Pharmacological interventions for the management of children and adolescents living with obesity—An update of a Cochrane systematic review with meta‐analyses

Importance: The effectiveness of anti-obesity medications for children and adolescents is unclear.Objective: To update the evidence on the benefits and harms of anti-obesity medication.Data Sources: Cochrane CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP (1/1/16-17/3/23).Study Selection: Randomized controlled trials >= 6 months in people <19 years living with obesity.Data Extraction and Synthesis: Screening, data extraction and quality assessment conducted in duplicate, independently.Main Outcomes and Measures: Body mass index (BMI): 95th percentile BMI, adverse events and quality of life.Results: Thirty-five trials (N = 4331), follow-up: 6-24 months; age: 8.8-16.3 years; BMI: 26.2-41.7 kg/m(2). Moderate certainty evidence demonstrated a -1.71 (95% confidence interval [CI]: -2.27 to -1.14)-unit BMI reduction, ranging from -0.8 to -5.9 units between individual drugs with semaglutide producing the largest reduction of similar to 5.88 kg/m(2) (95% CI: similar to 6.99 to similar to 4.77, N = 201). Drug type explained similar to 44% of heterogeneity. Low certainty evidence demonstrated reduction in 95th percentile BMI: similar to 11.88 percentage points (95% CI: similar to 18.43 to similar to 5.30, N = 668). Serious adverse events and study discontinuation due to adverse events did not differ between medications and comparators, but medication dose adjustments were higher compared to comparator (10.6% vs 1.7%; RR = 3.74 [95% CI: 1.51 to 9.26], I-2 = 15%), regardless of approval status. There was a trend towards improved quality of life. Evidence gaps exist for children, psychosocial outcomes, comorbidities and weight loss maintenance.Conclusions and Relevance: Anti-obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event.