Sarcopenic obesity: Call to action and nutritional agenda from the international clinical nutrition community

Sarcopenic obesity (SO; defined as obesity with low skeletal muscle function and mass) has been recently recognized as a relevant obesity phenotype, with substantial negative clinical impact. The prevalence of SO is likely increasing, due to the growing prevalence of major SO risk factors, including sedentary lifestyle, obesity-induced non-communicable diseases with muscle-catabolism, and a general global increase in the older adult population. Structured obesity management, including anti-obesity medications, also commonly leads to variable reductions in muscle mass with potential SO risk. Here, an international network of clinical nutrition Societies, including the European Society for Clinical Nutrition and Metabolism (ESPEN), the Latino American Federation of Nutritional Therapy, Clinical Nutrition and Metabolism (Federación Latinoamericana de Terapia Nutricional, Nutrición Clínica y Metabolismo - FELANPE), the Parenteral and Enteral Nutrition Society of Asia (PENSA), and the South African and Australasian Societies for Parenteral and Enteral Nutrition (SASPEN and AuSPEN) recognize SO as a research and clinical priority, with major implications for nutrition and nutritional care. They hereby promote a nutrition network focusing on SO nutritional implications, clinical nutrition research on SO, and implementation of SO diagnosis and treatment in routine clinical practice. The current paper includes statements on SO diagnosis, promoting simple tools based on the recent consensus-based Sarcopenic Obesity Global Leadership Initiative (SOGLI) diagnostic algorithm, and its relationship with malnutrition/undernutrition. Statements are also provided on nutritional prevention of SO through healthy diet and adequate protein and micronutrient provision, on the role of nutritional care in obesity with sarcopenia, and on nutrition-based strategies to minimize and monitor the risk of sarcopenia during obesity management. The relevance of multimodal treatment approaches including both optimal nutrition and exercise is also emphasized. This SOGLI Nutrition network hereby calls for coordinated action, including scientific, educational and advocacy initiatives, to raise awareness of SO and the key role of nutrition and nutritional care in its prevention and treatment, in order to reduce the burden of morbidity and mortality in the growing population of persons with obesity worldwide.