Background
Hypothalamic obesity may be encountered in children with genetic or syndromal disease or after brain trauma such as (treatment of) a suprasellar tumor. There is currently no effective treatment for hypothalamic obesity, and dietary and lifestyle interventions are the cornerstone of obesity treatment, regardless of the cause. We systematically searched the literature for evidence on feasibility and efficacy of dietary and lifestyle interventions for childhood hypothalamic overweight or obesity.

Methods
A systematic search was conducted in Pubmed, EMBASE, Cochrane and CINAHL (May 2023). Studies assessing the feasibility, safety or efficacy of any dietary or lifestyle intervention in children with hypothalamic overweight or obesity, were included. Risk of bias was assessed with an adapted Cochrane Risk of Bias Tool. Level of evidence was assessed using the GRADE system. 

Results
In total, twelve studies were included, with a total number of 118 patients (age 1 – 19 years) of whom one with craniopharyngioma, one with ROHHAD-NET syndrome, 50 with monogenic obesity and 66 with Prader-Willi syndrome. Four studies reported on feasibility: all diets were judged  to be feasible. Seven studies reported on the effect of a dietary intervention; a well-balanced restrictive caloric diet (30% fat, 45% carbohydrates and 25% protein) and various hypocaloric diets (8-10 kcal/cm/day) were effective in terms of weight stabilization or decrease.

Conclusions

Hypocaloric diet or restrictive macronutrient diet with lower percentage of carbohydrates seems feasible and effective for childhood hypothalamic obesity, although most of the studies were small, had no control groups, and had a high risk of bias. Lifestyle interventions only resulted in BMI decrease in short-term, indicating that additional guidance is needed to successfully implement lifestyle interventions in this group of patients.