<p>Craniopharyngiomas are rare sellar/parasellar embryogenic malformations of low-grade malignancy (WHO I^o). Whereas survival rates are high (92%), quality of survival is frequently impaired due to morbid hypothalamic obesity. Recent reports have indicated that the degree of obesity of affected patients is positively correlated with the degree and extent of hypothalamic damage. Therefore, craniopharyngioma can be considered a&#xa0;paradigmatic disease, reflecting challenges in diagnostic and treatment of hypothalamic obesity. Despite the availability of promising therapeutic approaches, such as antidiabetic drugs, central stimulating agents, Setmelanotide, or glucagon-like peptide&#xa0;1 (GLP1)-receptor agonists, it can be emphasized that currently there is no pharmacological therapy for hypothalamic obesity in craniopharyngioma that has been shown to be effective in randomized controlled studies. Bariatric interventions are effective, but non-reversible procedures such as bypass operations are controversial in the pediatric age group due to legal and ethical concerns. Recently, a&#xa0;treatment algorithm was published to improve management of hypothalamic syndrome/obesity by more personalized treatment. Decisions on treatment strategies should be made by experienced multidisciplinary teams and focus on preservation of visual, neuroendocrine, and hypothalamic integrity. Further research on novel treatment approaches for hypothalamic obesity are warranted to improve quality of survival after craniopharyngioma.</p>