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Topiramate for weight reduction in adolescents with severe obesity. BACKGROUND: Medications for use as an adjunct to lifestyle modification therapy (LSM) for severe adolescent obesity are limited. Topiramate results in weight reduction in adults with obesity, but has not been studied in adolescents. OBJECTIVE: To examine the effect of topiramate plus LSM on body mass index (BMI) reduction in adolescents with severe obesity. METHODS: Data for this retrospective chart review were collected from patients attending a pediatric weight management program who were treated with LSM plus topiramate for 3 months minimum. Mean BMI percent change from baseline was evaluated using t-tests. RESULTS: Twenty-eight patients (mean age 15.2 ± 2.5 years, mean baseline BMI 46.2 ± 10.3 kg/m(2)) were identified for inclusion. The 6-month percent change in BMI was -4.9, 95% confidence interval (-7.1, -2.8), P < .001. CONCLUSIONS: Topiramate with concurrent LSM was associated with clinically meaningful BMI reduction in adolescents with severe obesity. Randomized controlled clinical trials examining efficacy and safety of topiramate for severe obesity in adolescents are needed.