For decades, body weight and body mass index were used as the main parameters to estimate metabolic risk. Today it is known that these measurements are limited in identifying relevant changes in body composition. Among them is sarcopenic obesity, a condition characterized by the simultaneous presence of excess fat and reduced muscle mass and strength.
This condition can occur in people with a BMI considered normal or only slightly elevated. This means that it is possible to present an increased metabolic risk without significant changes in the scale.
An underdiagnosed condition
Sarcopenic obesity results from the association between two processes. Sarcopenia corresponds to the progressive loss of muscle mass and strength, often related to aging, a sedentary lifestyle, chronic inflammation and insulin resistance. Obesity involves the excessive accumulation of adipose tissue, especially visceral, associated with a worse metabolic profile.
When these conditions coexist, the effects on health tend to be more relevant than when they occur in isolation. National and international studies indicate that a significant portion of adults and elderly people present this body composition pattern without diagnosis, in part because BMI does not differentiate between fat and lean mass.
Metabolic, functional and cardiovascular impacts
Scientific evidence points to a consistent association between sarcopenic obesity and a greater risk of metabolic changes. Systematic reviews show increased prevalence of insulin resistance, metabolic syndrome, dyslipidemia and systemic inflammation in this group. Analyzes of large population databases also identified a greater likelihood of glycemic changes.
In the functional aspect, longitudinal studies with elderly people demonstrate a greater risk of mobility limitation, difficulty in activities of daily living and physical disability. Reduced muscle strength is considered a relevant marker of clinical vulnerability.
Regarding cardiovascular outcomes and mortality, cohorts followed for more than a decade observed a higher risk of death from all causes among individuals with sarcopenic obesity when compared to those with only obesity or only sarcopenia. Recent research indicates that low muscle strength may be associated with a higher incidence of cardiovascular events.
Evidence-based prevention and treatment
Addressing sarcopenic obesity requires strategies that simultaneously address muscle preservation and body fat control.
The diet must ensure adequate intake of high-quality proteins, distributed throughout the day, to stimulate muscle synthesis. The adequacy of micronutrients such as vitamin D, magnesium and B vitamins is also relevant. Very restrictive, low-protein diets can accelerate the loss of muscle mass, especially in older adults.
Resistance training presents consistent evidence of increased muscle mass and strength, even at older ages. When associated with aerobic exercise, it contributes to reducing visceral fat and improving insulin sensitivity. Programs that integrate strength, balance and cardiorespiratory conditioning tend to offer better results.
Clinical assessment must go beyond BMI. Methods such as DEXA, advanced bioimpedance and manual strength tests allow for a more precise analysis of body composition and muscle function, favoring individualized interventions.
Body composition as an indicator of health
The combination of excess fat and reduced muscle mass is associated with a greater risk of chronic diseases, functional limitations and cardiovascular events, even when body weight does not appear high. The assessment of body composition and muscle strength should be part of clinical routine and prevention strategies.
Broadening the view beyond total weight allows for earlier interventions that are aligned with the evidence, with the potential to reduce metabolic complications and preserve autonomy throughout aging.
Dr. Filippo Pedrinola – CRM/SP 62253 | EQR 26961
Endocrinologist
National Head of Endocrinology at Brazil Health
