How do I manage weight gain from craniopharyngioma at 53?

Question

Hello doctor,

I am 53 years old and had surgery for a craniopharyngioma a few years ago. Ever since then, my weight has continued to increase. No matter what I eat, my weight keeps going up. I count calories and walk every day, but nothing seems to change. How do I manage weight gain from craniopharyngioma at 53?

My doctor said I have hypothalamic obesity, but I still do not fully understand why my body is not responding to diet and exercise. I have seen some trending weight-loss medications.

Has anyone with a situation like mine actually lost weight with Mounjaro or Wegovy?

The weight gain is also affecting my knees and my confidence.

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

Weight gain after craniopharyngioma (a rare type of brain tumor) surgery can be extremely frustrating, especially when you are doing the things that usually help, such as watching your calorie intake and staying active, but your body seems to respond differently.

What you are describing is a recognized condition called hypothalamic obesity (severe weight gain caused by damage or dysfunction in the hypothalamus, often following a brain tumor or its treatment), and it is not simply a matter of willpower or lack of effort.

The hypothalamus is a part of the brain that helps regulate hunger, fullness, metabolism, and energy use. Craniopharyngiomas and their treatment can affect this area, sometimes disrupting the signals that tell the body when it has had enough food and how much energy to burn.

Following this type of injury, some people notice increased hunger signals, decreased calorie burning, increased insulin resistance, and changes in weight-regulating hormones. This means that the same diet and exercise plan that you used to work on may not work the same way again.

Medications such as Semaglutide (Wegovy) and Tirzepatide (Mounjaro or Zepbound) are used to treat obesity and have resulted in significant weight loss in many people with common forms of obesity.

However, people with hypothalamic obesity were not the main group studied in large clinical trials, so the results can be more variable.

Some patients with hypothalamic obesity experience meaningful weight loss and improved appetite control with these medications, while others have a smaller response because the underlying problem with brain regulation is still present. These medications may help, but they are not guaranteed to reset or reverse damage to the hypothalamus.

At 53, it is still very reasonable to seek treatment. A specialist approach is often needed, usually involving an endocrinologist who understands hypothalamic obesity.

The specialist may review your pituitary hormone function after surgery, thyroid levels, cortisol replacement if applicable, growth hormone status, sleep problems, medications that may promote weight gain, and overall metabolic health. Sometimes weight management requires a combination of approaches rather than relying on diet and exercise alone.

If you are considering Wegovy, Mounjaro, or another weight-loss medication, discuss it with your endocrinologist rather than starting it on your own. They can assess whether the medication is appropriate for you, review possible side effects, and monitor your nutrition, muscle mass, and other hormone-related issues.

I hope this helps.

Please revert in case of further queries.

Thank you.