Excess weight puts more pressure on your joints, which can lead to injury and inflammation. What’s more, excess weight can interfere with medications that treat psoriatic arthritis, so they don’t work as well. A review published in May 2018 in the journal PLoS ONE found that obesity was linked to a 60 percent greater chance that a class of biologic drugs commonly used to treat psoriatic arthritis, called tumor necrosis factor (TNF) inhibitors, wouldn’t work. The link between obesity and psoriatic arthritis is “very complex and not adequately understood,” says John Davis, III, MD, a clinical rheumatologist who specializes in psoriatic arthritis at Mayo Clinic in Rochester, Minnesota. “We believe that [obesity] drives inflammation, providing the link to the joint disease.” Psoriatic arthritis is also linked to other health conditions, such as heart disease, diabetes, and metabolic syndrome. For all of these, “Losing weight and maintaining weight in a healthy range is important,” says Melissa Ann Prest, DCN, RDN, a spokesperson for the Academy of Nutrition and Dietetics. The good news: Weight loss has been linked to an improvement in psoriatic arthritis symptoms, including painful, swollen joints and fatigue. “It’s probably reducing the inflammatory burden,” says Dr. Davis. American College of Rheumatology and National Psoriasis Foundation (NPF) guidelines, published in November 2018 in the journal Arthritis & Rheumatology, recommend weight loss for all obese people who have psoriatic arthritis to help improve their response to medication. Losing weight helps psoriatic arthritis symptoms in other ways, as well, explains Rajat Bhatt, MD, a rheumatologist with Memorial Hermann Health System in Texas. It decreases inflammation and stress on the joints and lowers uric acid levels linked to gout — another joint condition common in people who have psoriatic arthritis. And weight loss doesn’t have to be major. Research has found that overweight and obese people with psoriatic arthritis who lost just 5 percent of their body weight were more likely to have minimal disease activity. Although psoriatic arthritis symptoms such as fatigue and stiff, achy joints can make it more challenging to move, it’s possible to drop extra pounds with the right strategies and support. Here are a some tips to help you lose weight and improve your symptoms.
1. Cut back on added sugar, red meat, and full-fat dairy
Davis’s number one tip for weight loss in people who have psoriatic arthritis is to eliminate added sugars. They provide extra calories that don’t benefit your body and can increase chronic inflammation, upping your risk of related conditions, such as obesity and diabetes. Another reason to cut back on sugar: A review published in April 2020 in the journal Rheumatology and Therapy found that people who have psoriatic arthritis are significantly more likely to have type 2 diabetes than the population at large, possibly because inflammation of the skin and joints may affect glucose metabolism. Davis recommends limiting simple sugars and carbohydrates in your diet. “Sugar hides in processed foods, cereal, yogurts, and juices,” he says. The NPF also recommends cutting out the following:
Refined grains, such as white breadHighly processed foods, such as bacon and sausageFatty cuts of meat — especially red meatFried foodsSome full-fat dairy products, such as ice cream
“Foods from these sources are typically going to be higher in calories and trans fat, which can contribute to weight gain and inflammation,” says Dr. Prest. Because cutting out these foods helps reduce inflammation, which worsens psoriatic arthritis, it may also help reduce psoriatic arthritis symptoms, explains Dr. Bhatt.
2. Fill up on anti-inflammatory foods, including veggies, fruits, and fish
Research suggests that eating lots of fruits and vegetables can help you lose weight by keeping you full and satisfied on fewer calories, according to the Centers for Disease Control and Prevention (CDC). “People should definitely eat more fruits and veggies,” adds Davis. A plant-based diet can also help decrease inflammation levels, which may reduce psoriatic arthritis symptoms, adds Bhatt. He specifically recommends the Mediterranean diet, which is rich in anti-inflammatory omega-3 fatty acids. Dietary guidelines from the medical board of the NPF published in August 2018 in JAMA Dermatology, also recommend a Mediterranean diet, consisting of at least:
2 servings of vegetables a day3 servings of fruit a day3 servings of legumes per week3 servings of nuts per week3 servings of fish or seafood per week
“Make vegetables the star of your meal by filling half of your plate with non-starchy vegetables, and go with a serving of fruit or a serving of a vegetable for snacks,” says Prest.
3. Drink more water
It’s easy to confuse thirst for hunger, according to the NPF. So be sure to drink enough water to help with your weight loss efforts. About eight 8-ounce glasses per day is a good goal, according to the Mayo Clinic. You’ll know you’re hydrated if your urine is clear to light yellow.
4. Go for a swim or do another low-impact exercise
Physical activity helps reduce inflammation and pain. Weight loss guidelines from the CDC recommend at least 150 minutes of moderate physical activity per week. “Exercise is great for your overall health and to break through those weight loss plateaus,” says Prest. Staying physically active is especially important for people who have psoriatic arthritis, as metabolic syndrome has been linked to psoriatic arthritis disease activity and medication effectiveness, says Bhatt. Exercise can help you tackle metabolic syndrome by reducing inflammation and improving muscular metabolism. And that’s not all. “Exercise can increase range of motion in the joints and maintain joint flexibility and muscle strength,” says Bhatt. Physical activity also increases pain tolerance, helping psoriatic arthritis symptoms feel less debilitating, and decreases uric acid, which reduces joint pain in people who also have gout, he adds. If you’re experiencing a lot of joint pain in your lower extremities, Bhatt recommends swimming a few laps. “Swimming is a good low-impact activity for those who have access to a pool and enjoy it,” says Davis.
5. Use a fitness tracker
Walking is a great exercise for people with psoriatic arthritis to lose weight, says Davis. “Maintaining daily activity and step counts [helps] to increase metabolism,” he says. When combined with dietary changes, walking supports weight loss, according to the Mayo Clinic, and is especially important for weight loss maintenance. A study published in December 2018 in the journal BioMed Research International suggests that weight-bearing aerobic exercises, such as walking, may help reduce the risk of bone loss. That’s important, as another study, published in July 2020 in Annals of the Rheumatic Diseases, suggests that psoriatic arthritis treatments may increase the risk of osteoporosis. If you need extra motivation, use a fitness tracker to track your steps. Set small, manageable goals that slightly challenge you. And listen to your body: It’s natural to feel a bit sore or tired the next day, but take it easy if you feel pain. Once your routine is no longer challenging, consider increasing the intensity. “The body always has to be challenged. Choose something you like, so you can stick to a long-term plan,” says Bhatt.
6. Lift weights
Resistance training, which includes weight lifting and body weight exercises, such as squats, can help with both weight loss and overall fitness. One small study published in February 2018 in the journal Clinical Rheumatology found that people with psoriatic arthritis who did resistance training twice a week for 12 weeks reduced their disease activity and pain and improved their quality of life. What’s more, building muscle helps with weight loss. That’s because muscle burns more calories than fat does, even at rest, according to the Mayo Clinic. Lifting weights may be even more important when you’re cutting back on calories, because your body sheds some muscle mass along with fat when you lose weight. The CDC’s weight loss guidelines recommend incorporating strength-training activities that use all the major muscle groups two days a week. If joint pain makes this kind of exercise challenging, ask your doctor for tips on how to get started safely.
7. Keep a food journal
The dietary guidelines from the NPF recommend a reduced-calorie diet for people with psoriatic arthritis who are obese. Talk to your doctor to determine the right goal for you. Tracking your calorie intake can be especially helpful. “Studies show that just keeping a simple food journal reduces intake, because it makes you more aware of what you’re eating and helps you figure out a better choice,” says Prest. A study published in February 2019 in the journal Obesity followed 142 people on their weight loss journey for 24 weeks and found that those who more often used an online food journal reported more weight loss after six months. “I have used the photo journal technique with many clients, and they have had great success in reaching their weight loss goals,” says Prest. Free apps and online tracking tools also give you a great estimate of your overall diet, but keep in mind they’re not 100 percent accurate, she adds.
8. Prioritize sleep
A lack of sleep is linked to impairments in glucose metabolism and an increased risk of type 2 diabetes, metabolic changes, and inflammation, according to a review published in March 2015 in the journal Diabetology and Metabolic Syndrome. This can affect not only your weight loss efforts but also your overall health, including psoriatic arthritis symptoms. “A good night’s sleep helps with pain sensitization and improves pain tolerance, and therefore, psoriatic arthritis symptoms might be better,” says Bhatt. “When the body rests, it rids itself of toxins, which helps improve inflammation. And good sleep helps with weight loss.” Davis suggests people with psoriatic arthritis aim for at least 7 to 8 hours of sleep each night. A study published in October 2018 in the journal Reumatologia suggests that many people who have psoriatic arthritis have trouble sleeping. A few of Bhatt’s top sleep hygiene tips:
Avoid coffee in the eveningsHave your last meal at least 2 to 3 hours before bedtimeUse your bed for sleep only, not for watching TV or scrolling through InstagramExercise regularly during the day so you’re tired when you go to bed.
9. Work with specialists, such as a dietitian or physical therapist
“If [you’re] struggling, seeing a dietitian is a good idea,” says Davis. A dietitian can help you develop a customized meal plan, which can be especially helpful for people who have psoriatic arthritis. “People with psoriatic arthritis may find that they have other food sensitivity issues that may contribute to problems with weight loss. Working with a registered dietitian nutritionist is a great way to ensure you’re eating the right amount for weight loss,” says Prest. You can search for a registered dietitian nutritionist near you at eatright.org. If you’re struggling with exercise, a physical therapist or personal trainer can develop a fitness routine suited to your needs. Finally, keep at it, because even small changes can be powerful. “We often overemphasize pharmaceutical therapies and underemphasize lifestyle changes,” says Bhatt, “but lifestyle changes are equally important for all arthritis patients.”
