Lifestyle interventions targeting adiposity in adults with psoriasis: a systematic review and network meta-analysis.

OBJECTIVE: Excess adiposity drives inflammation and impairs treatment response in psoriasis. We compared the effectiveness of dietary energy restriction, aerobic exercise, and combined diet-exercise interventions in adults with psoriasis and overweight or obesity. METHODS: We searched four English- and four Chinese-language databases from inception to 15 January 2026 for randomized controlled trials of low-energy diet (LED), aerobic exercise (AE), diet plus aerobic exercise (D+AE), or usual care (UC). Primary outcomes were body mass index (BMI), body weight, and waist circumference; secondary outcomes included Psoriasis Area and Severity Index (PASI). A Bayesian random-effects network meta-analysis was performed with UC as the reference; certainty of evidence was assessed with Confidence in Network Meta-Analysis (CINeMA). RESULTS: Nine trials (1,066 participants) were included. Versus UC, LED produced the most consistent reductions in BMI (mean difference -2.89 kg/m2; 95% credible interval -4.78 to -0.73) and body weight (-7.97 kg; -13.07 to -0.81). The AE estimate was informed by only one trial and was highly uncertain. D+AE yielded the most favorable numerical PASI estimate (-2.48; -6.26 to 1.46), although the credible interval crossed the null. Certainty of evidence was low across outcomes. CONCLUSION: Low-energy diet showed the most consistent short-term reductions in BMI and body weight, whereas effects on waist circumference and PASI remained uncertain. Given the sparse network and low certainty of evidence, comparisons between lifestyle strategies should be regarded as hypothesis-generating rather than confirmatory. SYSTEMATIC REVIEW REGISTRATION: www.crd.york.ac.uk/prospero, CRD420261291403.