“Sarcopenic obesity” describes the confluence of low muscle mass and/or strength with obesity in older adults, thought to contribute to increased risk for poor health outcomes compared to either condition alone. Despite almost 20 years of research into sarcopenic obesity, it currently lacks a consensus definition and this is a barrier to research and clinical investigations. This narrative review summarises current evidence of the role of sarcopenic obesity in age-related declines in musculoskeletal and cardiometabolic health, and potential treatment strategies. Research to date suggests that sarcopenic obesity, when defined by low muscle strength, contributes to significantly increased risk for poor physical function and possibly falls. It is likely that sarcopenic obese individuals have reduced bone quality relative to obese alone, and combined with an increased falls risk, may be predisposed to increased risk for fractures. Low muscle mass in obesity may also be associated with increased risk for cardiovascular disease, type II diabetes and mortality, however prospective studies are required to confirm the effects of sarcopenic obesity on musculoskeletal and cardiometabolic health in older adult populations. Similarly, large-scale randomised controlled trials are needed to clarify the most effective methods for reducing prevalence and incidence of sarcopenic obesity, but it is likely that lifestyle modification interventions which combine aerobic and resistance training, caloric restriction, and protein and/or vitamin D supplementation, may be most effective.