THEAround menopause, talking only about kilos risks missing the point. Sarcopenic obesity describes the coexistence of excess adiposity and reduced muscle mass or function. Not a simple sum of two labels, but a body profile that can weigh on general well-being and the quality of the years of life lived. [1]
Today, scientific consensus suggests starting first from muscle function and then from body composition and weight. In other words, “weighing less” is now a secondary objective, maintaining a body capable of moving effectively is the real goal. [1]
Beyond the scales
The phenomenon of sarcopenic obesity is very common, at least in elderly populations. A meta-analysis of 50 studies estimated a global prevalence of 11% in those over 60in studies centered on the over 75s it reached 23%. The point, however, is methodological: estimates change a lot depending on definitions and measurement tools. [2]
For this reason i numbers should be read as orders of magnitude, not as defined photographsgo. The shared definition is recent and not all works give the same weight to strength, muscle mass or waist circumference. Which is why the phenomenon could be even more widespread. [1,2]
What changes around menopause
The best longitudinal data suggest that the menopausal transition is one critical phase for body composition. In the SWAN study, at the beginning of the transition the rate of increase in fat mass almost doubles, while lean mass begins to decline. Yet weight and BMI do not show a similar acceleration. It’s one reason why the scale can only tell half the story. [3]
Longitudinal work on 4,766 Korean women aged 42-52, with a median follow-up of 9.1 years, goes in the same direction. Compared to premenopause, the risk of sarcopenic obesity was higher in late transition and postmenopause when the definition used muscle mass plus percentage of body fat. With BMI, however, the association was not significant.[4]
Because it matters for health and autonomy
The most solid part on clinical outcomes comes especially from the elderly. A meta-analysis of 106 studies and 167,151 older people associated sarcopenic obesity with higher all-cause mortality compared to those considered healthy. In the same work, functional limitation and various cardiometabolic outcomes also increased. [5]
In women, a concrete fact concerns falls. In a prospective cohort of 11,020 post-menopausal women followed for seven years, sarcopenic obesity was associated with a greater risk of recurrent falls in women over 50. [6]
A look at Italy
In Italy the picture of excess weight is significant. According to ISTAT, in 2023 44.6% of adults were overweight or obese, and 11.3% were obese. Among women, the overall rate of excess weight and obesity was 36.1%. Excess weight increases with age and, already between the ages of 45 and 54, affects almost 5 out of 10 people. [8]
What is missing, however, is an updated and truly comparable national estimate of sarcopenic obesity in the general Italian population. Surveillance systems describe overweight and obesity well, but the combination of adiposity and reduction of strength or muscle mass much less. To underline how the vision of bodily functionality, beyond mere body composition, is still new and uncommon. [1,8]
What is still missing
The main issue is standardization. The shared definition is recent, studies use different criteria for strength, muscle mass and adiposity, and this makes it difficult to compare prevalences, thresholds and individual risks. [1,2]
We also need a qualitative leap in studies on middle-aged women, more longitudinal cohorts with repeated measures of body composition and more long trials, with robust clinical outcomes. Not just kilos lost, but strength, cardiorespiratory fitness, autonomy and quality of life. [4,5,7]
So: is this a new label or a real problem?
The most solid literature suggests the second hypothesis. Especially around menopause, weight alone can underestimate adverse body change, and as years pass, this combination is associated with worse outcomes. To transform this intuition into precision medicine, however, we need more uniform definitions, better studies and a new approach to medicine that looks at the functionality of our body. [1,4,5,7]
Scientific sources
- Donini LM, Busetto L, Bauer JM, et al. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Clin Nutr. 2022;41(4):990-1000. doi:10.1016/j.clnu.2021.11.014. PMID:35196654.
- Gao Q, Mei F, Shang Y, et al. Global prevalence of sarcopenic obesity in older adults: A systematic review and meta-analysis. Clin Nutr. 2021;40(7):4633-4641. doi:10.1016/j.clnu.2021.06.009. PMID:34229269.
- Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insights. 2019;4(5):e124865. doi:10.1172/jci.insight.124865. PMID:30843880.
- Cho Y, Jang Y, Park JH, Chang Y, Ryu S. Risk of Sarcopenic Obesity Across Menopausal Transition Stages in Middle-Aged Korean Women. Nutrients. 2025;17(20):3238. doi:10.3390/nu17203238.
- Liu C, Wong PY, Chung YL, et al. Deciphering the “obesity paradox” in the elderly: A systematic review and meta-analysis of sarcopenic obesity. Obes Rev. 2023;24(2):e13534. doi:10.1111/obr.13534. PMID:36443946.
- Follis S, Cook A, Bea JW, et al. Association Between Sarcopenic Obesity and Falls in a Multiethnic Cohort of Postmenopausal Women. J Am Geriatr Soc. 2018;66(12):2314-2320. doi:10.1111/jgs.15613. PMID:30375641.
- da Silva Goncalves L, Santos Lopes da Silva L, Rodrigues Benjamim CJ, et al. The Effects of Different Exercise Training Types on Body Composition and Physical Performance in Older Adults with Sarcopenic Obesity: A Systematic Review and Meta-Analysis. J Nutr Health Aging. 2023;27(11):1076-1090. doi:10.1007/s12603-023-2018-6. PMID:37997730.
- ISTAT. BES 2024 – Health. 2023 data on overweight/obesity in the Italian adult population. Published in 2024.
Michele Bonaccorso
Doctor Michele Bonaccorso.
The Dr. Michele Bonaccorso He is a surgeon, specialized in anesthesia and resuscitation, oxygen-ozone therapy and functional medicine.
His virtuous course of study has allowed him to be today among the most qualified exponents of functional medicinewith particular reference tooxygen-ozone therapy and to pain therapy.
He graduated with honors from LUniversity of Catania. For over 10 years he has successfully practiced oxygen-ozone therapy for the treatment of musculoskeletal pathologies, in the treatment of neurodegenerative and inflammatory diseasesand as a technique prevention and slowing down of aging.
He attended anti-aging medicine school AMIA (Italian Antiaging Doctors Association) directed by Dr. Galimberti. He graduated from the school ofAIMF HEALTH (Italian Association of Functional Medicine) which allowed him to become functionalist doctor. Finally, he obtained a II level Master’s degree in Pain Therapy from the University of Parma. He served as the group’s pain therapy manager Multimedical. He follows national and international conferences with interest which allow him to always stay up to date on the latest news in the field of functional medicine and anti-aging.
Doctor Nicola Marino
The Dr. Nicola Marino carries out research activities with the Swiss group Women’s Brain Foundationfor which he is a member of the advisory board, in the fields of longevity and artificial intelligence. Director of AEON Foundation and former political consultant in the field of digital health and longevity, he is the author of numerous scientific publications.
He carried out an internship at the Harvard Medical School and the Dana-Farber Cancer Institute of Bostonwas a member of Scientific Committee of the Italian Association of Digital Health and Telemedicine (AISDET) and consultant for the US company Health Catalyst. He carries out scientific journalism activities for national and international media, and has been involved as an expert for CFI.co, Il Sole 24 Ore, Corriere della Sera, Millionaire, Rai1 and Sky TG24, to name a few.