ORF50-02 - Effects of Topiramate Plus Health Behavior and Lifestyle Treatment on Body Mass Index, Eating Behaviors, and Cognitive Outcomes Among 65 Adolescents with Severe Obesity

Background: Topiramate is often prescribed in weight management clinics as an adjunct to health behavior and lifestyle treatment (HBLT). While studies have shown topiramate’s effectiveness for BMI reduction when used in pediatric obesity treatment, little is known about its effects on eating behaviors and cognition, a concern with topiramate use, in this setting. We sought to characterize the effects of topiramate plus HBLT on BMI, BMI percent of the 95th percentile (%BMIp95), eating behaviors, and cognition in 12 to < 18 year olds with class 2 or 3 obesity who were enrolled in a 14-week single-arm open label clinical trial (NCT04986631).

Methods: All participants received topiramate (25 mg daily x 1 week, 50 mg daily x 1 week, 75 mg x 12 weeks) and two HBLT sessions (baseline, 6 weeks). Anthropometrics, eating behaviors assessed by visual analog scales (VAS) and surveys (sugar sweetened beverage [SSB] consumption: Beverage Intake Questionnaire-15; hunger and satiety: VAS and Adult Eating Behavior Questionnaire [AEBQ]; food cravings: Food Cravings Questionnaire-Trait-reduced; food addiction: dimensional Yale Food Addiction Scale; binge eating tendencies: Rapid Assessment of Reward-Related Eating-5), and cognitive outcomes (verbal fluency: Controlled Oral Word Association test; working memory and processing speed: List Sorting Working Memory [LSWM] and Pattern-Comparison Processing [PCP] tests, respectively, from the NIH Toolbox) were obtained at baseline, 6, and 14 weeks. The treatment effect was calculated as the mean change from baseline.

Results: 65 adolescents participated (mean age 14.95 ± 1.65 years; baseline BMI 38.78 ± 4.53 kg/m2, %BMIp95 141 ± 16). At 14 weeks, BMI and %BMIp95 were statistically significantly reduced by 3.65% (95% CI: -5.02, -2.28) and 6.11% (95% CI: -8.07, -4.15), respectively (both p< 0.001), and SSB consumption by 4.20 oz/day (95% CI: -6.98, -1.43; p=0.004). There were also statistically significant reductions in hunger (via VAS and AEBQ), food cravings, food addiction, and binge eating tendencies, and an increase in satiety (via AEBQ) at 6 and 14 weeks (most associations p< 0.001). Verbal fluency was statistically significantly lower at 6 weeks (p < 0.001), but not at 14 weeks (p=0.619). Working memory and processing speed were higher at 6 and 14 weeks (6-week LSWM: p=0.018; all others p< 0.001).

Conclusion: Among 65 adolescents with severe obesity treated with topiramate plus HBLT, we found statistically significant reductions from baseline in BMI and %BMIp95, and improvements in SSB consumption, hunger, satiety, food cravings and addiction, and binge eating tendencies, at 6 and 14 weeks. We also found no significant reduction in verbal fluency at 14 weeks of topiramate treatment, and no worsening in working memory or processing speed. Further studies are needed, including randomized controlled trials over longer durations, to expand on these findings.