Warming in Anorexia Nervosa: A Review

Anorexia nervosa (AN) is a severe psychiatric condition primarily affecting young women, and AN has the highest mortality rate among psychiatric disorders. AN continues to be a disorder refractory to psychological or pharmacologi-cal treatment. An innovative approach arises from research in rats simultaneously placed on a restricted feeding schedule and given free access to an activity wheel. The detrimental effects of combining diet and exercise in rats can be reversed by a manipulation of ambient temperature (AT). Warming animals exposed to these experimental arrangements reverses running activity, preserves food intake, and enables rats to recover from acute weight loss. This represents a strong preclinical evidence that provides a rationale for a translational approach for the treatment of AN. However, heat application to AN patients was already a recommendation made by William Gull in his seminal paper on AN disorder. A historical perspective of supplying heat to AN patients reviews the circumstances and foundation of this practice. The manipulation of AT in activity-based anorexia (ABA) rats has ended with a period of neglect of AT that parallels the complete neglect of the role of AT in the human AN disorder, either as a risk factor, as a modulating factor in the course of the disorder, or in terms of its utility in the treatment of AN.