasis and is a strong predictor of cardiovascular risk and mortality [4]. Chronic inflammation, shared pathways, and overlapping risk factors contribute to this burden [2, 3]. Obesity is highly prevalent in psoriasis, with rates estimated at 30%–40% [5]. It influences disease severity, therapeutic response, and cardiovascular risk [1, 2]. Stringent control of cardiovascular risk factors, including weight reduction through lifestyle modification, is essential. However, studies show that even with marked skin improvement under biologics, BMI does not necessarily improve [2]. While lifestyle modification remains the foundation of weight management, pharmacologic agents such as GLP-1 agonists are emerging as effective adjuncts [1]. This cross-sectional study aimed to explore patient-reported factors influencing lifestyle behaviors during biologic therapy and surveyed biologic-treated patients with psoriasis from a tertiary hospital outpatient clinic between May and November 2022. Eligible patients had been on biologic therapy for at least six months and met Medicare criteria for continuation (Psoriasis Area and Severity Index [PASI] 75 reduction). Of the 96 patients (80% response rate), 57.3% were male, had early-onset psoriasis (< 35 years), and were on their first biologic (Table 1). Before initiating biologic therapy, 31% of patients reported motivation to eat healthily, and 54% were motivated to exercise. Following treatment, these figures increased to 63% and 59%, respectively. Additionally, 73% reported improved mood. Despite these positive changes, barriers to adopting healthy behaviors persisted, with life stress (45.8%), lack of time for exercise (40.5%) and meal preparation (30.2%), low-weight-loss motivation (29.2%), and financial stress (27.1%) being the most frequently cited obstacles (Figure 1). Most participants acknowledged the link between obesity and psoriasis severity (63%) as well as cardiovascular health (91%). However, only 50% believed that obesity could impact biologic response. Access to a multidisciplinary healthcare team was identified as the most helpful factor (44.8%) in supporting healthy lifestyle changes, with additional patient support programs, greater involvement of general practitioners, and increased education on healthy lifestyles also deemed beneficial. These findings highlight the interplay between psoriasis, treatment, motivation, and lifestyle behaviors. Although biologic therapy appears to enhance motivation for healthier habits, significant barriers remain. Prior research suggests obesity may independently predict diminished response to biologic therapy [1, 2]. Additionally, tumor necrosis factor (TNF) inhibitors have been associated with weight gain, though mechanisms remain unclear. It is uncertain whether biologic-induced improvements in quality of life directly translate into sustained lifestyle changes. Addressing obesity in psoriasis is crucial, as weight loss improves disease control, therapeutic response, and cardiometabolic outcomes [1, 2, 5]. Despite this, patient motivation to engage in lifestyle modifications is influenced by psychosocial stressors and the availability of multidisciplinary support. Improved education on the psoriasis–obesity–cardiovascular link may help empower patients to adopt sustainable changes. Study limitations include its cross-sectional design and modest sample size, limiting generalizability. Nonetheless, it provides valuable insights into patient perspectives on lifestyle factors in psoriasis management and may inform future research and clinical strategies. In conclusion, psoriasis affects patient motivation and lifestyle behaviors, potentially contributing to persistently elevated BMI despite skin clearance. Patients advocate for a multidisciplinary approach that supports healthy lifestyle behaviors. Addressing obesity in this cohort remains essential for optimizing disease control, treatment response, and mitigating cardiovascular risk. Lifestyle modification should be considered an integral component of psoriasis management, complementing pharmacologic therapy to enhance long-term outcomes. We acknowledge the invaluable support of Nurse Vivienne Speirs and express our gratitude to the patient cohort for their participation in this study. The study was approved by Western Sydney Local Health District Human Research Ethics Committee; Study Reference Number 2021/ETH11639 and was performed in accordance with the Helsinki Declaration of 1964 and its later amendments. The authors declare no conflicts of interest. S.Z. has received unrestricted research grants to their institution from Abbott and Biotronik as well as consulting fees and speaking honoraria from Novartis, The Limbic, Medtronic, AstraZeneca, the Heart Foundation, and Boehringer Ingelheim that are unrelated to the content of this manuscript. Dr. Annika Smith has received institutional support and/or consulting fees and/or speaking honoraria from UCB, AbbVie, Eli-Lilly, Janssen, Amgen, BMS, Novartis, Sun Pharma, GSK, LEO Pharma, which is unrelated to this manuscript. The datasets generated during and/or analyzed during this study are available from the corresponding author upon reasonable request.