Context: The efficacy of treatments for pediatric obesity remains unclear.

Objective: We performed a systematic review of randomized trials to estimate the efficacy of nonsurgical interventions for pediatric obesity.

Data Sources: Librarian-designed search strategies of nine electronic databases from inception until February 2006, review of reference lists from published reviews, and content expert advice provided potentially eligible studies.

Study Selection: Eligible studies were randomized trials of overweight children and adolescents assessing the effect of nonsurgical interventions on obesity outcomes.

Data Extraction: Independently and in duplicate, reviewers assessed the quality of each trial and collected data on interventions and outcomes.

Data Synthesis: Of 76 eligible trials, 61 had complete data for meta-analysis. Short-term medications were effective, including sibutramine (random-effects pooled estimate of body mass index (BMI) loss of 2.4 kg/m² (95% confidence interval (CI) 1.8, 3.1, proportion of between-study inconsistency not due to chance (I²) = 30%) and orlistat (BMI loss 0.7 kg/m² (CI 0.3, 1.2), I² = 0%). Trials that measured the effect of physical activity on adiposity (i.e. percent body fat, fat free mass) found a moderate treatment effect (effect size -0.52, CI -0.73, -0.30, I² = 0%) while trials measuring the effect on BMI found no significant effect (effect size -0.02, CI -0.21, 0.18, I²= 0%), but reporting bias may explain this finding. Combined lifestyle interventions (24 trials) led to small changes in BMI.

Conclusions: Limited evidence supports the short-term efficacy of medications and lifestyle interventions. The long-term efficacy and safety of pediatric obesity treatments remains unclear.