Tias Anggani, M. Barlian Nugroho, Shabrina Narasati, Achmad Zaini
Background: Sarcopenic obesity (SO) is the combination of excess adiposity and age-related loss of skeletal muscle and is an underappreciated geriatric syndrome associated with higher mortality, cardiometabolic risk, and disability than either sarcopenia or obesity alone. Objective: To review the current literature on the definition, pathogenesis, diagnosis, and treatment of SO with emphasis on the differences between SO, obesity, and isolated sarcopenia. Methods: This narrative review summarized consensus statements, systematic reviews, meta-analyses, and clinical trials published from 2018 to 2025, including pharmacological, exercise, dietary, and behavioural interventions, as well as diagnostic criteria. Results: SO is characterized by chronic low-grade inflammation, adipokine-myokine dysregulation, mitochondrial dysfunction, myosteatosis, hormonal changes, and anabolic resistance leading to progressive fat gain and muscle loss. Diagnosis is based on the stepwise approach of the ESPEN-EASO, which includes screening, functional evaluation, body composition assessment, and severity staging. There is high-quality evidence that multicomponent rehabilitation, incorporating resistance, aerobic, balance, functional, and power training, along with high-protein hypocaloric nutrition, vitamin D and micronutrient optimization, behavioral strategies, and specific pharmacological or hormonal adjuncts, improves cardiometabolic health, body composition, and muscle mass and strength Conclusion: Management of SO is not possible without simultaneous fat reduction and preservation or improvement of muscle mass and function, unlike isolated sarcopenia. At present, the strongest evidence base for improving these outcomes is for multicomponent, SO-specific rehabilitation, which includes exercise, nutrition, and behavioral and pharmacological adjuncts.