Weight Reduction in Behavioral and Pharmacological Randomized Controlled Trials in Children and Adolescents: A systematic review and meta-analysis
Location
Lions Eye Building
Presentation Date
30-10-2025 11:00 AM
End Date
30-10-2025 1:00 PM
Description
Background: Intensive health behavior lifestyle treatment (IHBLT) is a critical component of pediatric obesity care.1 The American Academy of Pediatrics (AAP) 2023 Clinical Practice Guideline (CPG) recommends at least 26 contact hours of IHBLT over the course of 3 to 12 months to achieve clinically significant weight reduction.1 Pharmacologic therapy, including newly approved GLP-1 agonists, is also recommended as an adjunctive treatment option for eligible youth 12 years and older.1,2 However, the expected rate of weight change with IHBLT and pharmacotherapy remains unclear, indicating an information gap for families and healthcare providers as they review treatment options.
Methods: We systematically reviewed randomized controlled trials of IHBLT ≥26 hours and obesity pharmacotherapy with health behavior lifestyle treatment in youth (ages 2–18) as reported in the 2023 AAP CPG, U.S. Preventive Services Task Force (USPSTF) recommendation statement, and PubMed/MEDLINE (2019–2025). Pharmacotherapies were categorized as “first generation” (e.g., metformin, orlistat) vs. “second generation” (e.g., liraglutide, semaglutide). Random-effects meta-analyses estimated pooled effects (weight, BMI, BMI z-score). Reduction in weight and BMI z-score are reported over a 1-year period. The following results are an interim analysis.. The following results are an interim analysis.
Results: Preliminary analyses included 18 studies of first generation pharmacotherapies, 8 of second generation pharmacotherapies, and 22 of IHBLT with BMI outcomes; 14 first generation pharmacotherapy studies, 7 second generation pharmacotherapy studies, and 15 IHBLT studies were analyzed with weight outcomes; and 15 first generation pharmacotherapy studies, 1 second generation pharmacotherapy study, and 29 IHBLT studies with BMI z-score outcomes. Pooled estimates showed decreases in BMI of –1.36 kg/m² (SE 0.22 kg/m², p = 0.00001) with first generation pharmaceuticals, –1.53 kg/m² (SE ± 0.52 kg/m², p = 0.022) with second generation pharmaceuticals, and –0.75 kg/m² (SE ± 0.23 kg/m², p = 0.004) with IHBLT alone. For weight, reductions were –2.88 kg (SE ± 0.80 kg, p = 0.003) with first generation pharmaceuticals and –4.25 kg (SE ± 1.09 kg, p = 0.008) with second generation pharmaceuticals, whereas IHBLT was not associated with significant change (–0.41 kg, p = 0.45). IHBLT reduced BMI z-score by –0.24 (SE ± 0.05, p < 0.0001), and first generation pharmacotherapies reduced BMI z-score by –0.15 (SE ± 0.05, p = 0.006).
Conclusion: These findings highlight the amount of average weight loss over 1-year from IHBLT and pharmacotherapy. Future analysis should examine sub-group differences by age, BMI status, and other patient characteristics. Together, these analyses will help inform clinical decision-making by providing evidence-based expectations to patients, families, and healthcare providers for the degree of weight loss achievable through each approach.
Recommended Citation
Abbenante, Ethan, "Weight Reduction in Behavioral and Pharmacological Randomized Controlled Trials in Children and Adolescents: A systematic review and meta-analysis" (2025). Medical Student Research Poster Symposium. 1.
https://digitalscholar.lsuhsc.edu/sommrd/2025MSRD/session2/1
Abstract
Weight Reduction in Behavioral and Pharmacological Randomized Controlled Trials in Children and Adolescents: A systematic review and meta-analysis
Lions Eye Building
Background: Intensive health behavior lifestyle treatment (IHBLT) is a critical component of pediatric obesity care.1 The American Academy of Pediatrics (AAP) 2023 Clinical Practice Guideline (CPG) recommends at least 26 contact hours of IHBLT over the course of 3 to 12 months to achieve clinically significant weight reduction.1 Pharmacologic therapy, including newly approved GLP-1 agonists, is also recommended as an adjunctive treatment option for eligible youth 12 years and older.1,2 However, the expected rate of weight change with IHBLT and pharmacotherapy remains unclear, indicating an information gap for families and healthcare providers as they review treatment options.
Methods: We systematically reviewed randomized controlled trials of IHBLT ≥26 hours and obesity pharmacotherapy with health behavior lifestyle treatment in youth (ages 2–18) as reported in the 2023 AAP CPG, U.S. Preventive Services Task Force (USPSTF) recommendation statement, and PubMed/MEDLINE (2019–2025). Pharmacotherapies were categorized as “first generation” (e.g., metformin, orlistat) vs. “second generation” (e.g., liraglutide, semaglutide). Random-effects meta-analyses estimated pooled effects (weight, BMI, BMI z-score). Reduction in weight and BMI z-score are reported over a 1-year period. The following results are an interim analysis.. The following results are an interim analysis.
Results: Preliminary analyses included 18 studies of first generation pharmacotherapies, 8 of second generation pharmacotherapies, and 22 of IHBLT with BMI outcomes; 14 first generation pharmacotherapy studies, 7 second generation pharmacotherapy studies, and 15 IHBLT studies were analyzed with weight outcomes; and 15 first generation pharmacotherapy studies, 1 second generation pharmacotherapy study, and 29 IHBLT studies with BMI z-score outcomes. Pooled estimates showed decreases in BMI of –1.36 kg/m² (SE 0.22 kg/m², p = 0.00001) with first generation pharmaceuticals, –1.53 kg/m² (SE ± 0.52 kg/m², p = 0.022) with second generation pharmaceuticals, and –0.75 kg/m² (SE ± 0.23 kg/m², p = 0.004) with IHBLT alone. For weight, reductions were –2.88 kg (SE ± 0.80 kg, p = 0.003) with first generation pharmaceuticals and –4.25 kg (SE ± 1.09 kg, p = 0.008) with second generation pharmaceuticals, whereas IHBLT was not associated with significant change (–0.41 kg, p = 0.45). IHBLT reduced BMI z-score by –0.24 (SE ± 0.05, p < 0.0001), and first generation pharmacotherapies reduced BMI z-score by –0.15 (SE ± 0.05, p = 0.006).
Conclusion: These findings highlight the amount of average weight loss over 1-year from IHBLT and pharmacotherapy. Future analysis should examine sub-group differences by age, BMI status, and other patient characteristics. Together, these analyses will help inform clinical decision-making by providing evidence-based expectations to patients, families, and healthcare providers for the degree of weight loss achievable through each approach.
Comments
Mentor: Dr. Amanda Staiano, Pennington Biomedical Research Center- Pediatric Obesity & Health Behavior Laboratory