European Association for the Study of Obesity (EASO) position statement on the diagnosis and management of obesity in older adults

Background: Obesity is increasingly prevalent among older adults and is a major contributor to cardiometabolic diseases, functional decline, frailty, and loss of independence. The intersection between population ageing and the obesity epidemic poses major public health and clinical challenges. Summary: This European Association for the Study of Obesity (EASO) position statement represents an update of the EASO guideline from 2012, and provides a comprehensive overview of the epidemiology, pathophysiology, clinical consequences, and management of obesity in adults aged ≥65 years. It summarises current evidence and offers practical recommendations for diagnosis and treatment tailored to this age group. Key messages: 1) Obesity affects up to one third of older adults globally, with prevalence varying by sex and geography; 2) Ageing is associated with changes in body composition, hormonal milieu, and lifestyle factors (diet, physical inactivity, polypharmacy) that favour fat accumulation and sarcopenic obesity; 3) Body mass index alone is insufficient; assessment should include body composition analysis (including fat distribution and muscle mass), psychological status and functional performance; 4) A multimodal approach is recommended, including moderate energy restriction with adequate protein intake, structured multicomponent exercise, behavioural support, and, where appropriate, obesity management medications and/or metabolic bariatric surgery. The focus should be on preserving muscle mass, functional capacity, and quality of life, rather than weight loss alone. Effective management of obesity in older adults should focus on individualized, multidisciplinary strategies that balance the benefits of weight reduction against the risks of sarcopenia, malnutrition, and loss of independence.