Abstract:
Introduction: The clinical manifestations of hypothalamic obesity mainly include severe obesity, accompanied by eating, social, and cognitive disturbances. It can be either genetic or acquired, and there is no specific treatment available.
Case report: We followed two children with hypothalamic obesity following surgery for craniopharyngioma. The aim was to assess the effectiveness of dietary management and therapeutic education for the patient and their family. Our two patients, aged 12 and 13 respectively, underwent transsphenoidal surgery for craniopharyngioma. Both had anterior pituitary insufficiency and diabetes insipidus. Weight gain began preoperatively in the first patient, with an increase of 8 kg over 9 months, worsening postoperatively, leading to the development of an eating disorder. The total weight gain was 21 kg over 2 years (BMI = 34 kg/m²). In the second patient, weight gain started postoperatively concurrent with the development of an eating disorder, with a total weight gain of 25 kg over 3 years (BMI = 35 kg/m²). The eating disorder in both cases involved mainly nocturnal snacking, selective food intake, and binge eating, especially in the immediate postoperative period. Dietary analysis revealed a hypercaloric, hypoproteinic, hyperglycemic, and hyperlipidic diet in both patients, with low consumption of dietary fibers and dairy products but high consumption of refined carbohydrates and soda. Neither patient received nutritional follow-up during the craniopharyngioma treatment period. We proposed dietary counseling with a normoproteinic diet (1g/kg/day to 1.5g/kg/day) and a hypocaloric diet to promote weight loss. Meal splitting (3 to 4 meals) and varied, balanced diet rich in fibers were recommended. Therapeutic education aimed to understand and manage eating disorders, particularly binge eating, and plan low-density meals for snacking. Over 6 months of weekly initially, then monthly dietary follow-up, we were able to stabilize the initial weight and achieve a slight weight loss of 2 kg in the first patient and 3 kg in the second patient.
Conclusion: Regular, personalized nutritional follow-up and early therapeutic education during the initial stages of disease treatment for patients with hypothalamic obesity could lead to avoide significant weight gains, which are difficult to manage and can lead to additional complications
