Purpose <p>Sarcopenic obesity (SO), a condition characterized by the coexistence of obesity and sarcopenia, has primarily been studied in elderly populations. However, it can also affect individuals with chronic diseases. This study aims to evaluate the prevalence of SO in patients with acromegaly.</p> Methods <p>Observational, cross-sectional study, involving patients with acromegaly followed at a tertiary center and controls matched for age and sex. Health assessment questionnaire, physical tests, body composition and bone mineral density assessment, were performed in all participants. SO was diagnosed using criteria from ESPEN and EASO Consensus Statements.</p> Results <p>48 patients with acromegaly (acromegaly group – AG, 26 women, mean age 56.3 ± 11.6, mean BMI 31.3 ± 4.9) were compared to 48 controls (control group – CG, 26 women, mean age 56.7 ± 13.7, BMI 25.5 ± 4.7). Despite having greater total and appendicular lean mass, AG showed significant impairments in physical performance, particularly in strength, gait speed and balance (<i>p</i> &lt; 0.05). The prevalence of SO in the AG was 16.7%, compared to 0% in the CG (<i>p</i> = 0.006), and positively correlated with increased fat mass and impaired physical performance.</p> Conclusions <p>SO is present in patients with acromegaly and is associated with notable functional impairments despite increased muscle mass.</p>