SARCOPENIC OBESITY IN THE ERA OF INCRETIN-BASED THERAPIES: DIAGNOSTIC CHALLENGES, THE RISK OF MUSCLE MASS LOSS, AND PREVENTION STRATEGIES

Abstract

Introduction and purpose. Sarcopenic obesity (SO) is defined by the coexistence of excess adiposity and reduced muscle mass and function and is associated with disability, frailty, cardiometabolic disease, and increased mortality. This review aims to summarize current evidence on the definition and diagnosis of SO, assess the effects of incretin-based therapies on body composition, with a focus on practical strategies to reduce the risk of clinically relevant muscle loss during obesity treatment.  Material and methods. This manuscript was prepared as a structured narrative review based on publications identified in PubMed/MEDLINE, Google Scholar, and the Cochrane Library. Results. Current evidence suggests that semaglutide and tirzepatide produce significant and sustained reductions in body weight and fat mass, including visceral adipose tissue, while also being associated with a decrease in absolute lean body mass. These changes should not be interpreted automatically as clinically relevant skeletal muscle loss. However, older adults, frail individuals, and patients with low muscle reserve are more susceptible, especially without adequate protein intake, resistance exercise, and regular monitoring.  Conclusions. Incretin-based therapies represent a major advance in obesity treatment; however, in patients at risk of SO, they should be used within a multimodal strategy aimed at preserving muscle mass and function.