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Sarcopenic obesity: under recognised and over treated?

Nick Finer
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DOI: https://doi.org/10.7861/clinmedicine.14-4-454
Clin Med August 2014
Nick Finer
AUniversity College Hospitals London, UK
Roles: Consultant endocrinologist and bariatric physician
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Editor – Cruz-Jentoft and Landi's fine review of the growing importance of sarcopenia (Clin Med April 2014 pp 183–6) omitted to discuss the increasingly recognised condition of sarcopenic obesity. At an individual level the classification of overweight and obesity by body mass index (BMI) as a measure of (excess) fat and lean tissue mass is increasingly recognised as flawed,1 and many older people with apparently ‘healthy’ BMIs may in fact be sarcopenic.2 Meta-analyses consistently show that mortality and morbidity associated with overweight and obesity only increase at a BMI above 30 kg/m2 in the elderly. In addition, the incidence of cardiovascular disease, mortality and all-cause mortality is higher in those with sarcopenic obesity than those who are ‘simply’ obese. Sarcopenia probably lies at the heart of the so-called obesity paradox – the finding that modest overweight is beneficial. Thus in the elderly, weight loss interventions are best offered to patients who are obese rather than overweight (by BMI definition) and who have functional impairments, metabolic complications or obesity-related diseases that can benefit from weight loss. Physical activity and exercise should form part of any weight loss therapy, but are of particular importance in the elderly.

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2014 Royal College of Physicians

References

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    1. Finer N
    . Better measures of fat mass – beyond BMI. Clinical Obesity 2012;2:65.doi:10.1111/j.1758-8111.2012.00047.x
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  2. ↵
    1. Mathus-Vliegen EM
    , Obesity Management Task Force of the European Association for the Study of Obesity. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts 2012;5:460–83.doi:10.1159/000341193
    OpenUrlCrossRefPubMed
    1. Atkins JL,
    2. Whincup PH,
    3. Morris RW,
    4. et al.
    Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men. J Am Geriatr Soc 2014;62:253–60.doi:10.1111/jgs.12652
    OpenUrlCrossRefPubMed
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Sarcopenic obesity: under recognised and over treated?
Nick Finer
Clinical Medicine Aug 2014, 14 (4) 454; DOI: 10.7861/clinmedicine.14-4-454

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Sarcopenic obesity: under recognised and over treated?
Nick Finer
Clinical Medicine Aug 2014, 14 (4) 454; DOI: 10.7861/clinmedicine.14-4-454
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