Sarcopenic obesity in older adults: the dual burden of muscle loss and fat gain. Clinical consequences, diagnostic challenges, and integrated management strategies

Sarcopenic obesity is an emerging geriatric syndrome defined by the simultaneous presence of reduced skeletal muscle mass and function alongside excess adiposity. As populations age and obesity prevalence rises, this condition has grown in clinical importance, carrying risks of frailty, falls, disability, metabolic syndrome, cardiovascular disease, poor quality of life, and premature mortality that exceed those associated with either condition independently. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, clinical consequences, diagnostic challenges, and management of sarcopenic obesity in older adults. Its development involves a complex interplay of age-related muscle atrophy, adipose tissue dysfunction, chronic low-grade inflammation, insulin resistance, hormonal alterations, mitochondrial impairment, and diminished regenerative capacity, mechanisms that collectively reinforce one another in a self-perpetuating cycle. Diagnosis is hampered by the absence of a universally accepted definition; current frameworks differ in their choice of muscle mass indices, strength thresholds, performance measures, and adiposity cut-offs. Recent international consensus statements have proposed stepwise approaches to improve clinical recognition. Management centers on progressive resistance exercise combined with optimized protein intake and multidisciplinary care. Emerging pharmacological options, notably glucagon-like peptide-1 receptor agonists, offer important metabolic benefits but require careful use in older adults because of the risk of lean mass loss. Early detection, standardized diagnostic frameworks, and integrated lifestyle interventions are essential to mitigate the functional and metabolic burden of sarcopenic obesity.