Hypothalamic obesity is a complex condition. Dietary changes won’t likely result in lasting weight loss, but there are other benefits for long-term health.
The hypothalamus is a small but important area in the brain. It sends and receives signals to manage many body functions. These include your appetite, sleep, body temperature, mood, and blood pressure. Hypothalamic obesity (HyOb) is a type of obesity that develops when there is damage to the hypothalamus.
When the hypothalamus isn’t working correctly, it can no longer regulate how your body uses energy. The result is major shifts in your appetite and metabolism. This results in weight gain. Along with ongoing and persistent weight gain, you may also have trouble sleeping, fatigue, and changes in your mood.
While reducing the amount of food intake may not necessarily lead to significant weight loss with HyOb, maintaining a healthy diet helps ensure good nutrition. In turn, this can help you better manage your condition in the long term. Here’s more about how food can help manage HyOb.
The hypothalamus has many jobs. It’s the part of your body primarily responsible for determining your weight. It directs how your body uses and stores energy and is involved in regulating your appetite signals. When the hypothalamus is damaged, your brain can no longer balance those functions. Several factors can result in damage to the hypothalamus. These include brain tumors, a traumatic brain injury, radiation therapy, or a stroke.
The hypothalamus is the control center for your weight, appetite, and how your body uses energy. Body weight isn’t as simple as energy in versus energy out. It’s actually the result of complex systems of hormones and signals. When there’s damage to your hypothalamus, this system no longer works as it should.
This typically causes weight gain. Changes in your appetite and a slowed metabolism mean that your body readily gains weight, no matter what you do.
You might experience constant hunger, called hyperphagia. You may notice that you’re always thinking about food, or feel like there’s no “off switch” to your hunger.
Another change is that your metabolism slows down. Metabolism is the rate at which your body converts food into usable energy. A slower metabolism means your body uses less fuel for all its functions. When it uses less fuel, the body stores more energy as fat.
Damage to your hypothalamus has other effects, too. It can often disrupt sleep cycles. You may feel deep fatigue that makes it hard to get through your day. Many people with HyOb are also managing mood disorders.
Crash diets that involve a drastic restriction of calories with the goal of rapid weight loss generally don’t work for anyone trying to achieve a healthy weight long term.
It’s even more complicated with HyOb. Eating less and moving more does not typically result in weight change. Weight gain in HyOb happens as a result of shifts in appetite and metabolism, and the way you eat won’t change that.
This is not to say that what and how often you eat doesn’t matter.
Certain eating patterns can help keep you feeling fuller or improve your mood or energy. High blood pressure and diabetes are more common in HyOb. Balanced nutrition can help manage those conditions.
A balanced meal plan and regular mealtimes can be helpful if you have HyOb.
Lower carbohydrate
Some research has found that lower carbohydrate diets may help stabilize weight and help you feel less hungry. Eating carbohydrates stimulates insulin production. Eating more protein and healthy fats and fewer carbohydrates may help to regulate insulin and blood sugar levels.
However, a low carbohydrate way of eating isn’t helpful for everyone. You might find that it feels too restrictive. Feeling deprived can actually increase your appetite and cravings.
If you decide to try a low carbohydrate diet, it’s important to discuss it with your doctor or a dietitian who can guide you on how to get enough variety and nutrients.
More fiber and protein
When the hypothalamus isn’t working correctly, the body can’t receive the usual cues to hunger and fullness. This can make you feel hungry most of the time.
Try to include more sources of fiber and protein in your diet. These nutrients slow down digestion to keep you feeling fuller for longer. A high fiber diet is also helpful to manage cholesterol, blood pressure, and blood sugar levels.
Sources of fiber include:
- fruits and vegetables
- grains such as oats, barley, quinoa, and products made with whole grains
- beans, peas, and lentils, including chickpeas, kidney beans, red and green lentils, and black beans
- nuts such as pecans, walnuts, peanuts, cashews, almonds, pistachios, and hazelnuts
- seeds such as pumpkin, sunflower, chia, hemp, and flax
Sources of protein include:
- meat, poultry, fish, and seafood
- milk, yogurt, and cheese
- nuts and seeds
- beans, peas, and lentils
- soy products, such as tofu, soy beverages, and edamame
- eggs
Meal timing and structure
Without regular hunger and fullness cues, you won’t be able to rely on your body to know when and how much to eat. Many people find it helpful to follow a structured meal schedule. Try to include a variety of foods at your meals, as recommended by MyPlate. This can help you meet your nutrient needs. You might try experimenting to find the kind of meals that feel satisfying for you.
Consider mapping out a plan for your meals every week so you know what you’ll eat, rather than facing constant food decisions throughout the week.
Eat on a regular schedule to keep your mood and energy stable. Aim to eat something every 3 to 4 hours.
Living with HyOb is complex. Managing HyOb may include diet changes as well as medications, exercise, and mental health support.
Medications
Medications that target the hypothalamus may provide partial benefits for HyOb, depending on the extent and location of hypothalamic injury.
On the other hand, medications that act on other areas of the brain or other parts of the body are more likely to help.
There isn’t a lot of research that explores the role of medication in people with HyOb. Studies are small, and as with other medications, people will respond in different ways.
Metformin, a medication used to manage type 2 diabetes in the United States since
Glucagon-like peptide-1 (GLP-1) receptor agonists target the hypothalamus as well as other areas of the brain, the heart, stomach, and pancreas. Some studies suggest GLP-1 receptor agonists can help people with HyOb lose weight. These medications may also help regulate blood sugar and promote heart health.
Another potential medication for HyOb is a combination of tesofensine and metoprolol (Tesomet). Tesofensine acts on brain signals to lower appetite and cravings. Metoprolol helps manage high blood pressure. A 2022 randomized controlled trial in people with HyOb found that Tesomet reduced weight by an average of 6.6% over the 24-week study.
A newer medication called setmelanotide (Imcivree) has shown some results. A small
Physical activity
Many people think of exercising as a way to manage weight. However, when you’re living with HyOb, being more active is unlikely to result in significant weight loss.
Try reframing exercise as something that can benefit you in other ways. It’s great for your heart, can help you maintain muscle and flexibility, and it’s good for sleep and mood. Aim for different types of exercise and try to find something you enjoy.
Psychological and behavioral strategies
Managing constant hunger and cravings can be exhausting. Certain psychological and behavioral strategies may help. Consider using distractions to keep your mind and hands busy. Try keeping to a schedule of meals and snacks. If you feel the urge to eat outside of those times, try setting a timer to delay eating by a few minutes. This can help you make more conscious decisions about eating, rather than automatically responding to hunger.
Work on eating slowly and chewing your food well so meals are more satisfying.
In addition, consider working with a mental health specialist if you’re finding it hard to cope with all the symptoms and mood effects of HyOb.
Hypothalamic obesity (HyOb) is a complex condition. A person’s hypothalamus is involved in regulating weight and appetite. If your hypothalamus isn’t working correctly, you will likely experience many changes in your health, including persistent weight gain.
Changing what and when you eat may not help with weight management in the long term, but balanced eating patterns can still benefit your health.
Along with healthy eating, other approaches such as medications, exercise, and mental health support can help you manage HyOb and live a full life.