Obesity has emerged as a significant risk factor for psoriasis and has been associated with more severe disease. Psoriatic arthritis (PsA) affects from 6% to 42% of patients with psoriasis. While PsA is associated with an increased frequency of cardiovascular disease, it has been unclear what the relationship is between obesity and PsA. In this cohort study, Soltani-Arabshahi et al demonstrate that patients with psoriasis who were obese at age 18 years were 3 times more likely to develop PsA during the course of their disease. Psoriatic arthritis may predispose patients to obesity by reducing physical activity. Alternatively, obesity may precede PsA and may act as a predisposing factor for this condition.