Emerging Therapeutic Strategies for Child and Adolescent Obesity: A Narrative Review

Background/Objectives: Childhood obesity is a chronic, multifactorial disease requiring attention to biological, behavioral, psychological, family, and socioeconomic factors. This narrative review examined the integration of lifestyle, family-based, psychological, and pharmacological approaches, focusing on treatment engagement, eating disorders, attention-deficit/hyperactivity disorder (ADHD), and treatment durability. Methods: A single search interface covering PubMed/MEDLINE, Scopus, and Web of Science (the University of Turin library discovery platform) was used to identify studies published primarily from 2010 to August 2026. Pediatric trials, observational studies, systematic reviews, meta-analyses, guidelines, and public-health reports were prioritized. Results: Intensive family-based, multicomponent behavioral treatment remains the best-supported foundation of care, although psychological outcomes are infrequently assessed. Psychiatric comorbidity is heterogeneous; loss-of-control eating, emotional symptoms, ADHD, and executive-function difficulties may impair engagement in selected patients, and untreated ADHD has been associated with a slower BMI response to weight management. Professionally supervised obesity treatment containing a dietary component did not, on average, worsen eating psychopathology and reduced several related symptoms. Family participation improved outcomes, whereas logistical, socioeconomic, and psychological barriers reduced attendance. Across randomized trials, adding anti-obesity medication to behavioral treatment produced an additional, although on average modest, reduction in BMI. Semaglutide, liraglutide, and phentermine/topiramate produced larger numerical reductions than older agents in separate trials, but heterogeneity and the absence of head-to-head comparisons preclude formal ranking. Gastrointestinal adverse events were frequent with glucagon-like peptide-1 (GLP-1) receptor agonists. Pediatric trials and real-world evidence indicate partial weight regain after discontinuation, while prescribing remains limited and unequal. Conclusions: Pediatric obesity care should be phenotype-informed, multidisciplinary, and longitudinal. Pharmacotherapy can enhance BMI reduction but should complement rather than replace behavioral, psychological, and family care. Outcomes should extend beyond BMI to metabolic, psychological, functional, and long-term measures.