Obesity Management Pharmacotherapies and Lifestyle Treatment for Pediatric Obesity Management: A Systematic Review and Network Meta-Analysis
Abstract
Importance: Pediatric obesity is a global health challenge. Although health behavior and lifestyle treatment (HBLT) is foundational, the comparative effectiveness of HBLT, various pharmacotherapies, and their combinations remains unclear.
Objective: To compare the effectiveness of obesity management pharmacotherapies, structured lifestyle treatment, and their combinations on weight management outcomes in children and adolescents living with obesity.
Data sources: A systematic search was conducted in 4 electronic databases (Embase, CENTRAL, PsycINFO, and PubMed) from inception to June 17, 2025.
Data selection: Randomized clinical trials (RCTs) involving children and adolescents (aged 10-19 years) with obesity were selected. Interventions included lifestyle treatment (HBLT and counseling), obesity management pharmacotherapies (glucagon-like peptide-1 receptor agonists, metformin, orlistat, phentermine topiramate), or their combination vs control.
Data extraction and synthesis: Data were extracted and validity assessed according to PRISMA guidelines. A random-effects network meta-analysis was used to pool data. Meta-regression was used to explore outcome moderators.
Main outcomes and measures: Primary outcomes were body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and BMI z score; secondary outcomes included waist circumference (WC), fat mass (FM), and lean mass (LM).
Results: A total of 42 RCTs with 3835 participants (median [IQR]…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,835 participants or records.
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