With the high incidence of psoriasis and psoriatic arthritis among patients who are obese, it’s important for dermatologists to address weight and weight management. But, having that conversation is not always easy.
When broaching the subject, it’s important to take it slowly, and be compassionate, says Razieh Soltani-Arabshahi, M.D., clinical assistant professor of dermatology at Keck Medicine at the University of Southern California.
“This is a sensitive topic, and you don’t want to ruin someone’s internal body image,” she says. “So, clinicians must be kind when they open that door.”
To get the ball rolling, Dr. Soltani-Arabshahi suggests simply asking whether the patient has thought about a strategy to control or reduce their weight. Their answer can lead to further discussion about the weight management tactics they’ve used, and which ones might be a good next step.
Ask about their family history, she adds. If they have a family member with psoriasis or psoriatic arthritis, refer to that person as an example of what the patient could experience if they don’t address any weight concerns. Show them pictures to reinforce the message.
“Photographs of pretty crippling psoriasis or psoriatic arthritis is one of the most effective things I’ve seen in getting through to patients who struggle with obesity,” she says.
And, be prepared to offer exercise suggestions. For patients who are obese, water aerobics and hybrid therapy are good, safe options. If patients are uncomfortable going to a gym, designing an at-home workout can also be effective.
Even with these techniques in place, Dr. Soltani-Arabshahi finds that patients will likely fall into two categories — those willing to listen and those who aren’t interested. Stay patient, and continue to meet their needs as best as possible.
“You want to make sure they’re listening, but you don’t want to push so hard that they don’t come back to you,” she says. “They need to make sure you’ll work with them.”