|Year : 2023 | Volume
| Issue : 1 | Page : 1-2
Sarcopenic obesity: A new challenge for primary care physicians
Himel Mondal1, Sudip Bhattacharya2
1 Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
|Date of Submission||20-Feb-2023|
|Date of Decision||24-Feb-2023|
|Date of Acceptance||24-Feb-2023|
|Date of Web Publication||01-Mar-2023|
Dr. Himel Mondal
Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mondal H, Bhattacharya S. Sarcopenic obesity: A new challenge for primary care physicians. J Prim Care Spec 2023;4:1-2
Sarcopenic obesity is a condition characterized by the loss of muscle mass (sarcopenia) and the accumulation of body fat (obesity). It can be broadly categorized into age-related and lifestyle-related sarcopenic obesity. With the advancement of age, physical activity is declined, levels of hormones are changed, and fat cells increase reversing the body fat to water content. These factors contribute to age-related sarcopenic obesity. Young-aged people may also have sarcopenic obesity, and it is categorized as lifestyle-related sarcopenic obesity. The major underlying reason is sedentary behavior and an unhealthy diet that leads to decreased muscle mass and increased body fat.
The following are some of the pathologies associated with sarcopenic obesity:
- Hormonal changes: Age-related changes in hormone levels, like decreased levels of growth hormone and testosterone, can contribute to the development of sarcopenic obesity
- Insulin resistance: Accumulation of fat in muscle tissue can interfere with insulin signaling and glucose uptake, leading to insulin resistance
- Inflammation: Accumulation of body fat, particularly abdominal fat, can lead to the release of pro-inflammatory cytokines
- Oxidative stress: Increased levels of oxidative stress can contribute to the degradation of muscle protein, leading to muscle loss
- Mitochondrial dysfunction: A decline in the oxidative capacity of mitochondria with aging can result in impaired energy production and contribute to obesity
- Muscle protein degradation: An increased level of oxidative stress and inflammation can lead to the degradation of muscle protein and further muscle loss.
The diagnosis of sarcopenic obesity involves evaluating both muscle mass and body fat levels. The following are some common methods used to diagnose sarcopenic obesity:
- Dual-energy X-ray absorptiometry: It measures bone density and provides an estimation of body fat and muscle mass. This is rarely done in clinical practice and is commonly done in research
- Computed tomography (CT) or magnetic resonance imaging: These provide a detailed image of body composition, including muscle mass and body fat distribution. These are also rarely done in clinics due to resource limitations and the risk of radiation exposure (for CT) and cannot be used for routine screening
- Bioelectrical impedance analysis: It uses a small electrical current to estimate body composition by measuring resistance to the flow of the current. It requires a relatively cheaper device, but patients should be prepared according to the strict guideline for a credible reading
- Physical performance measures: Evaluation of physical function, such as grip strength, gait speed, and chair rise time, can provide information about muscle function and sarcopenia. Among these, gait speed and handgrip strength are two simple tests that can be used for screening purposes at clinics for primary care.
Sarcopenic obesity is a rapidly growing public health concern that is challenging primary health-care providers. The main challenge in addressing sarcopenic obesity is the lack of awareness and understanding among health-care providers. Many primary care providers are not trained to identify or manage sarcopenia, and may not recognize it as a distinct condition. Furthermore, the condition is often overlooked or misdiagnosed as simply obesity, leading to inadequate treatment.
Primary health-care providers must take a proactive approach in the diagnosis of sarcopenic obesity. When a person is diagnosed as obese according to the current definition of obesity suggested by the World Health Organization, a test for sarcopenia may be applied. A screening test by gait speed suggested by the Asian Working Group for Sarcopenia (2014) may be used. A gait speed ≤0.8 m/s is low and indicative of sarcopenia. In addition, handgrip strength may help to identify low muscular strength. A handgrip strength in men <26 kg and in women <18 kg may be considered low. After a provisional diagnosis, primary care providers should suggest further investigations to identify the underlying causes and refer for treatment. In settings where there is no availability of further investigations or higher medical facilities, primary care physicians may work closely with other health-care professionals, such as dieticians and physical therapists, to provide a comprehensive and coordinated approach to managing sarcopenic obesity.
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