Lifestyle modification (LM) alone is the primary treatment of childhood obesity, but has limited success. Off-label use of medications for weight-loss in youth is increasing secondary to the limited availability of FDA-approved medications. Although topiramate has been used as young as 2, the specific effect on weight-loss in younger children has not been examined. The objective of this study was to determine if obese children who were prescribed topiramate for any reason could lose weight and reduce their BMI z-score.


A retrospective study of patients ages 2-21 years with BMI ≥ 95th% treated in a pediatric weight management or NAFLD clinic from January 1, 2015-December 31, 2018 and prescribed topiramate. Patients with medical illness or medications that impacted weight were excluded.


109 youth (13.21± 3.76 years), female (67.89 %), black (40.37 %) were prescribed topiramate for migraine prophylaxis (63.3 %) or weight-loss (24.77 %). At 3-6 months in ages 14-21 years there was a mean reduction in BMI z-score of -0.044 ± 0.036, p=0.010 and mean weight change of -2.97 ± 2.87 kg, p=0.017. The greatest weight reduction (-3.66 kg SD 4.71, p=0.028) seen at 1-3 months in ages 14-21 years if topiramate was prescribed specifically for weight-loss.


Topiramate + LM was associated with BMI z-score reduction and weight-loss in youth with obesity, the greatest effects were noted when prescribed in adolescents specifically for weight-loss. Randomized controlled clinical trials examining efficacy of topiramate in children are needed.