GLP-1 Receptor Agonists for older adults with obesity pose sarcopenia risk, mitigated by exercise and protein.

Managing obesity in older adults presents unique challenges, often complicated by sarcopenia (age-related muscle loss) and sarcopenic obesity (SO), where excess fat coexists with low muscle mass. Current lifestyle modifications are often insufficient, making pharmacotherapy increasingly relevant. However, many anti-obesity medications can exacerbate muscle loss. GLP-1 Receptor Agonists (GLP-1 RAs) are potent weight-loss agents, but their impact on muscle preservation and SO risk in this vulnerable population requires careful evaluation.

This scoping review synthesized current evidence on GLP-1 RAs for obesity management in older adults, specifically focusing on their effects on sarcopenia and sarcopenic obesity. Researchers examined mechanistic insights and clinical considerations. The review aimed to consolidate existing literature regarding muscle mass indices, physical performance, muscle metabolism, and composition in the context of GLP-1 RA therapy, alongside common adverse events and strategies for muscle preservation.

GLP-1 RAs effectively induce weight loss, but concomitant muscle mass loss is a common concern, raising the risk of sarcopenia. Data on muscle mass indices and physical performance remain limited and inconsistent across studies. However, evidence suggests favorable effects on muscle metabolism and composition. Mechanistically, these benefits are linked to GLP-1 RA-mediated suppression of inflammatory pathways, modulation of skeletal muscle metabolism, and preservation of mitochondrial function, thereby influencing insulin resistance.

Integrating GLP-1 RA therapy with tailored resistance exercise and caloric restriction, including adequate protein intake of 1.2-1.6 g/kg/day, may help preserve muscle mass and function in older adults.