Purpose of Review <p>This review aims to provide a summary of treatment strategies for hypothalamic obesity (HO) and the latest data on pharmacologic interventions for HO.</p> Recent Findings <p>We summarize new consensus diagnostic criteria for acquired HO, non-pharmacologic interventions such as diet and physical activity, medications including the newly FDA approved setmelanotide, metabolic and bariatric surgery, and emerging treatment strategies that address the complex pathophysiology of HO.</p> Summary <p>Hypothalamic obesity is caused by hypothalamic injury that impairs energy balance, metabolism, and satiety and leads to refractory obesity that is resistant to traditional diet and exercise interventions. Despite recent progress, effective long-term management of HO remains challenging, with few controlled trials, significant heterogeneity in patient response, and lack of long-term follow up data. A new medication targeting the melanocortin-4 receptor (MC4R) pathway was recently approved for treatment with additional newer drugs in development [1].</p>