Authors' conclusions:

Metformin associated with lifestyle interventions may have a small favorable effect on BMI z-score and insulin resistance. It shows an acceptable safety profile in children and adolescents with obesity. The quality of the available evidence is variable.

Reviewers' commentary:

Obesity drug therapy could help to achieve targets in the short and medium term, but the effect in the long term remains unknown. Metformin has a modest effect on BMI and produces frequent gastrointestinal adverse events that could reduce completion of treatments. Individual use of metformin could be proposed in specific obesity cases, especially if they present metabolic consequences.

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