Obesity Screening, Cardiometabolic Care Key to Managing Moderate-to-Severe Psoriasis

Obesity may influence biologic treatment response in patients with psoriasis (PsO), supporting routine weight assessment and coordinated management of cardiometabolic risk alongside skin disease, according to Alexa Hetzel, DMSc, PA-C, at the Masterclasses in Dermatology NP/PA Institute.

Her presentation, “Beyond the Skin: Addressing Obesity &Cardiometabolic Risk in Psoriasis Management,” highlighted shared inflammatory pathways between obesity and psoriasis and noted that obesity can measurably reduce biologic response, including lower PASI 75, PASI 90, and PASI 100 responses and shorter drug survival.

“Screen every patient with moderate-to-severe PsO for obesity: BMI plus waist circumference, at every visit,” she advised.

Clinical assessment should extend beyond weight and skin involvement. Screening considerations include psoriatic arthritis symptoms, such as joint pain, morning stiffness, swelling, dactylitis, heel pain, and inflammatory back pain, with tools such as PEST considered when appropriate.

Cardiometabolic evaluation should include blood pressure, BMI and weight trajectory, lipid profile, and glycemic control, with appropriate primary care follow-up. Mental health assessment should address depression and anxiety, as well as the effects of psoriasis on relationships, employment, sleep, and quality of life.

Lifestyle discussions should address nutrition, physical activity, smoking, and alcohol use without requiring weight loss before appropriate psoriasis treatment. Preventive care considerations include age-appropriate cancer screening, vaccination status, and infectious disease screening relevant to systemic therapy.

Treatment selection should consider the ability of systemic or biologic therapy to achieve meaningful skin clearance while accounting for joint symptoms, obesity, comorbidities, patient preferences, and overall health.

Weight-directed interventions, including GLP-1 therapies, tirzepatide, and bariatric surgery, were identified as emerging adjuncts to biologic treatment, with combination approaches potentially improving skin, joint, and metabolic outcomes.

“PsO carries independent cardiometabolic risk beyond traditional factors,” Hetzel emphasized, recommending coordinated, multidisciplinary management for patients with psoriasis and obesity.

Reference
Hetzel A. Gastrointestinal disease and the skin. Presented at: Masterclasses in Dermatology NP/PA Institute; October 17–18, 2026; Dallas, TX.