Sarcopenic obesity: how do we treat it?

Abstract

Purpose of review: The increasing prevalence of sarcopenic obesity in older adults has heightened interest in identifying the most effective treatment. This review highlights recent progress in the management, with an emphasis on lifestyle interventions and pharmacologic therapy aimed at reversing sarcopenic obesity.

Recent findings: Whereas weight loss and exercise independently reverse sarcopenic obesity, they act synergistically in combination to improve body composition and physical function, beyond which is observed with either intervention alone. Optimizing protein intake appears to have beneficial effects on net muscle protein accretion in older adults. Myostatin inhibition is associated with favorable changes in body composition in animal studies, although experience in humans is relatively limited. Testosterone and growth hormone offer improvements in body composition, but the benefits must be weighed against potential risks of therapy. GHRH-analog therapy shows promise, but further studies are needed in older adults.

Summary: At present, lifestyle interventions incorporating both diet-induced weight loss and regular exercise appear to be the optimal treatment for sarcopenic obesity. Maintenance of adequate protein intake is also advisable. Ongoing studies will determine whether pharmacologic therapy such as myostatin inhibitors or GHRH analogs have a role in the treatment of sarcopenic obesity.

Figure 1. Changes in body composition after weight loss therapy in a frail obese older adult

Physical performance test (PPT) score 0–36 with higher scores indicating better performance (<32 indicates frailty)

Figure 2. Changes in body composition after combined (exercise plus weight loss) intervention in a frail obese older adult

Physical performance test (PPT) score 0–36 with higher scores indicating better performance (<32 indicates frailty)