In their cross-sectional study of 1147 community-dwelling women aged 60 years and older evaluated in a geriatric outpatient clinic, Önür and colleagues reported that only sarcopenic obesity (SO)—not sarcopenia alone or obesity alone—was independently associated with urinary incontinence (UI) after adjustment for key clinical covariates 1, 2. The association size (OR 1.82, 95% CI 1.16–2.85) is clinically meaningful, and it aligns with what many clinicians recognize at the bedside: the patient who is both “deconditioned” and “adipose” often struggles more with continence than would be predicted by BMI alone. The first practical implication is that a BMI-centered approach may misclassify risk in older women. In this study, SO was defined using a two-step method—low grip strength followed by bioimpedance-based body composition using population-specific thresholds—thereby incorporating muscle function rather than relying on weight metrics alone 1, 3. In routine geriatric practice, grip strength is quick, inexpensive, and already used for frailty screening. What this paper adds is a strong rationale to pair grip strength with an adiposity measure when UI is present (or when we are trying to prevent it): if the patient meets an SO phenotype, counseling should not default to “weight loss” or “Kegels” in isolation. A combined plan that targets fat reduction while preserving or rebuilding strength—progressive resistance training focused on lower extremity and core, adequate protein intake, and pelvic floor muscle training—better matches the phenotype described by the authors and the day-to-day drivers of leakage in older adults 4. Second, the paper highlights how often UI travels with bowel dysfunction and functional vulnerability. Constipation and fecal incontinence showed strong independent associations with UI in the fully adjusted model, and higher instrumental activities of daily living (IADL) scores were protective 1. Clinically, this argues for a brief “continence triad” checklist in geriatric visits: urine leakage, bowel habits (especially constipation), and function (IADL or a comparable measure). When constipation is present, optimizing bowel management may be a high-yield first step that reduces pelvic floor strain and urgency episodes and improves tolerance of pelvic floor training. Likewise, identifying IADL impairment helps triage whether the dominant problem is stress/urgency physiology versus mobility and toileting barriers—an important distinction when time and follow-up capacity are limited. Two small additions could further increase bedside usefulness without expanding scope: reporting predicted probabilities of UI across common combinations (e.g., SO with constipation) and presenting phenotype associations stratified by stress, urgency, and mixed UI, given that the study already captured subtype by interview 1. These clinically oriented summaries would help clinicians translate a statistically significant phenotype into a succinct, actionable message during routine care. Ruijuan Chen and Binglin Li conceptualized the correspondence. Ruijuan Chen drafted the initial manuscript. Ling Lei contributed to the literature review and clinical interpretation. Binglin Li critically revised the manuscript for important intellectual content and served as the corresponding author. All authors approved the final version. The authors have nothing to report. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. This publication is linked to a reply article by Önür et al. To view this article, visit https://doi.org/10.1111/jgs.70501. This Letter to the Editor does not include any new, unpublished patient-level data. All data discussed are derived from previously published articles cited in the manuscript and are available from those original publications and their respective publishers.
Chen et al. (Tue,) studied this question.