This systematic review and network meta-analysis compared the effectiveness of health behavior and lifestyle treatment (HBLT), obesity management pharmacotherapies (GLP-1 receptor agonists, metformin, orlistat, phentermine-topiramate), and their combinations on BMI, BMI z score, waist circumference, fat mass, and lean mass in children and adolescents aged 10–19 years with obesity across 42 RCTs (n=3,835) over typically 6–12 months.
Semaglutide plus counseling produced the largest BMI reduction (MD −8.31; 95% CI −12.33 to −4.28) and BMI z score reduction (MD −1.80; 95% CI −2.39 to −1.21). All pharmacotherapies were more effective when paired with lifestyle treatment. HBLT alone also showed meaningful reductions vs. control (BMI MD −3.85; BMI z score MD −0.89).
- Semaglutide combination estimates were based on a limited number of studies, reducing precision. - Outcomes reflect short-term follow-up (typically 6–12 months); long-term safety and sustainability data are limited. - Full text was under embargo; findings are based on the published abstract only.
Combine pharmacotherapy (especially semaglutide) with structured lifestyle treatment for the greatest short-term weight reduction in adolescents with obesity. HBLT alone still delivers clinically meaningful BMI reduction and should remain the foundation of any treatment plan.
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