The number of adults 65 years and older is increasing worldwide and will represent the 20% of the population by 2030. Half of them will suffer from obesity. The decline in muscle mass and strength, known as sarcopenia, is very common among older adults with obesity (sarcopenic obesity). Sarcopenic obesity is strongly associated with frailty, cardiometabolic dysfunction, physical disability, and mortality. Increasing efforts have been hence made to identify effective strategies able to promote healthy aging and curb the obesity pandemic. Among these, lifestyle interventions consisting of diet and exercise protocols have been extensively explored. Importantly, diet-induced weight loss is associated with fat, muscle, and bone mass losses, and may further exacerbate age-related sarcopenia and frailty outcomes in older adults. Successful approaches to induce fat mass loss while preserving lean and bone mass are critical to reduce the aging- and obesity-related physical and metabolic complications and at the same time ameliorate frailty. In this review article, we discuss the most recent evidence on the age-related alterations in adipose tissue and muscle health and on the effect of calorie restriction and exercise approaches for older adults with obesity and sarcopenia, emphasizing the existing gaps in the literature that need further investigation.

全球 65 岁及以上的成年人数量正在增加，到 2030 年将占人口的 20%。其中一半将患有肥胖症。肌肉质量和力量的下降，称为肌肉减少症，在患有肥胖症（肌肉减少性肥胖）的老年人中非常常见。肌肉减少性肥胖与虚弱、心脏代谢功能障碍、身体残疾和死亡率密切相关。因此，已做出更多努力来确定能够促进健康老龄化和遏制肥胖大流行的有效策略。其中，由饮食和运动方案组成的生活方式干预措施已被广泛探索。重要的是，饮食引起的体重减轻与脂肪、肌肉和骨量的减少有关，并可能进一步加剧老年人与年龄相关的肌肉减少症和虚弱的后果。在保持瘦体重和骨量的同时诱导脂肪量减少的成功方法对于减少与衰老和肥胖相关的身体和代谢并发症并同时改善虚弱状况至关重要。在这篇综述文章中，我们讨论了与年龄相关的脂肪组织和肌肉健康变化的最新证据，以及卡路里限制和锻炼方法对肥胖和肌肉减少症老年人的影响，强调了文献中存在的需要进一步的调查。