Supplementary Table 1. Binding and Activity of BIM and related melanocortin receptor agonists. hmc5r Ki(nM) hmc1r EC 50 (nm)

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1 BIM does not alter animal behaviour Activation of the melanocortin pathways has been associated with several non-feeding related activities. Increased yawning, muscular stiffness, stretching and penile erection have all been described as consequences of activation of the melanocortin pathways (32; 40-42). Observation of the animals before, during and after the administration of BIM verified that we did not see these side effects in our animals. The lack of muscular stiffness can also be observed by the increase in activity during the treatment period. Adverse effects that could result in confounding factors in regards to food intake are headaches, asthenia, nausea, vomiting and diarrhea, as mentioned in clinical studies with another MC4R agonist (32). Cages were inspected daily for vomiting and diarrhea, both of which were never observed. At all times, the monkeys were eager to accept a small peanut butter treat in the afternoon. From personal observations the peanut butter treat will be rejected when the animal has nausea, for instance when induced by GLP-1 administration (data not shown). Further, studies in beagles also failed to demonstrate an increase in nausea (personal communication with M Culler). In contrast, LY caused gapping, a sign of nausea in 2 animals. This is consistent with the findings of the clinical study with LY (32). Finally, food intake did return to normal levels during the course of drug tre ment in the current experiment. Supplementary Table 1. Binding and Activity of BIM and related melanocortin receptor agonists Binding Activity Compound hmc1r hmc3r hmc4r hmc5r hmc1r hmc3r hmc4r hmc5r BIM LY MT-II NDP- -MSH MSH MSH MSH MSH MSH Supplementary Table 2. Serum chemistry during and after treatment with BIM (0.5 mg/kg/day) Measured Variable Average Value on Drug Average Value off Drug Units Alanine Transaminase 58 ± 8 81 ± 14 Iu/L (ALT) Blood Urea Nitrogen (BUN) 11 ± ± 1 mg/dl Creatinine 1.1 ± ± 0.03 mg/dl tbilirubin 0.3 ± ± 0.03 mg/dl Albumin 3 ± ± 0.04 g/dl Creatinine Kinase 1750 ± ± 240 Iu/L

2 Supplementary Figure 1. Overview of the experimental outline with timeframes. Arrows indicate minipumps implantations, exchanges or removals. Stars denote timepoints during which the DEXA scanning and the intravenous GTT were performed.

3 Supplementary Figure 2. Food intake is decreased in lean NHP treated with BIM A) Daily food intake measured during exposure of the animals (n=6) to a minipump filled with saline (weeks 1, 3, 5 and 7) or increasing doses of BIM (weeks 2, 4 and 6). B) Food intake was calculated as a daily average over 5 days during the minipump implantations. Data was analyzed as a repeated measures ANOVA (p<0.0001) with Bonferroni post hoc testing. Each dose was significantly decreased compared to weeks 3 and 5 (p<0.05 for 0.17 dose, p<0.001 for 0.5 and 1.5 mg/kg/day dose). None of the doses were significantly different from each other. Supplementary Figure 3. Individual body weight graphs for all 12 animals treated with BIM (0.5 mg/kg/day).

4 Supplementary Figure 4. Food Intake (A) and Body Weight (B) during the treatment period (0.5 mg/kg/day) and an extended washout period. An ivgtt test was performed 12 weeks after washout where we calculated HOMA-IR (C) and the total insulin secretion during the glucose bolus (D). All data was analysed using ANOVA with repeated measures and Dunnett s posthoc test; p<0.05 was considered significant.

5 Supplementary Figure 5. Changes in food intake (A), body weight (B), insulin sensitivity (C) and cardiovascular parameters (D+E) during an 8 week treatment with 0.17 mg/kg/day subcutaneously of BIM

6 Supplementary Figure 6. Representative plots of 4 animals treated with 0.5 mg/kg/day of BIM or LY All changes in systolic blood pressure and heart rate are represented as changes compared to the vehicle period preceding the compound. Both vehicle and compound were delivered via osmotic minipump as described in the materials and method section. One animal is not reported as we noticed an increase of 50mm Hg two hours post-implantation of the 0.17 mg/kg/day dose. This animal was removed from the 0.5 mg/kg/day LY experiment. However, no increases were noted when this animal was given 0.5 mg/kg/day of BIM