Sarcopenia, as defined by the European Working Group on Sarcopenia Older People [EWGSOP (2018)], is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, and its diagnosis requires documentation of low muscle strength and low muscle mass. Poor physical performance is used as a criterion for classifying the severity of sarcopenia (1). Since sarcopenia includes both loss of muscle mass and muscle strength, it is considered in the category of muscle diseases with an ICD-10-CM Diagnosis Code (2).

Sarcopenia, which is seen in approximately 10–16% of the older population in the world, progresses without obvious symptoms at an early stage, like many chronic diseases; 15% of individuals over the age of 65 and 50% of those over the age of 80 suffer from sarcopenia (3). Sarcopenia, a major public health concern responsible for significant economic burden, is projected to become increasingly prevalent over the next 30 years. The older population represent the most commonly affected risk group (4, 5). Sarcopenia is a complex and progressive syndrome in which neurological, endocrine, and immune mechanisms play a role as well as aging. Ideal support of nutritional needs and muscle restructuring with resistance exercises are the most effective interventions in the treatment of sarcopenia, and it has been reported that studies on the use of drugs such as ACE inhibitors are ongoing (6, 7).

If the common decline in muscle mass with aging is overlooked and preventive measures are not implemented, it will inevitably lead to reduced physical performance, worsening balance problems, and an increased risk of falls (8–11). Nevertheless, by raising awareness and providing sufficient social and medical support, it is possible to promote healthy aging through the prevention of sarcopenia-related complications (12). Although it was previously defined only as loss of muscle mass due to aging, it has now been shown to accompany conditions like cancers and chronic diseases (e.g., cardiovascular and cerebrovascular). Insufficient protein-calorie intake, low physical activity levels can contribute to sarcopenia so it is important to closely monitor muscle strength and muscle mass in risk groups (13–15). As sarcopenia severity increases, individuals at risk experience reduced physical performance, limited mobility, balance issues, head and bodily injuries, bleeding, and fractures that can be fatal due to falls. It is reported that conditions such as obesity, malnutrition, and vitamin D deficiency are associated with the development of sarcopenia, a decrease in muscle mass causes an increase in fat mass, and insufficient protein and energy intake prepares the ground for malnutrition (16–18).

In aging world there appears to a need for primary health care professionals to take an active role in the management of sarcopenia. There are primary care studies on this subject around the world, and according to the current literature, the interest of researchers in this subject is increasing day by day (19, 20). Raising awareness, especially among health professionals, that sarcopenia can be prevented and treated through nutritional support, resistance training, and structured exercise will greatly improve quality of life and help reduce the overall healthcare burden (1, 7, 11, 21).

Providing health care services at the primary care level offers family physicians a valuable opportunity to prevent diseases and make early diagnosis. While structured training programs and clinical guidelines enhance family physicians’ ability to manage various conditions, sarcopenia remains underrecognized and undertreated.

Research suggests that many family physicians, despite being the initial healthcare contact for patients, have limited awareness and understanding of sarcopenia, contributing to its frequent underdiagnosis and insufficient management (19, 22). In this context, there is a need to increase the awareness and knowledge of family physicians about sarcopenia. In addition, providing the necessary equipment for the diagnosis of sarcopenia in primary care institutions can be a practical and cost-effective public health strategy to protect and promote health in aging societies. Due to the critical importance of early diagnosis and treatment of sarcopenia in terms of protecting and improving individual and community health, the availability of applicable and effective screening tools in primary care is crucial. However, many prominent studies in the literature highlight significant limitations that complicate this process in primary care. At this point, tools suitable for screening in primary health care settings are not sufficient (23). While the SARC-F questionnaire is frequently used due to its simplicity and low cost, and although basic questions (e.g., strength, assistance with walking, rising from a chair, climbing stairs, and falls) can be self-reported, it has been shown to lack sufficient sensitivity to detect sarcopenia in primary care settings (24). However, due to the high specificity of SARC-F, this tool was concluded to be preferred to use to exclude sarcopenia rather than to diagnose it (25).

One of the most important reasons why family physicians are not effective in the diagnosis of sarcopenia in primary care is the impracticality of the recommended diagnostic tools (26). Although dual-energy x-ray absorptiometry (DXA) to measure bone mineral density and assess body composition and bioelectrical impedance analysis (BIA) to assess body fat and lean mass are effective tools, their high cost, accessibility difficulties, and requirement of trained personnel make them impractical for use in primary care (27). Considering all these options, it may be more appropriate to use more practical tools such as hand grip test in primary care in sarcopenia assignment (28). The recently developed Sarcopenia Scoring Assessment Models (SarSA-Mod) are recommended as a viable option for diagnosis in primary care (29).

Since sarcopenia is often observed concurrently in many patients requiring palliative care, incorporating more comprehensive coverage of palliative care alongside sarcopenia in both undergraduate and postgraduate curricula may significantly enhance awareness and knowledge levels (30, 31).

This study aims to conduct the first survey to assess the awareness, knowledge, and competency levels of Turkish family physicians regarding sarcopenia management. The broader goal is to inform health authorities about the need for efficient strategies to raise sarcopenia awareness in primary care and improve management outcomes.

Our research on sarcopenia awareness, knowledge, and clinical practices of family physicians in Türkiye demonstrated notably low familiarity with the concept of sarcopenia with only a small fraction reporting formal training in this subject. Supporting our assumption, the presence of individuals diagnosed with sarcopenia in the immediate environment and the receipt of relevant training revealed a significant difference in knowledge and awareness between the groups. In the presented study, most participants had not previously received training on sarcopenia or palliative care.

In addition, the ability to recognize diagnostic criteria and use sarcopenia-specific tools was significantly below the expected levels. Limited exposure to specialized diagnostic tools (such as grip strength tests or gait assessments) in general practice may reduce familiarity. Furthermore, without standard definitions or attainable screening tools, sarcopenia remains less visible in everyday clinical workflows (23, 24, 33). The complexity and resource requirements of many diagnostic tools (e.g., DEXA and BIA) hinder their adoption in general practice. While measuring handgrip strength is inexpensive and practical, equipment such as dynamometers is not widely available in primary care settings, and alternatives such as chair stand or gait speed tests, despite their simplicity, are underutilized (24, 27, 28).

The findings of the presented study point to a fundamental issue that sarcopenia is underrecognized or overlooked in primary care. Like many healthcare professionals from different regions (34, 35). The findings of the presented study also revealed the need for training of family physicians on sarcopenia. Promisingly, the widespread rejection of the phrase that sarcopenia is inevitable among family physicians in the current study points to a strong basic understanding and, importantly, a professional readiness to take responsibility for sarcopenia prevention and proactively incorporate preventive strategies into routine primary care. Regional and professional differences in familiarity with sarcopenia diagnostic tools often stem from variation in training opportunities, the clinical prominence of geriatric medicine, and standardized practice environments. For instance, specialists such as geriatricians and rehabilitation physicians are more likely to learn and apply sarcopenia concepts regularly, whereas primary care providers and family physicians often have less exposure (19). Compared to earlier studies by Reijnierse (34) and Yeung (35), knowledge on this issue appears to be more widespread among our respondents, suggesting some progress in awareness. However, the proportion of physicians who reported having preliminarily diagnosed sarcopenia in the past year remains remarkably low highlighting a persistent gap between theoretical understanding and clinical application.

Initially, training interventions yield substantial gains in healthcare professionals’ belief in the preventability of sarcopenia and their familiarity with its diagnostic criteria. However, it cannot be asserted that the impact of one-time training interventions that are not supported by feedback and continuous training will be sufficient. This pattern aligns with Reijnierse et al.’s (34) work, where sarcopenia training significantly enhanced conceptual understanding and diagnostic tool usage specifically walking speed, grip strength, and muscle mass measurement. Yet, although this reflects positive learning outcomes, it is concerning that these newly acquired competencies appear to decrease unless actively reinforced. Yeung et al.’s (35) multicenter study similarly demonstrated dramatic immediate improvements in both sarcopenia awareness and the correct application of gender-specific grip strength thresholds immediately after training. However, 6 months later, these competencies had diminished markedly, highlighting a significant disparity between short-term learning and long-term retention” (35). Guralnik et al.’s (19) survey underscores a significant gap in the recognition and application of sarcopenia-related terminology among internists and family medicine physicians. A substantial proportion of these practitioners report limited familiarity with the term “sarcopenia,” and many do not consistently employ standardized diagnostic criteria. Instead, they often default to nonspecific terms such as “muscle loss” or “deconditioning,” which lack precise clinical definitions. This trend highlights a broader issue of conceptual ambiguity and a lack of standardization in the diagnosis and management of sarcopenia within primary care settings. The absence of a unified definition and diagnostic framework for sarcopenia may contribute to its underdiagnosis and undertreatment, emphasizing the need for enhanced education and consensus among healthcare providers.

In the current study, most family physicians were identified as mid-career professionals, and only a minority had completed formal residency in family medicine. Ter Beek et al.’s (36) multicenter study similarly highlighted that dietitians are often early in their professional journeys, and few are active in primary care. Both data sets converge on a critical finding: comprehensive understanding of sarcopenia remains limited. Interestingly, those working in institutional settings, such as hospitals or long-term care facilities, had a relatively stronger knowledge base. Importantly, however, neither years of experience nor professional tenure were reliable predictors of sarcopenia awareness (36). These findings suggest that clinical exposure alone does not guarantee preparedness in recognizing or managing sarcopenia. Therefore, effective educational strategies must reach across the spectrum of experience and workplace settings, ensuring that regardless of background or career stage, healthcare professionals gain the depth of understanding required to address sarcopenia proactively in their practice.

In current study it reveals that witnessing sarcopenia cases in the immediate vicinity strengthens the level of awareness and knowledge on the subject. As a matter of fact, in our study, the presence of individuals diagnosed with sarcopenia in the immediate environment revealed a positive significant difference in terms of sarcopenia management competence scores. A study by Kiss et al. (37) on healthcare workers in cancer clinics showed that there is a high level of awareness and knowledge about cancer-associated sarcopenia. In their study, majority of the clinicians were able to accurately evaluate the definition of sarcopenia and its importance in cancer treatment (37). These results can be interpreted to mean that malnutrition is common in cancer patients and oncologists are familiar to sarcopenia.

Our study suggests that while awareness of sarcopenia in obese individuals is improving among family physicians, actual diagnostic activity remains limited. Greater clarity in definitions, improved education, and better screening mechanisms could help bridge this gap—ultimately promoting more timely identification and management of sarcopenic obesity. The findings of Nimphan et al. (38) underscore the importance of recognizing sarcopenia even in the context of obesity among chronic stroke patients. This challenges the common assumption that higher body weight confers protection against muscle degeneration. Correspondingly, our survey of family physicians revealed that approximately half did not believe overweight or obese individuals are less prone to sarcopenia compared to their normal-weight counterparts. Moreover, there was near-unanimous agreement that sarcopenia contributes to higher hospitalization rates and elevates healthcare costs (38).

A major challenge complicating both diagnosis and awareness is the lack of a universally accepted definition of sarcopenia. This variability likely contributes to inconsistencies in identification and reporting across different settings. Addressing this issue requires not only broader consensus on diagnostic criteria but also enhanced training and practical tools to support clinicians in recognizing sarcopenia—particularly in patients who also present with obesity. The absence of universally adopted diagnostic criteria—despite efforts by groups like EWGSOP, Asian Working Group For Sarcopenia (AWGS), and Foundation for the National Institutes of Health (FNIH)—leads to fragmentation in both teaching and clinical practice. Different settings may favor one tool over another, leading to inconsistent awareness and use (39).

When the literature is reviewed, it is seen that although there are some studies conducted in clinics in Türkiye, especially on the older population who are in the sarcopenia risk group, there are also a small number of community-based prevalence studies and the prevalence of sarcopenia may differ according to the diagnostic criteria used and studies have shown that not focusing on this issue, not knowing diagnostic criteria and not using tools for diagnosis are barriers to ideally management of sarcopenia (40–42). In several studies small part of participants correctly answered the diagnostic criteria related items compared to current study (19, 35, 36). At this point, there is also a need for a national definition standard to accurately determine the prevalence of sarcopenia in Türkiye. Since the definition of sarcopenia cannot be standardized at the international level, it is inevitable that there will be difficulties in diagnosis and differences between diagnosis (43).

Sarcopenia can be attenuated or even reversed through a thoughtful combination of physical training and diet optimization. Implementing such integrative strategies in clinical practice carries significant potential to preserve mobility, autonomy, and quality of life in aging populations (7, 12, 15). The effectiveness of dietitian participants in nutrition monitoring and energy planning and the fact that physiotherapists are more effective in physical performance and function evaluation points reveal the need for a multidisciplinary approach in the management of sarcopenia. The adoption of this approach by primary care physicians can be considered an important factor for success in the management of sarcopenia (44). Our study reveals a limited level of awareness regarding key interventions for sarcopenia, such as resistance training, vitamin D supplementation, and protein support, among family physicians. This mirrors previous research indicating that familiarity with sarcopenia remains limited among internists and primary care practitioners, whereas geriatricians and rehabilitation specialists tend to display greater recognition of the condition (19). Interestingly, the few physicians in our sample who had undergone palliative care training often demonstrated stronger competency in sarcopenia management. This aligns with the broader notion that targeted clinical education especially when it relates to older adults’ care can significantly enhance practitioners’ readiness to address sarcopenia. Notably, earlier surveys highlight that a small minority of internal medicine and family physicians report familiarity with the term “sarcopenia,” while geriatricians and physical medicine specialists report considerably higher awareness (19, 34). This underscores a systemic gap: although the condition is prevalent in older adult populations seen in primary and internal care, it is not yet fully embraced within routine professional practice. Compounding this issue, even among geriatrics clinicians, there is evidence that proficiency in related geriatric assessments such as identifying malnutrition risk or fall vulnerability often falls short of expectations (45, 46) Similarly, multidisciplinary reviews from various countries highlight widespread gaps in knowledge about sarcopenia across health professions, except for oncology specialists who appear comparatively better informed (22).

Collectively, our findings and those from the literature show that positive attitudes toward sarcopenia may exist, but they are not consistently matched by actionable knowledge or practice. Primary healthcare inherently relies on collaborative teamwork, and nurses play a critical role in the early recognition and management of sarcopenia. A study from Thailand reported that over half of the participating nurses correctly identified the term “sarcopenia,” yet their practical awareness around its management remained limited (47). This finding underscores that healthcare outcomes improve when structured, cross-disciplinary frameworks support knowledge translation into action. Education and collaborative clinical environments appear essential particularly in primary care settings where nurses often serve as frontline responders to geriatric syndromes.

Undoubtedly, for success in the fight against sarcopenia, there is a need for healthcare providers to increase the knowledge and awareness of especially risky patient groups through effective communication and patient education.

This study has some limitations. Although the number of respondents met and slightly exceeded the statistical requirement for evidential value, we acknowledge that a larger sample size would have further strengthened the representativeness of the findings. Several elements may have influenced participation in the study. The voluntary nature of involvement and the absence of any obligation to respond may have contributed to a lower response rate. In addition, limited awareness regarding the importance of the research topic and intrinsically lower motivation within the field may have played a role. Moreover, the demanding workload and time constraints typically faced by primary care physicians may have further affected participation levels. Furthermore, reliance on an online survey platform may have posed accessibility challenges such as infrastructure limitations and unstable internet connectivity that could have hindered participation from certain individuals. Since there is no scale developed or validated in Türkiye on this subject, the data collection form was created by the researchers and no scores could be assigned to the answers of the participants. Taken together, these factors can be considered to have contributed to the underrepresentation of certain regions in the study. Nonetheless, this study represents the first research conducted among primary care family physicians in Türkiye on this topic. Nearly all physicians participating from different regions confirmed an increased awareness of sarcopenia through the survey questions. Furthermore, the study enabled the identification of educational needs and the challenges in the field. Therefore, we believe these findings can contribute to raising awareness and help guide future improvement plans and strategic initiatives in this field.

In conclusion, the findings of this study revealed the need for raising awareness about sarcopenia in primary care in Türkiye by pre- and post-graduate trainings. Family physicians should be supported by guidelines suitable for primary care and by equipment support for screening and diagnosis. Achieving a global consensus on the threshold values used in the diagnosis of sarcopenia and adapting them to societies ideally, infrastructure studies for the establishment of multidisciplinary support teams in the management of sarcopenia, the use of informative public spots on all media tools and social platforms to increase the awareness of the society, and the motivated efforts of physicians in this regard can provide significant gains in the fight against sarcopenia. We believe that studies focusing on sarcopenia will make a positive contribution in the context of preventing deterioration in quality of life due to falls and fractures, especially in the older population, and reducing health costs due to hospitalizations.