The Perfect Storm: Sarcopenia and Obesity

Do you know the term “perfect storm”? It means when two or more independent – usually negative – factors converge to create one massive challenge. In this article, we’ll explore the perfect storm that has formed where the obesity epidemic and sarcopenia meet.  

Before you conclude there’s no hope to fight the storm, we have a spoiler alert! You can reach a safe harbor if you choose to follow some simple steps. But first, let’s look at what sarcopenia is, how it relates to obesity, and what you can do to minimize the harmful effects of both. 

What Is Sarcopenia? 

Sarcopenia is a condition characterized by the gradual loss of muscle mass, strength, and function that occurs as a natural part of aging (for example, possibly contributed by a change in hormones). The amount of muscle mass that the average person loses naturally each year can vary widely based on factors such as age, physical activity level, genetics, and overall health. However, there is a general trend of muscle loss with aging. On average, adults may lose about 3-8% of their muscle mass per decade starting around the age of 30. 

Here’s a rough breakdown of average muscle loss by age group: 

• 30s: Minimal muscle loss, typically less than 1% per year. 
• 40s: Muscle loss may increase slightly, around 1-2% per year. 
• 50s: More noticeable muscle loss, around 1-2% per year. 
• 60s and beyond: Muscle loss can accelerate, with estimates ranging from 2-5% or more per year. 

Why should you care about the loss of muscle mass? It can increase your health risks in several critical areas that you should not ignore. These include: 

• Functional Decline: Sarcopenia can lead to a decline in physical function and mobility. As muscle mass and strength decrease, activities of daily living such as walking, climbing stairs, and lifting objects may become more challenging. This can significantly impact your independence and overall quality of life. 
• Increased Risk of Falls and Fractures: Weakened muscles can contribute to balance problems and an increased risk of falls, which can result in fractures, especially in older adults. Hip fractures are associated with serious health complications and a higher mortality rate. 
• Impact on Chronic Conditions: Sarcopenia can exacerbate the symptoms and complications of chronic conditions such as osteoarthritis, heart disease, and chronic obstructive pulmonary disease (COPD). It can also complicate the management of these conditions. 
• Metabolic Consequences: Muscle tissue is metabolically active, and its loss can negatively affect metabolic health. Sarcopenia has been linked to insulin resistance, impaired glucose metabolism, and an increased risk of developing type 2 diabetes. It can also contribute to weight gain and obesity as muscle tissue is more metabolically active than fat tissue. 
• Reduced Strength and Endurance: Muscle strength and endurance are essential for maintaining physical function and participating in physical activities. Sarcopenia can lead to weakness and fatigue, making it difficult to engage in exercise and other activities that promote overall health and well-being. 
• Loss of Independence: The loss of muscle mass and function can ultimately lead to a loss of independence. This may result in increased reliance on others for help with daily tasks and a decreased ability to live life on your own terms. 
• Malnutrition Risk: Sarcopenia can be associated with poor nutritional status, which can further exacerbate muscle loss. It can create a vicious cycle where inadequate nutrition contributes to muscle wasting, and muscle wasting, in turn, impairs the body’s ability to utilize nutrients effectively. 
• Longer Hospital Stays and Higher Healthcare Costs: Older adults with sarcopenia who experience injuries or illnesses may have longer hospital stays and higher healthcare costs due to complications and slower recovery. 
• Decreased Longevity: Sarcopenia has been associated with an increased risk of mortality. People with sarcopenia may have a reduced life expectancy compared to those with preserved muscle mass and function. 

Given these concerns, it is essential to monitor and address sarcopenia as part of your overall health and wellness.
 

Obesity and Sarcopenia 

As mentioned above, the onset of sarcopenia can exacerbate chronic conditions, but the reverse is also true. In particular, the chronic disease of obesity is a driver of reduced muscle mass independent of age. But as those who suffer from obesity age and experience the natural onset of sarcopenia, the outcomes could spell trouble. 

This is discouraging news at the individual level for sure, but if we take a step back to look at national statistics, the picture appears to be alarming. As reported by the Centers for Disease Control (CDC), obesity affects about 41% of US adults. Another 34% are diagnosed as overweight. That’s 75% of the US population with a weight control issue. 

US demographics highlight just how important it is for us to make healthy aging a priority. The 2020 US Census revealed that over 55 million people – or 16.8% of the population – are 65 years or older. By 2040, that number is expected to rise to over 88 million.
 

GLP-1 Meds, Obesity, and Sarcopenia 

In recent years, a new pharmaceutical tool emerged that at first appeared to be a miracle for helping people struggling with obesity to boost their weight loss results. These GLP-1 (Glucagon-Like Peptide-1) medications, such as semaglutide and tirzepatide, work by mimicking the action of the natural hormone GLP-1, which is involved in regulating blood sugar levels and appetite. Clinical studies show outstanding and safe results with between 15% and 20% body weight loss. They have become extremely popular since they hit the market. 

However, there may be a misconception about their use. Many might think the use of the medication alone will help them lose weight and improve their overall health without having to modify lifestyle habits or behavior. This belief is unquestionably false. The biggest reason? The elevated risk of sarcopenia.  

GLP-1 medications have several potential connections to sarcopenia: 

• Appetite and Weight Loss: GLP-1 medications can lead to reduced appetite and calorie intake, which can result in weight loss. While this can be beneficial for individuals with obesity, it’s essential to monitor the rate and extent of weight loss. Rapid or excessive weight loss can contribute to muscle loss and worsen sarcopenia. 
• Impact on Muscle Protein Synthesis: Some research suggests that GLP-1 receptors are present in muscle tissue, and GLP-1 may have a role in muscle protein synthesis. However, the exact mechanisms are not fully understood. There is some concern that the reduced appetite associated with GLP-1 medications could lead to reduced protein intake, which may negatively impact muscle preservation. 
• Potential for Muscle-Related Side Effects: GLP-1 medications can have side effects, including gastrointestinal symptoms like nausea and vomiting, which can affect dietary choices and nutrient intake. If these side effects lead to decreased food consumption or avoidance of protein-rich foods, it could contribute to muscle loss. 
• Individual Variation: The impact of GLP-1 medications on muscle and sarcopenia may vary from person to person. Genetics, lifestyle factors, and overall health can influence how individuals respond to these medications. 

Given these considerations, it’s crucial for patients using GLP-1 medications to be monitored and guided by a healthcare professional and not use them in isolation. 

The Simple Steps You Can Take to Fight the Storm 

Now that we’ve reviewed how the perfect storm has formed, we can see the brighter skies to safety. There are some very simple things you can and should do to make sure you build muscle where you’re able and maintain it as you age. Unfortunately, stopping aging is not a possibility, but you can minimize its effects. 

• Make sure you consume sufficient daily high-quality protein! Protein is the key nutrient in building and maintaining muscle. This is especially important if you decide to use GLP-1 medications. We recognize that they act as a powerful appetite suppressant, but you must make it a priority to consume muscle-protecting lean protein as part of an overall balanced diet. 
• Make physical activity a daily habit – especially strength-training exercises. This doesn’t mean you need to pump iron like Arnold Schwarzenegger. It does mean you should include weight-bearing exercises in your activities. Yoga is a great way to build strength (and develop long, lean muscles in the process). 
• Follow your provider’s guidance. It’s particularly important to work with your medical provider as part of a personalized plan that is tailored to your specific needs. This is especially true if you use GLP-1 medications as part of your plan. Your provider can address your health needs holistically and draw on several resources to help you achieve your weight loss and muscle retention goals. 

We all want to age gracefully, which means conserving vitality and strength. That’s why it is important to understand how sarcopenia works and how you minimize its impact. And you don’t have to do it alone! Find a participating provider in the CMWL network to get you on the road to lifelong wellness.