Sarcopenic Obesity in the Era of Incretin-Based Weight-Loss Therapies: A Narrative Review of Pathophysiology, Clinical Implications and Nutritional Management
Year: 2026
Type: review
Abstract: Sarcopenic obesity is a clinically important condition in which excess adiposity coexists with reduced skeletal muscle mass and impaired muscle function. The condition is increasingly relevant because ageing, physical inactivity, insulin resistance, chronic low-grade inflammation, endocrine changes and inadequate dietary intake can simultaneously promote fat accumulation and deterioration of skeletal muscle. The rapid expansion of pharmacological obesity treatment, particularly glucagon-like peptide-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists, has added a new dimension to this problem. These therapies can produce substantial weight and fat loss, but reductions in lean soft tissue may also occur during treatment. Lean-mass loss, however, should not be equated automatically with sarcopenia, which requires consideration of muscle strength and/or physical performance in addition to muscle quantity. This narrative review synthesises current evidence on the definition, epidemiology, pathophysiology, diagnosis and clinical consequences of sarcopenic obesity, and examines the implications of conventional weight loss, bariatric surgery and incretin-based pharmacotherapy for muscle health. Nutritional strategies, including adequate energy and high-quality protein intake, together with progressive resistance exercise and body-composition and functional monitoring, are discussed as central components of management. The review highlights the need to move beyond body-weight reduction alone and towards treatment strategies that optimise fat loss while preserving skeletal muscle, physical function and long-term metabolic health.
Language: English
Subfield: Physiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7217152704