Sarcopenic Obesity Evaluation and Management in Primary Care: A Narrative Review

Sarcopenic obesity, the coexistence of excess adiposity and impaired skeletal muscle mass, strength, and physical performance, is increasingly prevalent due to population aging and the global obesity epidemic. It carries a disproportionate burden of adverse outcomes—including frailty, falls, disability, cardiometabolic disease, reduced quality of life, and mortality—yet remains under-recognized in primary care, where reliance on body mass index can mask abnormal body composition and functional decline. This narrative review synthesizes contemporary evidence to clarify evolving definitions and conceptual frameworks of sarcopenic obesity and to summarize key biological mechanisms linking adiposity to muscle dysfunction, including chronic low-grade inflammation, insulin resistance, hormonal changes, inactivity, and suboptimal protein intake. We highlight the epidemiology and clinical consequences most relevant to primary care populations and propose pragmatic approaches to case-finding and evaluation emphasizing feasible functional measures (e.g., grip strength, gait speed, chair rise performance) alongside anthropometry and, where available, bioelectrical impedance analysis, with dual-energy X-ray absorptiometry reserved for confirmatory assessment or specialist pathways. Management is reviewed through a primary-care lens, underscoring multimodal lifestyle intervention—resistance training combined with adequate dietary protein and cautious energy restriction—as the therapeutic foundation, supported by optimization of multimorbidity care, medication review, and coordinated referral to dietetic and rehabilitation services. Integrating these components into routine primary care may enable earlier recognition and more effective prevention of downstream functional and metabolic complications.