Hypothalamic Obesity (HyOb)

What is hypothalamic obesity?

Hypothalamic obesity (HyOb) is a type of obesity that happens when your hypothalamus isn’t working as it should. Your hypothalamus is located at the base of your brain and has many important functions like regulating your hormones, controlling your appetite and managing your metabolism. Damage or injury to your hypothalamus disrupts these functions. This can lead to excess weight gain that results in obesity.

What are the symptoms of hypothalamic obesity?

Signs and symptoms include:

• Rapid weight gain.
• Uncontrollable hunger.
• Low metabolic rate (how your body burns calories and stores fat).
• Gaining weight despite limiting calories or food intake.
• Being tired or having insomnia.
• Having a limited ability to do physical activities (exercise intolerance).

What causes hypothalamic obesity?

Damage, trauma or injury to your hypothalamus causes the condition. Because your hypothalamus regulates your appetite and affects how you burn calories and store fat, damage to it can lead to weight gain.

Some of the specific causes are:

• Tumors like craniopharyngiomas, gliomas, hamartomas and pituitary adenomas. It can be from the tumor itself or from complications of removing the tumor. A craniopharyngioma causes over half of all cases of HyOb.
• Brain injuries like bleeding, infection or swelling (for example, from a car accident or a fall).
• Genetic conditions like Prader-Willi syndrome or being born with hypothalamic dysfunction.

Everyone reacts differently to HyOb. You might always be hungry, despite eating appropriately sized meals and snacks. You may gain weight even when you reduce how much food you eat and increase how often you exercise.

What are the complications of hypothalamic obesity?

Complications of the condition include:

• Difficulty regulating your blood pressure or heart rate.
• Type 2 diabetes.
• Fatty liver disease.
• Electrolyte imbalance.
• Sleep problems or disruptions to your circadian rhythm.
• Poor body image or other physiological and emotional side effects.

Damage to your hypothalamus can affect how it communicates with your pituitary gland. It’s common for people with hypothalamic obesity to have hypopituitarism, which is a condition where your pituitary gland doesn’t make enough of one or more hormones.

How is hypothalamic obesity diagnosed?

A healthcare provider will review your symptoms, perform a physical exam and ask you for your medical history. They may suspect HyOb if you tell them you haven’t been able to lose weight with lifestyle changes like getting exercise and eating healthy. Your provider may ask you if you’ve had any head injuries.

Then, they’ll order:

• Blood tests to check hormone levels: Irregular levels of certain hormones may point to hypothalamus damage.
• Imaging tests of your brain: A CT scan (computed tomography scan) can check for signs of brain damage. This is especially important if you’ve recently been in an accident or experienced head trauma.

What age does hypothalamic obesity occur?

Most people are diagnosed with hypothalamic obesity between the ages of 5 and 14 (because a tumor causes most cases). But it can happen at any age.

How is hypothalamic obesity treated?

There’s currently no cure and no approved treatment for the condition. Your healthcare provider will work with you to determine how best to manage your symptoms so that it can improve your overall well-being. They may try different treatments to help with obesity, although they typically won’t work.

Some options include:

• Medication: Medications for obesity like GLP-1 agonists could help by regulating appetite and decreasing hunger. Taking medications that contain hormones could help improve pituitary gland and hypothalamic function.
• Surgery to remove a tumor: Your provider may recommend surgery to remove a tumor, if the pressure from a tumor is damaging your hypothalamus. This can help, but your hypothalamus is typically permanently damaged.
• Gastric bypass surgery: This surgery is usually a last resort after all other methods don’t work.

What should I eat if I have HyOb?

There isn’t a one-size-fits-all meal plan for this condition. You’ll work with a nutritionist or dietitian to help you determine what foods are best for you. Everyone is different, but most people will need to eat more nutritious foods (vegetables, lean proteins and whole grains) and fewer processed foods (desserts and prepackaged foods).

Can you prevent HyOb?

No, you can’t prevent it because things like injuries, trauma or a tumor cause it. But you can take steps to reduce your risk by:

• Wearing a helmet and protecting your head to avoid brain injuries.
• Getting routine medical care. Seeing a healthcare provider regularly is a great way to detect health conditions.

What can I expect if I have hypothalamic obesity?

Having hypothalamic obesity can be extremely challenging. There’s no treatment for it, so it often involves working closely with your healthcare team to find different ways to manage your symptoms and improve your quality of life. It can be frustrating to try traditional treatments for obesity, only to find that they don’t work. Know that your symptoms aren’t happening due to something you did or didn’t do. Work closely with your healthcare providers to find the support you need, even if that support includes talking to a psychologist about ways to cope.

When should I see my healthcare provider?

Contact your healthcare provider if you have symptoms of hypothalamic obesity like gaining weight rapidly and feeling hungry. This is especially important if you have a tumor affecting your hypothalamus or if you’ve had a recent head injury.