While HBLT alone remained an essential foundation for effective weight management—producing meaningful weight loss and improvements in body composition—the addition of anti-obesity medications resulted in the largest reductions in
BMI and BMI z scores. These findings highlight that
lifestyle interventions and pharmacotherapy work synergistically and should be considered complementary, core components of adolescent obesity treatment, with ongoing monitoring of long-term safety and sustainability.
The study, published in JAMA Pediatrics, was conducted by Ke-wen Wan and colleagues from the Academy of Wellness and Human Development, Faculty of Arts and Social Sciences, Hong Kong Baptist University, Hong Kong SAR, China.
Pediatric obesity is a growing global health concern linked to long-term metabolic, cardiovascular, and psychological complications. While lifestyle-based interventions are considered first-line treatment, the comparative effectiveness of these approaches, obesity medications, and their combinations has remained unclear.
To investigate this, researchers conducted a systematic review and network meta-analysis of 42 randomized clinical trials involving 3,835 children and adolescents aged 10–19 years with obesity. The median participant age was 14.5 years, and 59.2% were female.
The study compared lifestyle interventions, including health behavior and lifestyle treatment (HBLT) and counseling, obesity medications such as GLP-1 receptor agonists, metformin, orlistat, and phentermine-topiramate, as well as combined treatment strategies. Outcomes assessed included BMI, BMI z score, waist circumference, fat mass, and lean mass.
Key Findings:
- Combined pharmacotherapy and lifestyle treatment produced the greatest improvements across all obesity-related outcomes.
- Semaglutide combined with counseling was associated with the largest reduction in BMI (mean difference: −8.31) and BMI z score (mean difference: −1.80) compared with control groups.
- The estimates for semaglutide plus counseling were based on a limited number of studies.
- All obesity medications were more effective when combined with lifestyle treatment than when used as standalone therapies.
- Combination therapy resulted in significantly greater reductions in BMI and BMI z scores than the same medications administered alone.
- Health behavior and lifestyle treatment (HBLT) alone was associated with substantial reductions in BMI (mean difference: −3.85) and BMI z score (mean difference: −0.89) compared with controls.
- Adolescents receiving lifestyle treatment without medications achieved meaningful weight-loss benefits, underscoring the importance of behavioral and lifestyle interventions as a core component of obesity management.
The researchers concluded that combining obesity medications with structured lifestyle treatment provides the greatest short-term weight-loss benefits for adolescents with obesity. They emphasized that lifestyle treatment is a core component of care that enhances the effectiveness of pharmacotherapy. Further studies are needed to assess the long-term safety, sustainability, and durability of these treatment strategies.
Reference:
Wan K, Lei EF, Liu Y, et al. Obesity Management Pharmacotherapies and Lifestyle Treatment for Pediatric Obesity Management: A Systematic Review and Network Meta-Analysis. JAMA Pediatr. Published online June 22, 2026. doi:10.1001/jamapediatrics.2026.2248
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