Understanding Sarcopenic Obesity and Its Effect on Longevity
Overview Obesity is a widespread medical condition that affects millions of people. Individuals with obesity have an increased risk of developing various comorbidities, including diabetes, heart disease, hypertension, osteoarthritis, sleep apnea, etc. However, obesity has not yet gained sufficient attention as a debilitating disease that affects the human body from within. But what if a patient develops another equally devastating condition that further escalates obesity and creates a vicious cycle of illness, inability to recover, and exacerbation? Sarcopenic obesity is the loss of muscle mass, strength, and functions on the foundation of obesity and can lead to serious health complications. While this concurrence of diseases is often ignored and underappreciated, its prevalence is shockingly high. For example, according to a 2021 study by Frontiers in Physiology, sarcopenic obesity can occur in up to 85.3% of males and 80.4% of females. This article discusses the detrimental impact of sarcopenic obesity, its symptoms, the culprits behind this double layer of disease, and the currently available approaches to treating and managing sarcopenic obesity. Sarcopenic Obesity: A Vicious Cycle of Weight Gain and Muscle Loss What Is Sarcopenic Obesity? Definition According to Karger Research, sarcopenic obesity is characterized by the coexistence of sarcopenia – a disease that causes low muscle mass – and high body fat percentage, particularly in the abdominal region. This condition has been identified as a geriatric syndrome with a complex etiology, and its prevalence increases with age. The term “sarcopenia,” which derives from the Greek words “sarx” (meaning “flesh”) and “penia” (meaning “loss”), originally referred to the age-related decrease of muscle mass. Today’s consented definition refers to sarcopenic obesity as having an amount of lean mass lower than average relative to the existing amount of fat mass. Typically, in healthy young and older people, bones and muscles grow harmoniously with increased body weight. In other words, if you gain weight, your bones and muscles grow and become stronger. However, in those with sarcopenic obesity, weight gain occurs without a parallel increase in either muscle mass or strength. Diagnosis Diagnosing sarcopenic obesity requires the assessment of several parameters, including: Loss of muscle mass Fat distribution Waist circumference Body mass index (BMI) The percentage of muscle loss is measured by analyzing a person’s skeletal muscle mass index (SMI), calculated by dividing muscle mass by height squared. A low SMI indicates a loss of muscle mass, a characteristic of sarcopenic obesity. In addition to muscle loss, identifying the percentage of increased body fat also helps determine the condition. This parameter is measured using dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA). Waist circumference is another critical parameter used to diagnose sarcopenic obesity. A waist circumference greater than 102 cm in men or 88 cm in women indicates abdominal obesity, associated with an increased risk of chronic diseases. BMI is often the most useful diagnostic criterion. A BMI greater than 30 kg/m2 indicates obesity, which, combined with muscle loss, suggests sarcopenic obesity. What Are the Symptoms of Sarcopenic Obesity? Sarcopenic obesity symptoms can vary depending on each individual. Some people experience mild symptoms, while others are more severe and debilitating. The combination of sarcopenia and obesity can make it difficult to differentiate between symptoms specifically related to one condition versus the other. Therefore, a thorough evaluation is necessary to diagnose sarcopenic obesity accurately. Sarcopenia-related Symptoms Decreased muscle strength and endurance Reduced mobility and physical function Fatigue and weakness Difficulty performing daily activities Poor balance and coordination Slower walking speed Increased risk of falls and fractures Obesity-related Symptoms Increased body fat, particularly in the abdominal region High blood sugar levels or insulin resistance Elevated cholesterol and triglyceride levels Elevated blood pressure Cardiovascular disease Type 2 diabetes Sleep apnea and other breathing problems Joint pain and reduced range of motion Increased risk of certain cancers What Causes Sarcopenic Obesity? Excess Energy Intake and Inactivity The first cause of sarcopenic obesity is excess energy intake and inactivity. Today’s society is bombarded with highly processed, calorie-dense foods that are low in nutrients. Amplified by sedentary lifestyles, this extra energy intake can lead to obesity and muscle loss. According to the World Health Organization (WHO), over 1.9 billion people were overweight in 2016, with over 650 million classified as obese. Also, the Global Health Observatory (GHO) shows that physical inactivity is responsible for around 3.2 million deaths annually. Adipose Tissue Derangements The second likely cause of sarcopenic obesity is adipose tissue derangements. Adipose tissue, or body fat, is a passive storage depot for excess energy and an active endocrine organ that produces hormones. In obesity, adipose tissue becomes dysfunctional, leading to low-grade chronic inflammation and insulin resistance. These factors can negatively impact muscle metabolism, further exacerbating sarcopenia. According to a study by the Journal of Physiology, leptin – a hormone released by adipose tissue – plays a vital role in muscle metabolism. Therefore, individuals with adipose tissue dysfunction may experience a loss in muscle mass and strength. Muscle Metabolism Diseases Muscle metabolism diseases can include genetic disorders such as muscular dystrophy or acquired conditions such as skeletal muscle dysfunction due to chronic obstructive pulmonary disease (COPD) or cancer cachexia. According to a study by the Journal of Cachexia, Sarcopenia, and Muscle, cancer cachexia alone affects up to 80% of advanced cancer patients, significantly impacting muscle mass and function in a phenomenon known as muscle wasting. These conditions can result in an impaired balance between protein synthesis and degradation, a breakdown of muscle tissue, and decreased muscle size and number. Age-related Muscle Loss The last possible cause of sarcopenic obesity is age-related muscle loss. Our bodies undergo numerous changes as we age, including decreased muscle mass and function. This phenomenon is then further exacerbated by a sedentary lifestyle and poor nutrition. According to the same study by the Journal of Cachexia, Sarcopenia, and Muscle, the prevalence of sarcopenia increases with age, from 15% at 65 to 50% at 80 years old. Beyond 50, natural aging is associated with