Hyperphagia

Hyperphagia is a condition characterized by abnormally increased appetite and persistent overeating, resulting in excessive caloric intake. It reflects a chronic drive to eat that can be difficult to control and may occur as part of broader medical conditions, rather than as a normal fluctuation of hunger. Hyperphagia is distinct from episodic binge eating, which involves discrete episodes of excessive intake with distress; hyperphagia refers to ongoing appetite dysregulation.

Causes of hyperphagia are heterogeneous and grouped as primary or secondary. Primary hyperphagia includes genetic or hypothalamic disorders that disrupt hunger and satiety signals, such as Prader-Willi syndrome or rare leptin signaling defects. Secondary hyperphagia arises from brain injury or disease affecting appetite-regulating centers, certain tumors, infections, or inflammatory processes. Medications and endocrine factors can also contribute, including some antipsychotics, corticosteroids, and other drugs that increase appetite. Mechanistically, hyperphagia often involves impaired hypothalamic circuits and altered signaling of hormones like leptin and ghrelin.

Diagnosis relies on clinical history and examination, with attention to persistent caloric excess and ongoing hunger. Evaluation aims to identify underlying etiologies, including metabolic, endocrine, genetic, or neurologic conditions. Laboratory testing, imaging when indicated, and genetic studies may be employed to clarify causation.

Management centers on treating the underlying cause when possible, coupled with strategies to control intake and support weight management. Approaches include structured dietary plans, behavioral and nutritional counseling, regular physical activity, and multidisciplinary care. Pharmacologic options are limited and used selectively; growth hormone therapy may be beneficial in certain syndromic forms. In severe cases, obesity-management interventions or, rarely, surgical options may be considered.

Hyperphagia can lead to obesity-related complications, including metabolic syndrome, type 2 diabetes, sleep apnea, liver disease, orthopedic problems, and psychosocial burden. Prognosis depends on the underlying cause and the effectiveness of comprehensive management.