Psychosocial aspects of obesity in adults with psoriasis: A systematic review

Abstract

Background: Excess weight is a common (30%-40%) multifactorial concern that remains understudied in adults with psoriasis. Objectives: This systematic review aimed to synthesise the evidence on the psychosocial factors associated with body weight in psoriasis and to use these findings to inform clinical practice. The review was registered with PROSPERO (registration number: CRD42020201138). Methods: Electronic databases, related reviews and associated reference lists were searched. Observational and experimental studies reporting on the relationship of psychosocial factors to weight-related outcomes in adults with body mass index (BMI) of ≥30 kg/m 2 and psoriasis were eligible. The methodological quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP). Results: Eighteen studies were included in the review, the majority of which (n = 16) examined cross-sectional associations between psychosocial factors and weight outcomes. Although the strengths of the associations were heterogeneous, most studies confirmed the positive association between high BMI and increased reports of depression and anxiety, impaired quality of life, deteriorated sleep quality, sexual dysfunction, and daily functioning issues. Only four studies were rated as high quality. Conclusions: The current evidence of the association between psychosocial factors and weight-related outcomes is largely cross-sectional with unclear directionality of causality. Longitudinal studies are needed to examine the replicability and generalisability of the examined obesity-related psychosocial factors in psoriasis. Theoretical exploration of subgroup differences and similarities may pave the way towards intervention personalisation, and ultimately, improved patient outcomes. K E Y W O R D S psoriasis, psychodermatology, quality of life | INTRODUCTIONPsoriasis and obesity are major public health issues, both on the rise. 1,2 Psoriasis is a debilitating inflammatory systemic disease, affecting an estimated 29.5 million adults worldwide and about 1 million in the UK population. 2 A third of people living with psoriasis are obese, defined as a body mass index (BMI) ofThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The importance of illness severity and multimorbidity in the association between mental health and body weight in psoriasis: Cross‐sectional and longitudinal analysis

“…15 Incorporating a more accurate indicator of body fat such as waist circumference, alongside BMI, may allow for more precise monitoring of the association between obesity and comorbid medical and mental health conditions, including anxiety and depression. 6,7 Common psoriasis-and obesity-associated comorbidities such as cardiometabolic, kidney and gastrointestinal diseases are also overlooked in the association between mental health and obesity in psoriasis. 16,17 These co-morbid conditions may increase the psychological burden on patients' lives.…”

“…This would allow for a more tailored and effective approach to weight reduction that addresses the multifaceted needs of people living with psoriasis, ultimately resulting in better patient outcomes. 7 This study used data collected as part of routine specialist care to gain a more robust understanding of the role of depression and anxiety in psoriasis patients' weight-related outcomes (including waist circumference and BMI), considering the limitations of earlier studies. First, the relationship between illness-related factors and body weight outcomes in psoriasis were assessed to determine if they may be potential confounds in the relationship between depression or anxiety and weightrelated outcomes.…”

“…One‐third of people living with psoriasis have comorbid obesity, 2 defined as a body mass index (BMI) of ≥30 kg/m 3 . Psoriasis and obesity frequently co‐occur with depression and anxiety in a bi‐directional fashion, where obesity may drive mental health issues and vice versa 4‐8 . This co‐occurrence may be due to the physical and emotional toll that psoriasis and comorbid obesity have on patients' lives 9,10 .…”

Psychodermatology special edition

“… 4 Since the journal was launched, I noticed that we had had quite a few manuscripts submitted that would definitely fit under the category of predominantly Psychodermatology or Dermatology manuscripts with a psychological overlay. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 The editorial team of SHD will launch a themed issue later in the year on the subject of Psychodermatology. I am extremely grateful to Prof Tony Bewley and Dr Susannah Baron (London) and Prof John Koo and Dr Marwa Hakimi (San Francisco) for agreeing to be guest editors.…”

“…It includes equally Psychiatric diseases that present with skin symptoms and signs (such as delusional infestation) or more commonly, the psychiatric or psychological problems associated with dermatological illness, such as depression associated with psoriasis 4 . Since the journal was launched, I noticed that we had had quite a few manuscripts submitted that would definitely fit under the category of predominantly Psychodermatology or Dermatology manuscripts with a psychological overlay 4‐11 . The editorial team of SHD will launch a themed issue later in the year on the subject of Psychodermatology.…”