Endocrinologist Dr. Victoria Bouhairie answers questions about insatiable hunger in people with hypothalamic obesity.
If you have hypothalamic obesity, you have an increase in appetite and food intake (hyperphagia). This can happen if the parts of your brain that control hunger and fullness are damaged or not working properly. The arcuate, ventromedial, and paraventricular regions of the hypothalamus are very important for telling the brain that you are full. When these areas are damaged, a person feels constantly hungry, never fully satisfied after eating, and has the urge to keep eating. In contrast to what typically drives overeating, this kind of hunger is abnormal and hard to control. Because of this, many people who have hypothalamic obesity gain a lot of weight very quickly, even when they try to limit what they eat. Hypothalamic obesity is one of the most challenging types of obesity to treat because the drive to eat is biological rather than purely behavioral.
Some of the things that can cause this are damage to the part of the brain that controls hunger. This can be from various causes, such as tumors, surgery, radiation, or traumatic brain injury. Genetic or birth defects like Prader-Willi syndrome or genetic obesity conditions can sometimes damage the hypothalamic signaling pathways and cause people to eat too much.
Treatment of this condition can be very challenging. Lifestyle changes are useful but have only little or short-term benefits. Due to the increased drive to eat, most people with this condition are unable to sustain weight loss due to their strong desire to eat. Medications like melanocortin-4 receptor (MC4R) agonists, intranasal oxytocin, naltrexone, and glucagon-like peptide-1 (GLP-1) receptor agonists, as well as bariatric surgery in some cases, are useful options. The treatment choice should be individualized and discussed in detail with your healthcare team.
Diet and exercise can help, but not as much as they can in cases of obesity from other causes. Due to damage to the part of the brain that controls appetite, it becomes very difficult to control hunger and energy well.
In children, meal plans can help decrease the amount of weight gained. However, it’s hard to keep off the weight because of the constant need to eat. Many people will continue to find it challenging to manage their obesity despite intentional meal planning.
Exercise can be useful to support health by improving metabolism, which may help control hunger signals. Due to the complexity of the condition, diet and exercise need to be combined with other treatment options.
Due to the complex nature of the disease, care is normally provided by a team of different specialists rather than one type of doctor. This team includes pediatric or adult endocrinologists, obesity medicine experts, neurologists, neuro-oncologists, and primary care doctors.
Patients who don’t get care are more likely to become severely obese, develop complications such as metabolic syndrome early, heart disease, have a lower quality of life, sleep and breathing issues, have problems with their social relationships, and have shortened life expectancy.
Dr. Victoria Bouhairie is triple ABMS board-certified in Endocrinology, Obesity Medicine, and Lifestyle Medicine. She is the Founder and CEO of Parry’s Wellness and Diabetes Center and holds director and advisory roles in the healthcare payor space. She serves on national committees with the American Diabetes Association and on the boards of DiabetesSisters and Wake Forest University’s MHA program.