Abstract

Obesity in older adults constitutes a distinct clinical entity shaped by age-related changes in body composition, chronic inflammation, neuromuscular decline, and multimorbidity. In later life, weight loss carries metabolic benefits and functional risks: intentional weight reduction can ameliorate hypertension, diabetes, hepatic steatosis, sleep apnea, and mobility issues, yet may also accelerate muscle and bone mass loss, thereby worsening gait speed, balance, and independence. Accordingly, management must prioritize muscle preservation, physical function, and quality of life rather than weight reduction alone. Dietary interventions emphasizing adequate protein intake, moderate caloric restriction, and anti-inflammatory dietary patterns, such as the Mediterranean can optimize body composition while minimizing sarcopenia risk. Exercise—particularly resistance training—is the most effective strategy to maintain muscle mass, strength, and mobility, and it should be integrated with aerobic training. As incretin-based anti-obesity medications become widely available, their use in older adults requires careful assessment of frailty, baseline muscle function, and lean mass loss risk; furthermore, combined nutrition and exercise support is essential. A frailty-centered perspective is critical: in individuals with frailty or sarcopenia, functional preservation often supersedes weight loss, whereas healthy older adults may benefit from modest, well-supervised weight reduction. Ultimately, the most effective strategy is prevention—maintaining a healthy weight, muscle mass, and physical activity from midlife onward to mitigate later-life sarcopenia, visceral adiposity, and metabolic decline. Managing obesity in older adults demands a function-centered, individualized, and life-course–oriented clinical framework.