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  • Review Article
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Sarcopenic obesity in older adults: a clinical overview

Nature Reviews Endocrinology volume 20, pages 261–277 (2024)Cite this article

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Abstract

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.

Key points

  • 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.

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Fig. 1: Clinical consequences of sarcopenic obesity.
Fig. 2: Risk of various clinical consequences of sarcopenic obesity.
Fig. 3: Factors contributing to the development of sarcopenic obesity.
Fig. 4: Factors that contribute to weight gain and resulting changes in body composition, including sarcopenic obesity.
Fig. 5: Proposed algorithm for screening and diagnosis of sarcopenic obesity.
Fig. 6: Current, emerging and potential management strategies for sarcopenic obesity.

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Acknowledgements

J.A.B. acknowledges the support of grant R01-AG077163 from the National Institute on Aging of the National Institutes of Health. The authors thank F. Teixeira Vieira and M. Montes-Ibarra of the University of Alberta for their substantial contributions in conceptualizing and developing Fig. 6. The authors thank their librarian, J. Thorlakson of the University of Alberta for her invaluable assistance with the literature search. L.M.D. acknowledges the support of grant PE00000003 (decree 1550, 11.10.2022) (“ON Foods – Research and innovation network on food and nutrition Sustainability, Safety and Security – Working ON Foods”) from the Italian Ministry of University and Research (CUP D93C22000890001) under the National Recovery and Resilience Plan (NRRP), funded by the European Union – NextGenerationEU.

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Authors and Affiliations

  1. Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada

    Carla M. Prado

  2. Division of Geriatric Medicine, School of Medicine, and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    John A. Batsis

  3. Department of Experimental Medicine, Sapienza University, Rome, Italy

    Lorenzo M. Donini

  4. Postgraduate Program in Nutrition and Food, Pelotas, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil

    M. Cristina Gonzalez

  5. Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA

    M. Cristina Gonzalez

  6. School of Population Health, Curtin University, Perth, Western Australia, Australia

    Mario Siervo

  7. Curtin Dementia Centre of Excellence, enAble Institute, Curtin University, Perth, Western Australia, Australia

    Mario Siervo

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  1. Carla M. Prado
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  4. M. Cristina Gonzalez
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Contributions

All authors researched data for the article, contributed substantially to discussion of the content, wrote the article, and reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Carla M. Prado.

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Competing interests

C.M.P. has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science, Fresenius Kabi and Pfizer; and investigator-initiated funding from Almased Wellness GmbH for research and/or work not directly related to this Review. C.M.P. has current trainees supported through MITACS scholarship/fellowships in collaboration with industry partner My Viva Plan. J.A.B. has equity in a remote monitoring startup, SynchroHealth LLC, with associated patents related to this technology. M.C.G. has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia and Nestlé Health Science Brazil. M.S. has received honoraria and/or paid consultancy from Life2good. L.M.D. declares no competing interest.

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Nature Reviews Endocrinology thanks M. El Ghoch, C. Haywood and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Prado, C.M., Batsis, J.A., Donini, L.M. et al. Sarcopenic obesity in older adults: a clinical overview. Nat Rev Endocrinol 20, 261–277 (2024). https://doi.org/10.1038/s41574-023-00943-z

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