Sarcopenic obesity: under recognised and over treated?

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.

• © 2014 Royal College of Physicians