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No single therapy has proven effective for treatment. We aimed to evaluate effectiveness of long\u2010term methylphenidate therapy on body mass index (BMI) change in children with hypothalamic obesity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis included children with a history of brain tumor and hypothalamic obesity receiving methylphenidate (10\u201060\u00a0mg\/day) for hypothalamic obesity. Subjects were evaluated for BMI trajectory before and after methylphenidate start. Given that <jats:italic>z<\/jats:italic>\u2010scores can be skewed in severely obese children, we calculated BMI as a percent of the BMI at the 95th percentile for the child's age and gender (BMI% 95th).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve patients with hypothalamic obesity completed methylphenidate therapy for at least 6\u00a0months (median 3.1\u00a0years, range 1.0\u20105.8\u00a0years). All subjects had a suprasellar tumor (nine [75%] with craniopharyngioma) and pituitary dysfunction. Pretreatment median BMI percent of the 95th percentile was 125.6% (interquartile range [IQR] 25\u201075: 115.3\u2010138.3%) with BMI <jats:italic>z<\/jats:italic>\u2010score of 2.4 (IQR 25\u201075: 2.1\u20102.6). Following methylphenidate treatment, there was a 69.9% reduction in the median slope of BMI change. Eleven of 12 patients (92%) had a reduction in the slope of their BMI change on methylphenidate treatment. Postmethylphenidate median BMI percent of the 95th percentile decrease to 115.2% (IQR 25\u201075: 103.6\u2010121.2%) with median BMI <jats:italic>z<\/jats:italic>\u2010score of 2.1 (IQR 25\u201075: 1.8\u20102.2). Mild side effects were noted in six patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Methylphenidate use reduced and sustained BMI change in children with hypothalamic obesity. Stimulant therapy is an effective first\u2010line agent for treatment of hypothalamic obesity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28379","type":"journal-article","created":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T13:06:35Z","timestamp":1588943195000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Methylphenidate improves weight control in childhood brain tumor survivors with hypothalamic obesity"],"prefix":"10.1002","volume":"67","author":[{"given":"Vincent E.","family":"Horne","sequence":"first","affiliation":[{"name":"Division of Diabetes and Endocrinology Department of Pediatrics Baylor College of Medicine Texas Children's Hospital  Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0790-2931","authenticated-orcid":false,"given":"Kevin","family":"Bielamowicz","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology Department of Pediatrics The University of Arkansas for Medical Sciences Arkansas Children's Hospital  Little Rock Arkansas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine Texas Children's Hospital  Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Hilsenbeck","sequence":"additional","affiliation":[{"name":"Department of Statistics Baylor College of Medicine Texas Children's Hospital  Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holly","family":"Lindsay","sequence":"additional","affiliation":[{"name":"Division of Nutrition Department of Pediatrics Baylor College of Medicine  Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rona","family":"Sonabend","sequence":"additional","affiliation":[{"name":"Division of Diabetes 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