A systematic analysis of nutritional interventions reveals that sarcopenic obesity—the simultaneous presence of excess fat and muscle loss—affects older adults through complex metabolic pathways requiring targeted macronutrient optimization. The review synthesized evidence showing that protein, carbohydrate, and fat distribution must be individually calibrated alongside resistance training to address this dual-pathology condition that increases cardiovascular disease, diabetes, and frailty risks. This finding represents a significant shift from one-size-fits-all dietary approaches toward precision nutrition for aging populations. Sarcopenic obesity affects millions globally as populations age, making this a critical public health priority. The emphasis on combined nutritional and exercise interventions reflects growing understanding that muscle preservation and fat reduction require coordinated metabolic strategies. However, the review's reliance on existing studies limits direct causal conclusions, and the heterogeneity of included interventions suggests implementation challenges. The personalized approach marks an important evolution in geriatric nutrition science, moving beyond simple calorie restriction toward targeted macronutrient therapy that addresses the unique metabolic dysfunction underlying this complex age-related condition.