Inclusion Criteria:  Body mass index (BMI) </= 1.2 times the 95th percentile (age and sex-adjusted) and/or BMI >/= 35 kg/m2 Ages 12 to < 18 years old Deemed appropriate candidates to receive topiramate (without contraindications) for weight loss by an obesity medicine specialist at the University of Minnesota  Exclusion Criteria:  History of metabolic/bariatric surgery Obesity associated with a diagnosed genetic disorder (i.e. monogenic obesity, Prader-Willi, Bardet-Biedl syndrome) Clinically diagnosed hyperthyroidism or uncontrolled hypothyroidism as determined by local medical monitor (who is a board certified endocrinologist) History of glaucoma History of nephrolithiasis History of seizures (aside from febrile seizures) Major psychiatric disorder as determined by local medical monitor History of bulimia nervosa or anorexia nervosa History of suicide attempt within the last year Current or recent (< 6 months prior to enrollment) use of anti-obesity medication(s) defined as orlistat, phentermine, topiramate, combination phentermine/topiramate, liraglutide (or other glucagon-like peptide (GLP1-RA)), and/or combination naltrexone/bupropion (monotherapy use of naltrexone or bupropion is not an exclusion) Current or recent (< 6 months prior to enrollment) use of medication(s) associated with weight gain (e.g. oral steroids, anti-psychotics), unless participant has been on stable doses of such medication(s) for ≥ 6 months Current or recent (< 6 months prior to enrollment) use of stimulant medications, unless participant has been on stable doses of such medication for ≥ 6 months Baseline bicarbonate < 18 mmol/L Baseline creatinine > 1.2 mg/dL Females: pregnant, planning to become pregnant, or, if sexually active, unwilling to use 2+ acceptable contraceptive methods during the study period