Sarcopenic obesity in older adults: a clinical overview

Sarcopenic obesity is characterized by a concurrent decline in muscle mass and function, along with increased adipose tissue. Sarcopenic obesity is a growing concern in older adults owing to significant health consequences, including implications for mortality, comorbidities and risk of developing geriatric syndromes. A 2022 consensus statement established a new definition and diagnostic criteria for sarcopenic obesity. The pathophysiology of this condition involves a complex interplay between muscle, adipose tissue, hormonal changes, inflammation, oxidative stress and lifestyle factors, among others. Sarcopenic obesity is treated with a range of management approaches, such as lifestyle interventions, exercise, nutrition and medical therapies. Emerging therapies that were developed for treating other conditions may be relevant to sarcopenic obesity, including novel pharmacological agents and personalized approaches such as precision medicine. In this Review, we synthesize the current knowledge of the clinical importance of sarcopenic obesity, its assessment and diagnosis, along with current and emerging management strategies. Sarcopenic obesity is a growing clinical problem because of ageing populations and the increasing prevalence of obesity. This Review highlights the new consensus definition and diagnostic criteria for sarcopenic obesity, and provides an overview of the pathogenesis, clinical outcomes, and management of this syndrome. Sarcopenic obesity involves an ageing-associated increase in adiposity and reduction in muscle mass and function, poses a major health risk to older adults, and presents diagnostic and management challenges in clinical settings.The multifaceted pathophysiology of sarcopenic obesity requires a comprehensive understanding of hormonal shifts, inflammation, muscle and adipose tissue changes, and lifestyle factors for effective patient care.Recently proposed consensus criteria developed by international experts are enhancing the clinical diagnosis and assessment of sarcopenic obesity and aid in achieving more precise and consistent patient evaluations.Management strategies vary from lifestyle modifications, including exercise and targeted nutritional plans, to emerging drug therapies, broadening the treatment options for sarcopenic obesity.As sarcopenic obesity research progresses, the need for clinician involvement in collaborative research efforts and the implementation of new findings into clinical practice is paramount.The increasing use of digital technology in delivering diet and exercise interventions offers a promising avenue for modernized, patient-centred care, countering outdated perceptions about engagement with e-health by older adults.