Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Unintended risks of sarcopenic obesity during weight-loss interventions in older people

Nature Medicine (2026)Cite this article

Subjects

Older adults over 65 years of age with obesity are physically not all the same, exhibiting distinct trajectories and responses to weight-loss interventions. Incretin mimetic drugs (IMDs) such as semaglutide and tirzepatide are increasingly prescribed and can induce substantial weight loss1, often accompanied by reductions in fat and muscle. Given the central role of muscle in strength, mobility and independence, its preservation has clinical relevance in older adults. These shifts in body composition have renewed interest in muscle─fat dynamics, particularly sarcopenic obesity, defined by increased fat mass and reduced muscle health2. Regardless of its definition, sarcopenic obesity is consistently associated with worse physical function, lower quality of life and higher mortality than either sarcopenia or obesity alone3.

Data have shown that lifestyle-based, structured diet and exercise programs supported by behavioral counseling reduce obesity-related complications but may cause unintended losses in lean mass, which includes muscle mass, connective tissue, viscera, and bone density and content; this necessitates a careful balance of benefits and harms4. In older adults, these losses are clinically meaningful, translating to declines in strength, balance and resilience. Most trials report body composition changes over 6–12 months, with limited long-term data.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Locatelli, J. C. et al. Diabetes Care 47, 1718–1730 (2024).

    Article  CAS  PubMed  Google Scholar 

  2. Gortan Cappellari, G., Zanetti, M., Donini, L. M. & Barazzoni, R. Curr. Opin. Clin. Nutr. Metab. Care 27, 402–409 (2024).

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Prado, C. M., Batsis, J. A., Donini, L. M., Gonzalez, M. C. & Siervo, M. Nat. Rev. Endocrinol. 20, 261–277 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Villareal, D. T. et al. N. Engl. J. Med. 376, 1943–1955 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nuijten, M. A. H. et al. Obes. Rev. 23, e13370 (2022).

    Article  PubMed  Google Scholar 

  6. Wilding, J. P. H. et al. N. Engl. J. Med. 384, 989–1002 (2021).

    Article  CAS  PubMed  Google Scholar 

  7. Jastreboff, A. M. et al. N. Engl. J. Med. 387, 205–216 (2022).

    Article  CAS  PubMed  Google Scholar 

  8. Butler, J. et al. Lancet 403, 1635–1648 (2024).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Beaudart, C. et al. Aging Clin. Exp. Res. 37, 100 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Beavers, K. M. et al. Am. J. Clin. Nutr. 94, 767–774 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Geriatric Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    John A. Batsis

  2. Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    John A. Batsis

  3. Department of Experimental Medicine, Sapienza University, Rome, Italy

    Lorenzo M. Donini

  4. Department of Agricultural, Food, and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada

    Carla M. Prado

Authors
  1. John A. Batsis
    View author publications

    Search author on:PubMed Google Scholar

  2. Lorenzo M. Donini
    View author publications

    Search author on:PubMed Google Scholar

  3. Carla M. Prado
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to John A. Batsis.

Ethics declarations

Competing interests

J.A.B. has consulted for Regeneron, Abbott Nutrition and MedaCorp. C.M.P. has previously received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science and Novo Nordisk.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Batsis, J.A., Donini, L.M. & Prado, C.M. Unintended risks of sarcopenic obesity during weight-loss interventions in older people. Nat Med (2026). https://doi.org/10.1038/s41591-026-04210-2

Download citation

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41591-026-04210-2

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing