TOPLINE

Children and adolescents with obesity who received a combination of drugs and structured lifestyle treatments achieved the largest short-term reductions in BMI.

METHODOLOGY

• Researchers conducted a systematic review and network meta-analysis, searching literature databases through June 2025, to assess obesity treatments that worked best for young people.
• The final analysis included 42 randomized clinical trials involving 3835 participants aged 10-19 years with obesity (median age, 14.5 years; 59.2% female individuals); most studies followed up participants for 6-12 months.
• Interventions included structured behavioral and lifestyle treatments (standard and intensive); counseling; the use of drugs such as GLP-1 receptor agonists, metformin, orlistat, and phentermine-topiramate; and the combination of drugs with lifestyle treatment.
• The primary outcomes were changes in BMI and BMI z-score, and the secondary outcomes were changes in waist circumference, fat mass, and lean mass. Interventions were ranked in the order of effectiveness.
• The risk for bias was judged low in 21.4% of trials and high in 26.2%, and 52.4% had some concerns. The overall certainty of evidence ranged from very low to high.

TAKEAWAY

• Across 35 trials that reported BMI and 19 that reported BMI z-score, drugs produced larger reductions when paired with lifestyle treatments than when used alone. For instance, combining metformin with behavior and lifestyle treatment was linked to a reduction of 4.95 in BMI, whereas the use of metformin alone showed no significant change in BMI.
• Semaglutide plus counseling was associated with the largest reduction in BMI (mean difference [MD], -8.31) and BMI z-score (MD, -1.80); the estimate came from a single trial.
• Behavioral and lifestyle treatment alone was associated with reductions in BMI (MD, -3.85; five studies) and BMI z-score (MD, -0.89; one study), matching or exceeding the effect of certain drugs alone.
• Combination treatments were linked to the largest reductions in fat mass (21 studies).

IN PRACTICE

“[The] finding suggests that even combining medication with basic counselling was still superior to giving medication without any lifestyle support,” the researchers wrote. “Medications should never be prescribed in isolation; a person-centered, family-centered approach matching treatment intensity to medical need is essential,” they added.

SOURCE

This study was led by Ke-wen Wan, MSc, of Hong Kong Baptist University in Hong Kong SAR, China. It was published online on June 22 in JAMA Pediatrics.

LIMITATIONS

Results for newer drugs were based on only a few small trials. The wide age range may have obscured differences by age or stage of puberty. Most trials did not report data on race, ethnicity, or income.

DISCLOSURES

This study received funding from grants from Hong Kong Baptist University. One author reported serving on professional boards related to childhood obesity and receiving travel grants or reimbursements, and another author reported receiving consulting fees from pharmaceutical companies. Detailed disclosures are available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.