Sarcopenic obesity: definition, pathophysiology, and intervention strategies

Sarcopenic obesity (SO) is increasingly recognized as a clinically relevant condition associated with functional impairment, cardiometabolic complications, disability and mortality. However, its diagnosis remains challenging because of heterogeneous definitions, uncertain thresholds, and limited accessibility of body composition assessment in routine clinical practice. This review summarizes recent advances and remaining challenges in the characterization and management of SO.

Recent studies have contributed to a better understanding of the epidemiology, clinical consequences and multifactorial pathophysiology of SO, highlighting the importance of muscle quality and the interplay between adipose tissue, skeletal muscle, immune, endocrine and metabolic pathways. Emerging approaches, including pragmatic functional screening tools, innovative phenotype index and artificial intelligence, may improve disease characterization and risk stratification, although further validation is needed. Multicomponent lifestyle interventions combining exercise and nutritional optimization remain the mainstay of management, while incretin-based therapies raise new questions regarding muscle preservation and weight cycling.

SO remains a heterogeneous and incompletely characterized condition. Progress toward clinical implementation will require greater harmonization of diagnostic approaches, validation of emerging tools, and intervention trials assessing muscle-related and patient-centred outcomes.