Illustration depicting the contrast between healthy muscle and excessive fat in sarcopenic obesity.

Sarcopenic Obesity: Unmasking the Silent Threat to Your Health

Kai Mendoza in Health & Wellness November 2025 • 4 min read.

"Discover how the dangerous combination of muscle loss and excess fat impacts your long-term well-being and what you can do about it."

The prevalence of obesity has increased alarmingly in older adults in recent years, with studies indicating that nearly 30% of men and women aged 60 and over in the United States are affected. This increase is mirrored in Europe, highlighting a global trend that demands attention.

As we age, our bodies naturally undergo changes, including a progressive increase in fat mass, which typically peaks around age 65 for men and later for women. This is often coupled with shifts in body fat distribution, characterized by an increase in visceral abdominal fat and a decrease in subcutaneous abdominal fat. What's more concerning is the development of ectopic fat deposition, where fat accumulates within non-adipose tissues such as skeletal muscle, cardiac muscle, liver, and pancreas. This phenomenon can occur even without significant changes in overall body mass index (BMI) or body weight.

Concurrently, age-associated muscle mass and strength loss occur even in individuals who maintain a stable weight. This juxtaposition of increased fat and decreased muscle leads to a condition known as sarcopenic obesity (SO), which presents unique health challenges.

What is Sarcopenic Obesity?

Illustration depicting the contrast between healthy muscle and excessive fat in sarcopenic obesity.

Sarcopenic obesity (SO) was first defined in 2000 by Baumgartner and colleagues as the coexistence of low muscle mass and high body fat mass. Since then, numerous definitions have been proposed, each attempting to capture the nuances of this complex condition. The initial definition may underestimate sarcopenia in overweight and obese individuals, potentially leading to underdiagnosis.

Several limitations exist across the proposed definitions. Many definitions fail to account for the quality of muscle, particularly fat infiltration and fibrosis. Studies have documented that increased triglycerides within muscle tissue can negatively impact muscle function. Body composition methods like Dual Energy X-ray Absorptiometry (DXA) and Bioelectrical Impedance Analysis (BIA), commonly used to assess sarcopenia, often can't detect myosteatosis (MS) or myofibrosis (MF), critical indicators of muscle health.

Muscle quality overlooked by most definitions
Assessment tools fail to recognize key indicators
Muscle function is not adequately considered
BMI-based fat quantification is limiting

Another significant concern is that SO definitions often do not adequately consider muscle function in terms of strength and performance. Muscle strength and performance decline more rapidly with age than muscle mass. Current definitions don't align with the European and International Working Group on Sarcopenia in Older People, which recommends evaluating both low muscle mass and low muscle function to diagnose sarcopenia. Using BMI to quantify fat is also problematic, as it may not accurately reflect fat distribution, especially in older adults. Visceral abdominal fat, which increases with age, even without BMI changes, is a more relevant indicator. Measuring abdominal circumference can better assess fat distribution and identify at-risk individuals.

Taking Action Against Sarcopenic Obesity

The age-related reduction in muscle mass and increase in fat mass are interconnected, emphasizing the need for a holistic approach. Identifying elderly individuals at risk can help mitigate adverse health outcomes. While improving sarcopenia definitions is crucial, proposed definitions like dynapenic abdominal obesity (DAO) offer promising alternatives, utilizing simple measurements to identify those at high risk. A combined approach of proper exercise, diet and regular checkups with doctors will help prevent Sarcopenic Obesity.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/b978-0-12-810422-4.00006-3, Alternate LINK

Title: Sarcopenic Obesity

Journal: Nutrition and Skeletal Muscle

Publisher: Elsevier

Authors: Andrea P. Rossi, Sofia Rubele, Mauro Zamboni

Published: 2019-01-01

Everything You Need To Know

What exactly is sarcopenic obesity, and why is it a concern?

Sarcopenic obesity (SO) is a condition defined by the coexistence of low muscle mass and high body fat mass. Baumgartner and colleagues first defined it in 2000. The initial definition may underestimate sarcopenia in overweight and obese individuals, potentially leading to underdiagnosis of the condition.

Why are current methods for assessing sarcopenic obesity potentially missing key indicators of muscle health?

Current diagnostic methods, like Dual Energy X-ray Absorptiometry (DXA) and Bioelectrical Impedance Analysis (BIA), often fail to detect myosteatosis (MS) or myofibrosis (MF). These are critical indicators of muscle health where fat infiltrates the muscle tissue (myosteatosis) or there is an increase in fibrous tissue (myofibrosis), both of which negatively impact muscle function. Improving the detection of these conditions would give a more accurate sarcopenic obesity diagnosis.

How do current sarcopenic obesity definitions fall short in considering muscle function, and what are the broader implications?

Current definitions of sarcopenic obesity often don't adequately consider muscle function, specifically strength and performance, which decline more rapidly with age than muscle mass. The European and International Working Group on Sarcopenia in Older People recommends evaluating both low muscle mass and low muscle function to diagnose sarcopenia. Incorporating measures of muscle strength and performance into the definition of sarcopenic obesity would align it with current recommendations for sarcopenia diagnosis.

Beyond improving definitions, what proactive steps can be taken to address and prevent sarcopenic obesity?

While improving the definitions of sarcopenic obesity is important, alternative approaches like dynapenic abdominal obesity (DAO) offer promising ways to identify at-risk individuals using simple measurements. Lifestyle interventions such as proper exercise and diet, combined with regular checkups, are important steps in preventing sarcopenic obesity and mitigating its adverse health outcomes.

How does the distribution of body fat, particularly visceral fat, play a role in understanding the risks associated with sarcopenic obesity?

The increase in visceral abdominal fat, which accumulates with age even without changes in overall body mass index (BMI), is a more relevant indicator of sarcopenic obesity risk than BMI alone. Measuring abdominal circumference provides a better assessment of fat distribution and can help identify individuals at higher risk. Focusing on visceral fat accumulation, rather than just overall BMI, would improve the identification of individuals with sarcopenic obesity.