Sarcopenic obesity: pathogenesis, epidemiology and management in older adults

Sarcopenic obesity is the confluence of low skeletal muscle mass and function with excess adiposity. Sarcopenic obesity is becoming increasingly prevalent among older adults and may contribute to greater risk of functional decline, falls, fractures and mortality than sarcopenia or obesity alone. This narrative expert review, based on targeted literature searches and the authors' personal libraries, outlines the current understanding of sarcopenic obesity, including its multifactorial pathophysiology. We also describe the current operational definition and estimated prevalence in older populations, and its impact on musculoskeletal and cardiometabolic health. Evidence from interventional studies exploring the use of targeted multimodal lifestyle behavior interventions, with a focus on the primary role of exercise and caloric restriction, to address sarcopenic obesity and its consequences is presented. Finally, we discuss recommendations for clinical practice and future research aimed at optimizing body composition and physical function in older adults. Despite a lack of consistent evidence on its prevalence, it is clear that sarcopenic obesity conveys serious health consequences. Further research is required to determine the optimal approaches to its diagnosis and management, but this should not act as a barrier to assessment and intervention in clinical settings.