Killer Fashion: An Industry in Denial

Eating disorders are rampant, and models are dying.

Libby Rodenbough

Anorexia nervosa claimed the life of 28-year-old French model Isabelle Caro, who had spent the last years of her life publicizing the horrors of the disease. (Photo by: ANDREAS SOLARO/AFP/Getty Images)

On Nov. 17, 2010, anorexia nervosa claimed the life of 28-year-old French model Isabelle Caro, who had spent the last years of her life publicizing the horrors of the disease. Her mother, devastated by grief and guilt, committed suicide several weeks later. In 2007, Caro had appeared in No Anorexia,” an ad campaign by provocative fashion photographer Oliviero Toscani, shown above on a billboard in Rome. The images of her naked, grotesquely emaciated body shocked and revolted. The campaign, intended to disassociate unhealthy thinness with connotations of glamour, sparked controversy, in part because some pro-anorexia and -bulimia websites used its ads as thinspiration” (collections of images or videos of slim to skeletal women used by those suffering from eating disorders for weight-loss motivation). Despite her commitment to heightening awareness of anorexia, Caro could not escape its demons. 

Caro’s unsettling death recalled a string of fatalities in 2006 and 2007 of fashion models who suffered from eating disorders, which, while highly publicized at the time, had since largely faded from the public’s – and the fashion industry’s – memory.

On Aug. 2, 2006, moments after stepping off a catwalk in Montevideo, Uruguay, 22-year-old fashion model Luisel Ramos collapsed and died from heart failure believed to have been triggered by self-imposed starvation. Ramos’ father reported that she had been subsisting on a diet of lettuce and Diet Coke in anticipation of the show. On Nov. 15, 2006, 21-year-old Brazilian model Ana Carolina Reston died in a São Paulo hospital from generalized infection. Her body had been rendered powerless to fight it by an extended battle with anorexia and bulimia. And on Feb. 13, 2007, Ramos’ sister, Eliana, also a model and only 18 years old, was found dead at her grandparents’ home, apparently having suffered a heart attack linked to malnutrition.

This rapid succession of casualties provided a wake-up call for the international fashion industry. One detail in particular made it impossible to ignore: All three women, even on the brink of death, were taking home paychecks as working models. The industry responded with regulations varying by country in substance and severity. But the effects of voluntary measures adopted in the United States are unknown, thanks in no small part to the continuing silence of industry leaders and insiders in New York City. 

The industry’s reaction

Within months, the fashion capitals of Madrid, Milan and São Paulo introduced new procedures for their runway shows, such as requiring that participating models pass a doctor’s examination or meet a minimum Body Mass Index (BMI) of 18. (BMI is a measure of body fat based on height and weight; the World Health Organization classifies someone with a BMI of less than 18.5 as underweight.”)

Other industry leaders, however, shied away from such specificity. The fashion establishments in London and New York did take steps to address model health, but both opted for conspicuously less explicit regulations. London’s British Fashion Council forwent minimum BMI requirements and doctors’ assessments, but did produce an action plan of concrete steps to shift the international culture of fashion in a healthier direction. New York’s industry leaders, on the other hand, elected only to frame a set of vague guidelines known as the Health Initiative. 

The Council of Fashion Designers of America (CFDA), a trade association, issued the initiative in January 2007. It recommends creating a healthy backstage environment at runway shows and referring models with eating disorders to professional help. It also advises that models participating in runway shows should be 16 or older. As in London, missing from the guidelines are minimum BMIs and medical evaluations for models. Also absent: any means to ensure the implementation of the recommendations, which are voluntary.

An inadequate response?

Advocacy groups cried foul. Weeks before the release of the Health Initiative, in an unprecedented joint effort, three of the most prominent organizations of their kind in the United States, the Eating Disorders Coalition (EDC), the National Eating Disorders Association (NEDA) and the Academy for Eating Disorders (AED) had formulated their own set of guidelines for the industry.

Their guidelines included a minimum BMI requirement of 18.5 for models over 18 and a graduated system of BMI requirements for younger models. They called for the development of action steps to identify models in need of intervention.” And they proposed an outright ban on airbrushing photos of models to create unrealistically thin images. Furthermore, the AED urged the industry to institute regular, yearly medical evaluations and developmentally-appropriate medical and psychological screening and assessments for all models.”

These nonprofit advocacy groups volunteered their own resources to assist the fashion industry in implementing the above proposals. While they have scant financial resources, these groups do serve to network physicians and other eating disorder experts. Conversely, what the multi-billion dollar fashion industry lacks in medical expertise, it compensates for in revenue. In an e-mail to In These Times, Cynthia M. Bulik, director of the University of North Carolina Eating Disorders Program and former president of the AED, wrote: We have the advocates, we have the brainpower, we have the ability to help build and evaluate programs, but our meager dollars couldn’t come close to the depth of their pockets!”

That seemingly fortuitous partnership has yet to become a reality. The CFDA Health Initiative fails to include some of the bolder recommendations of the eating disorder activists. Indeed, preemptively addressing any such criticism, the Initiative reads: The CFDA Health Initiative is about awareness and education, not policing. Therefore, the committee does not recommend that models get a doctor’s physical examination to assess their health or body-mass index to be permitted to work. Eating disorders are emotional disorders that have psychological, behavioral, social, and physical manifestations, of which body weight is only one.”

Eating disorders are complex psychiatric disorders, but some experts worry that without concrete screening methods the Health Initiative will be ineffectual. You can’t tell someone’s health by the BMI. It is not a perfect indicator. But the American fashion industry did not refuse to use BMI because they don’t think it is a good indicator. They basically tried to take the teeth out of any real standards,” says Jennifer L. Pozner, founder and executive director of Women in Media and News (WIMN). Anything that would change the industry and hold them accountable in ways they could not deal with, they rejected.”

In These Times asked CDFA if it has taken any specific measures to ensure the effectiveness of the Health Initiative and why it was not requiring a doctor’s evaluation to ensure that models are in good physical health. Christine Olsen, CDFA’s manager for public relations and special events, refused to answer, saying only, We do not have a statement to add at this time.” 

Doctors’ evaluations and screening models based on BMI are not foolproof ways to detect eating disorders, but they do have potential benefits. “[The screening methods] can definitely reduce the pressure on models to engage in unhealthy weight control behaviors,” says Bulik. They also help protect the consumers of the fashion industry from constantly being barraged by images of unusually thin women.”

High standards of beauty

The pressure on models, both female and male, to be thin – and the resultant pressure on girls, boys, women and men to conform to an unattainable ideal – is immense. Because a model’s professional success depends almost entirely on appearance, models obsess about their bodies. Yet the physical standards that models feel pressured to meet are unrealistic. A 2002 Centers for Disease Control report found that the average American woman is 54” and weighs 163 pounds; in 2006, it was estimated that the average female fashion model is 59” and 110 pounds.

The day-to-day stress of modeling is considerable, chiefly because all but the most famous are easily disposable. If a model doesn’t fit into designers’ samples, an agency can simply bring in a thinner replacement, and the ousted model has no channel for redress. Dutch model Marvy Rieder, 31, explains, If you want to work, you have to fit into the clothes. That’s not something your agent has to tell you; you come up with it very quickly yourself.”

Though modeling has often been cast as a glamorous occupation epitomized by jet-setting socialites like Kate Moss and Gisele Bündchen, very few models are able to achieve such a degree of celebrity or financial security. You have to realize that modeling is like a pyramid,” says Rieder. The majority of the models are at the bottom of the pyramid. It is a huge layer of really nice, really beautiful girls who cannot make a good living. I compare it to top athletes. They have a period of time when they peak, and then it’s over.”

Rieder, whose marVie Foundation provides health guidance for models through workshops and trainings, points out that in this survival-of-the-thinnest vocation, runway models in their twenties must compete with 15- and 16-year-old girls. When I was 15 years old,” she says, I was just thin, and I could eat anything. But every girl…develops a female figure. From then on, the pressure increases. You have to stop the natural growth of your body to stay the same.” 

Rieder’s long tenure in the profession has emboldened her to defy the compulsion to sacrifice health for work. She recognizes that her adult body no longer meets the strict expectations for models who walk the glitziest international runways. 

Struggling against nature, some models turn to decidedly unnatural weight control methods like laxatives, self-induced vomiting and fasting. When those weight control methods metastasize into a full spectrum eating disorder, models face more serious risks than unemployment. Eating disorders are mental illnesses, and often deadly ones. Anorexia has the highest rate of mortality of any mental illness, at around 20 percent. Eating disorders are more than two times more prevalent in the United States than Alzheimer’s disease, although funding for anorexia research is less than one-fiftieth of that for Alzheimer’s research.

The causes of eating disorders are not entirely understood, but models are exposed to a conflagration of risk factors. Harriet Brown, a professor at S.I. Newhouse School of Public Communications at Syracuse University, is the author of Brave Girl Eating, a memoir about her daughter’s struggle with an eating disorder. You’re often triggered by a perfect storm of things, genetics, puberty, hormones and cultural factors among them,” she says. In fact, it’s less about triggers and more about aggregation.” 

Models are often discovered at age 14 or younger, at a time when their bodies – and their feelings about their bodies – are in a state of flux. In 86 percent of reported cases, the onset of an eating disorder occurs before age 20. Compound the susceptibility of youth with a profession that entails continual – and competitive – monitoring of body measurements, and it’s no wonder so many models fall victim to eating disorders. Every model is afraid of being measured,” says Rieder. Every model is afraid of the centimeter.”

Models fear they will be replaced by a thinner alternative if they do not conform to the sample size--sometimes a size 00, which is, incomprehensibly, one size less than 0.
From runway to living room

That fear is not confined to the world of sample sizes and catwalks. According to The Journal of Adolescent Health, 81 percent of American 10-year-olds are afraid of being fat. Of course, very few 10-year-olds attend runway fashion shows. Instead, they – and Americans of all ages – get their thinspiration” from a variety of media, among them ads for all manner of consumer goods that invariably feature tall, stick-thin models.

The physical ideal established by models on the runway, in ads and on reality TV does not translate directly to eating disorders, but it affects us, both as emotionally vulnerable beings and as consumers. Dr. David B. Herzog, director of the Harris Center for Education and Advocacy in Eating Disorders at the Massachusetts General Hospital, has advised the CFDA on matters of model health. Most people who look at pictures of high fashion models do not develop eating disorders,” he says. In the people who develop eating disorders, there’s a sizeable percentage that have little interest in fashion. It is not at all a direct correlation, but the thin ideal that the industry has had a role in developing … has a big impact on how people feel about themselves.”

As part of a wider trend, the fashion industry’s perceived endorsement of thinness at any cost promotes unhealthy eating practices that, in individuals with existing risk factors, may manifest themselves as anorexia, bulimia, binge eating or other partial- or full-spectrum eating disorders. Some types of disordered eating may progress to obesity; others may lead to severe malnutrition or death.

Where responsibility lies

So, who’s to blame? The problem can’t be fixed until the culprit is determined. Therein lies the roadblock. No one component of the fashion industry seems poised to instigate change. 

Modeling agencies are most profitable when they provide the thin models that are popular with designers. Often those designers are gay men whose standard for physical beauty eschews feminine curves. Designers contend that they aren’t to blame because all the models are so thin that they are forced to tailor clothing to skeletal frames. Advertisers and manufacturers of a vast spectrum of products profit from existing standards.

Models fear they will be easily replaced by a thinner alternative if they do not conform to the sample size, which is sometimes an American size 00, which is, incomprehensibly, one size less than 0.

The CFDA’s tight-lipped response to questions from In These Times was echoed by fashion magazine editors, designers and modeling agency representatives. All declined request to comment. 

The CFDA has received flak for not ensuring model health with stricter regulations, but it is not properly equipped to resolve the issue on its own. Claire Mysko, former director of the American Anorexia Bulimia Association, puts it this way: The CFDA is not a union. They don’t have the resources to enforce guidelines, and it would take a system to be in place for that to happen.” Even if the CFDA were to address model health in a meaningful and specific way, as several organizations devoted to eating disorder awareness already have, it has no regulatory authority to implement such directives. The AED, EDC and other advocacy organizations have offered the CFDA their help, but have received no response from the industry.

Herzog cautions against demonizing the industry. The question I always get asked is, do I really believe these fashion leaders are serious about change, or do I think I’m being used? I would suggest that they actually are interested in making changes. It’s just that it’s hard to get all the various parties on board, especially in such a competitive industry,” he says. I do believe, though, that this industry has a responsibility to create healthy images for the public at large.”

For the fashion industry to fulfill that responsibility, both to its models and to the public that consumes its products, it will have to undertake comprehensive changes, and in the process go up against entrenched beliefs about the role and purpose of fashion models. Mysko and model Magali Amadei, authors of Does This Pregnancy Make Me Look Fat?, suggest that models form a union that could empower them to negotiate the terms of their contracts without fear of losing jobs to an endless stream of ever-thinner – and more desperate – hopefuls.

Direct government regulation is another option. Fashion images do not cause eating disorders or other health conditions, in the same way that cigarette ads do not cause lung cancer nor liquor ads cause alcoholism. Nevertheless, governments have deemed their influence detrimental enough to public health to merit regulation. In the United Kingdom, Britain’s Royal College of Psychiatrists suggests that warning symbols be placed on airbrushed images of models alerting viewers to their deceptiveness. And in 2007, Bronx Assemblyman José Rivera proposed legislation that would create a state advisory board to establish standards for the employment of models under the age of 18, in part to help prevent the development of eating disorders. 

Until government acts – an unlikely prospect in the laissez-faire United States – America’s fashion industry ought to act to quell our dangerous obsession with thinness, or acknowledge its central role in perpetuating it.

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