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In a randomized, double-blind, placebo-controlled trial involving 100 children with severe obesity (612 years), alongside lifestyle interventions conducted for 6 months, the metformin group showed a greater reduction in BMI (difference between metformin and placebo groups 1.09 0.38 kg/m 2 , p = 0.006) and BMI z-score (difference between metformin and placebo groups 0.07 0.03, p = 0.02) [42]