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Currently, the medical community has no standard treatment guidelines or approach to establishing treatment benefit. This narrative review discusses current understandings of the pathophysiology, burden, and treatment of hyperphagia and summarizes findings from a systematic literature review of validated instruments for assessing the response to hyperphagia treatment. Hyperphagia can result from dysfunction within, or damage impacting, hypothalamic pathways including the MC4R pathway, a key regulator of energy balance. The burden of hyperphagia is substantial, with negative effects experienced across physiologic, emotional, and social domains. Approaches for hyperphagia management include environmental control, lifestyle intervention, pharmacotherapy, neurocognitive approaches, and neurostimulation. There are varied approaches to determine treatment response; however, standard methodology has not been determined and largely relies on questionnaires. Studies of rare MC4R pathway diseases have improved understanding of the etiology of hyperphagia and established the need for indication-specific treatment. Targeted treatments are limited, and methods for determining treatment efficacy are varied. There is a need for consensus guidelines to establish a standard approach for the management of hyperphagia and related assessment of treatment response to improve patient morbidity.<\/jats:p>","DOI":"10.1007\/s11154-025-09984-3","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T03:46:00Z","timestamp":1750823160000},"page":"917-935","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Hyperphagia in rare melanocortin-4 receptor pathway diseases: therapeutic options and assessing treatment response"],"prefix":"10.1007","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5826-0276","authenticated-orcid":false,"given":"Jes\u00fas","family":"Argente","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2489-3355","authenticated-orcid":false,"given":"Karine","family":"Cl\u00e9ment","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6605-1028","authenticated-orcid":false,"given":"Jessica","family":"Duis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7609-3504","authenticated-orcid":false,"given":"I. 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Accessed 4 March 2024."}],"container-title":["Reviews in Endocrine and Metabolic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11154-025-09984-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11154-025-09984-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11154-025-09984-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T16:03:34Z","timestamp":1762877014000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11154-025-09984-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":168,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["9984"],"URL":"https:\/\/doi.org\/10.1007\/s11154-025-09984-3","relation":{},"ISSN":["1389-9155","1573-2606"],"issn-type":[{"value":"1389-9155","type":"print"},{"value":"1573-2606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]},"assertion":[{"value":"17 June 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"JA received compensation for lectures and the BBS advisory board from Rhythm Pharmaceuticals, Inc. KC is a primary investigator for Rhythm Pharmaceuticals, Inc., and her research group has received research support from Rhythm Pharmaceuticals, Inc. JD is employed by Neurocrine Biosciences. The opinions in this manuscript are her own. ISF received compensation for lectures from Rhythm Pharmaceuticals, Inc. and led trials funded by Rhythm Pharmaceuticals, Inc. and Eli Lilly. JLM has received study funding from Rhythm Pharmaceuticals, Inc., Soleno Therapeutics, and Harmony Biosciences. PK has participated on a safety board for and their institution has received funding for clinical trial research from Rhythm Pharmaceuticals, Inc. CLR\u2019s institution has received research support from Rhythm Pharmaceuticals, Inc. EvdA\u2019s institution received compensation for writing and presentations from Federatie Medisch Specialisten, Medialane TV, Pfizer, and Stichting Kwaliteitsgelden Medisch Specialisten and study funding from Nederlandse Hartstichting\/ZonMW, Rhythm Pharmaceuticals, Inc., and Stichting Erasmus Trustfonds.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}