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Semaglutide and Phentermine-Topiramate Lead Pediatric Weight LossTwo medications show promise for weight management in children

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Key Takeaway
Semaglutide and phentermine-topiramate are top adjuncts for pediatric obesity; phentermine-topiramate offers better tolerability.

A network meta-analysis of 41 randomized controlled trials evaluated pharmacologic adjuncts to lifestyle therapy in 3,923 children and adolescents with overweight or obesity. Semaglutide and phentermine-topiramate emerged as the most effective agents for reducing BMI.

Semaglutide lowered the 95th BMI percentile by 20.40% (95% CI -24.22 to -16.58) compared with lifestyle modification alone. It also increased the likelihood of achieving a ≥5% BMI reduction by 500 per 1000 person-years and a ≥10% reduction by 399 per 1000 person-years.

Phentermine-topiramate reduced the 95th BMI percentile by 18.35% (95% CI -22.26 to -14.45). It was associated with 554 additional responders per 1000 person-years for ≥5% BMI reduction and 734 additional responders for ≥10% reduction. Liraglutide and exenatide also showed reductions, though effect sizes were not reported.

Phentermine-topiramate was noted for favorable tolerability, making it a potentially optimal adjunct to lifestyle interventions. The certainty of evidence was assessed using the GRADE approach, but specific limitations were not reported.

These findings support the use of these medications in youth, though clinicians should weigh efficacy against tolerability and individual patient factors.

How this fits prior evidence

This systematic review extends the finding that semaglutide showed the greatest weight reduction in adolescents with obesity and type 2 diabetes. It also builds upon the evidence that semaglutide and liraglutide are associated with the greatest weight reductions in patients with schizophrenia. This analysis specifically quantifies the reduction in the 95th BMI percentile for semaglutide and phentermine-topiramate in the pediatric population.

Managing weight in children and adolescents is a significant challenge that requires effective tools. A large review of 41 clinical trials looked at how different medications work when added to standard lifestyle changes, like diet and exercise. The study included data from nearly 4,000 children and teenagers to see which treatments were most effective.

The analysis found that both semaglutide and phentermine-topiramate led to a reduction in the 95th BMI percentile, which is a measure used to track weight relative to age and height. Specifically, semaglutide showed a 20.40% reduction, while phentermine-topiramate showed a 18.35% reduction. Both drugs also increased the number of children reaching significant weight loss milestones.

While both medications were linked to weight management, phentermine-topiramate was noted for having favorable tolerability. Because these results come from a network meta-analysis of multiple trials, the evidence provides a broad look at these options. Talk to a doctor to see if these treatments are right for a child's specific needs.

What this means for you:
Semaglutide and phentermine-topiramate both help children and teens manage weight alongside lifestyle changes.

Common questions

Which medications were most effective for children?

Both semaglutide and phentermine-topiramate were closely linked to weight management in children and adolescents. Semaglutide showed a 20.40% reduction in the 95th BMI percentile, while phentermine-topiramate showed a 18.35% reduction. Both medications helped more children reach weight loss goals of 5% and 10% of their body weight.

Is phentermine-topiramate safe for kids?

The study reported that phentermine-topiramate had favorable tolerability for those using it as an addition to lifestyle changes. While the study did not report specific side effects or serious adverse events, it highlighted this medication as a well-tolerated option for weight management.

How do these drugs work for weight loss?

These medications are used as adjuncts, which means they are added to lifestyle therapy like diet and exercise. The study looked at 3,923 children and adolescents to see how these additions helped them reach weight goals compared to lifestyle changes alone.

Study Details

Study typeSystematic review
Sample sizen = 399
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
AIMS: The escalating global prevalence of childhood and adolescent overweight and obesity constitutes a pressing public health issue. This network meta-analysis aimed to compare the efficacy and safety of pharmacologic interventions as adjuncts to lifestyle therapy in this population. MATERIALS AND METHODS: Randomized controlled trials (RCTs) were sourced from systematic searches of PubMed, Embase (using the OVID platform), the Cochrane Library (CENTRAL), the WHO International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov from database inception to July 28, 2025. A frequentist network meta-analysis was performed using a random-effects model. We used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to evaluate the overall certainty of evidence and categorized the interventions. RESULTS: A total of 41 RCTs (N = 3923) were included. Compared with lifestyle modification alone, semaglutide produced the largest reduction in the 95th BMI percentile (MD -20.40%, 95% CI -24.22 to -16.58), with an additional 500 and 399 patients per 1000 person-years achieving ≥ 5% and ≥ 10% BMI reduction, respectively. Phentermine-topiramate showed the next largest reduction (MD -18.35%, 95% CI -22.26 to -14.45), corresponding to 554 and 734 additional responders per 1000 person-years. Liraglutide and exenatide also significantly reduced the 95th BMI percentile compared with lifestyle modification alone, although the reductions were smaller than those achieved with semaglutide and phentermine-topiramate. CONCLUSIONS: Both semaglutide and phentermine-topiramate were closely linked to weight management, and phentermine-topiramate, with its favourable tolerability, may serve as the optimal adjunct to lifestyle interventions.
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