Sarcopenic obesity and skeletal development in children: recent advances

Childhood obesity has become one of the most prevalent chronic health conditions and represents a major risk to normal growth and development in pediatric populations. As its global incidence continues to rise, increasing attention has been directed toward sarcopenic obesity (SO) as an important and emerging phenotype. This condition is defined by the coexistence of excessive adiposity and diminished muscle mass, which can negatively influence physical development as well as skeletal health in children. During childhood and adolescence, skeletal growth progresses rapidly and is highly sensitive to metabolic and hormonal influences. In this context, SO may impair bone formation via mechanical loading alterations, endocrine dysregulation, and chronic low-grade inflammation, ultimately contributing to reduced bone mineral content. Moreover, the combined impact of excess fat and insufficient muscle mass during these critical developmental stages may have long-term consequences that extend into adulthood, highlighting the importance of timely prevention and intervention. This narrative review examines the relationship between sarcopenic obesity and bone mass in children. It synthesizes recent evidence on epidemiology, underlying pathophysiological mechanisms, clinical features and evidence, as well as screening and management strategies, and further proposes recommendations focused on lifestyle-based interventions.