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Sarcopenic obesity: how do we treat it?

Bouchonville, Matthew F.a; Villareal, Dennis T.b,c

Current Opinion in Endocrinology, Diabetes and Obesity: October 2013 - Volume 20 - Issue 5 - p 412–419
doi: 10.1097/
OBESITY AND NUTRITION: Edited by Caroline M. Apovian and Jeffrey I. Mechanick

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.

aDivision of Endocrinology, Diabetes, and Metabolism

bDivision of Geriatrics, University of New Mexico School of Medicine

cSection of Geriatrics, New Mexico Veterans Affairs Healthcare System, Albuquerque, New Mexico, USA

Correspondence to Dennis T. Villareal, MD, New Mexico VA Healthcare System, Geriatrics (111K), 1501 San Pedro Dr, Albuquerque, NM 87111, USA. Tel: +1 505 256 5400; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins