Craniopharyngioma is associated with increased risk for obesity. The risk is significantly increased after near total surgical intervention and/or radiation therapy. Among 16 patients diagnosed with craniopharyngioma in our center between 1993 and 2003, all but 3 developed obesity after surgery. We additionally detail 5 patients with craniopharyngioma diagnosed at ages 6 to 18 years who developed obesity after surgery and radiation therapy. The risk factors for obesity in patients with craniopharyngioma include hypothalamic damage as a result of the tumor itself, extent of surgery, and use of radiation therapy. Because the hypothalamus is a major neural center controlling food intake and body weight, damage to the ventromedial and lateral areas of the hypothalamus impairs regulation of appetite and energy expenditure, thus causing hypothalamic obesity. A variety of therapeutic approaches have been tried for hypothalamic obesity in patients with craniopharyngioma with limited success. These include controlling food intake and energy expenditure by lifestyle changes and antiobesity medications. Hence, there is a need for development of new therapeutic strategies. In this article, we review current and some of the future therapeutic options.