Weighing the risk of GLP-1 treatment in older adults: Should we be concerned about sarcopenic obesity?

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been pivotal for obesity treatment, achieving 15-25 % weight loss over 12-24 months, but questions remain about the potential influence of concomitant losses in muscle mass. Furthermore, low adherence, driven by high costs and side effects, results in up to two-thirds of users discontinuing treatment within a year, although up to a half reinitiate treatment. Given that cessation of treatment often leads to significant weight regain, there are concerns that older adults may be at risk for sarcopenic obesity; a condition characterized by excessive adiposity and low skeletal muscle mass which is prevalent in 10-20 % of older adults. The risk for sarcopenic obesity may be further exacerbated by weight cycling related to repeated treatment cessation which may concomitantly exacerbate fat mass gains while reducing muscle mass. This mini-review examines the risk of sarcopenic obesity as an unintended consequence of GLP-1 RA cessation in older adults, highlighting the need for raising awareness and preventative strategies.