To evaluate the efficacy and safety of orlistat, glucagon-like peptide-1 receptor agonists (GLP-1RA), and the combination of phentermine and topiramate in the treatment of childhood obesity.Relevant literature on anti-obesity drug treatments for children was searched in databases including China National Knowledge Infrastructure, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, PubMed, Embase, Web of Science, and Cochrane Library, with the search time frame spanning from the inception of each database to April 24, 2025. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. The quality of the included literature was evaluated using the Cochrane bias risk assessment tool, meta-analysis was conducted using Revman 5.3 software. Heterogeneity was assessed. The outcome indicators were the weight loss (body weight and body mass index) and improvement of metabolic indicators (low-density lipoprotein cholesterol and blood glucose) by anti-obesity medications, as well as related adverse events.According to the inclusion and exclusion criteria, a total of 21 articles were included, involving 21 randomized controlled trials with a total of 2 186 patients. Orlistat treatment demonstrated lower body weight and body mass index compared to the control group after 6 months [:-0.29 (-0.55--0.04) and -0.34 (-0.60--0.09),∶0 and 4%, both<0.05]. After three months of treatment with orlistat, both low-density lipoprotein cholesterol and fasting blood glucose levels were lower than those in the control group (both<0.05). Orlistat can increase the risk of oily bowel movements (=6.35, 95%: 4.02-10.05), fecal incontinence (=12.39, 95%: 2.29-66.89), abdominal bloating (=2.55, 95%: 1.42-4.58), and abdominal pain (=1.98, 95%: 1.25-3.13). GLP-1RA(liraglutide or semaglutide) showed lower body weight and body mass index compared to controls after 12 months of treatment [:-0.41(-0.61--0.22) and -0.39(-0.62--0.16), bothwere 0, both<0.05]. After 6 and 12 months of treatment with GLP-1RA, fasting blood glucose levels were lower than those in the control group (both<0.05). GLP-1RA can increase the risk of constipation (=3.98, 95%: 1.05-15.09), nausea (=2.62, 95%: 1.92-3.58), vomiting (=4.19, 95%: 2.73-6.42), and abdominal pain (=1.65, 95%: 1.04-2.62). After 12 weeks of treatment, both phentermine monotherapy (mean difference=-1.4 kg) and phentermine combined with topiramate (mean difference=-3.9%) resulted in lower weight compared to the placebo group (both<0.05), with a low incidence of serious adverse events.Orlistat, GLP-1RA (liraglutide and semaglutide), fenfluramine combined with topiramate demonstrate favorable efficacy and safety profiles in the treatment of childhood obesity. Objective: Methods: Results: Conclusion: SMD I P P RR CI RR CI RR CI RR CI SMD I P P RR CI RR CI RR CI RR CI P2 2
