Given the weight of evidence that obesity impacts patients with skin diseases such as psoriasis, dermatologists need to find a way to help support their patients.

Melbourne dermatologist Dr Josephine Yeatman told the ACD ASM that many clinicians feel uncomfortable raising the topic with their patients.

There was understandable concern about fat shaming but in fact many patients who were obese did want to talk about it and find help.

Dr Yeatman said a first consultation may not be the ideal time to talk about weight loss as it was important to first develop a rapport.

Initial conversations in patients with psoriasis could include obesity amidst other independent lifestyle factors such as stress, smoking and alcohol that contribute to their skin condition or might reduce the efficacy of treatments.

She said there was evidence supporting the fact that weight loss could improve psoriasis.

A recent meta-analysis confirmed the modest weight loss from diet and exercise could lead to small but sustained improvements in the severity of psoriasis.

It found little evidence existed for weight loss pharmacotherapies such as liraglutide in patients with psoriasis.

And while there was evidence that weight loss achieved via bariatric surgery could help prevent psoriasis, there was less convincing evidence for its role in mediating existing disease.

However bariatric surgery had been shown to lead to significant weight loss and a reduction in comorbidities such as diabetes, which was known to amplify the impact of obesity on skin conditions including psoriasis.

“Weight loss surgery is certainly extreme but we are talking people with a BMI of 35-40. So yes, it’s extreme but the problem is extreme. I think the problem we have is that for those people, it’s the only thing there is any evidence for,” she told the limbic.

“We have to deal with extremes and advocate for our patients on the basis of the best available evidence. And patients are queuing up for bariatric surgery. These surgeries are very common.”

“It won’t always work but even if it doesn’t help their psoriasis, it helps them in a lot of other ways. Their diabetes goes away, their NAFLD, their arthritis goes away. So you’re still going to win, even if you lose.”