On the Catwalk, How Thin is Too Thin?

Spain's top fashion show made international headlines this week not for the clothes on display but for the size of the women wearing them.

The Sept. 13 decision from the Madrid regional government to enforce a ban on underweight models for Madrid Fashion Week catwalks has sent shock waves through the global fashion industry and set off a chorus of calls to expand the ban and formulate a new industry standard. The government's decision is intended to promote a healthier body image.

The unprecedented move marked the first time organizers of a major fashion show imposed weight limits in line with World Health Organization guidelines for healthy height-to-weight ratios used to calculate a person's body mass index, which estimates the portion of fat in the body.

Over 30 percent of the models who appeared in Madrid shows last year were disqualified under the new guidelines that will likely prevent the participation of top models such as Brazil's Fabiana, Spain's Esther Canadas, Britain's Kate Moss and Estonia native Carmen Kass.

"This is a great call to global action," says Lynn Grefe, chief executive officer of the Seattle-based National Eating Disorders Association.

"We worked hard to restrict advertising for alcohol and tobacco because of the potential dangers to our young people, and fashion is now the only major industry without health guidelines," Grefe said. "It is high time we ask for some responsibility from within the industry for the impact fashion has on potentially life-threatening eating disorders."

International Reaction
Reaction from the international fashion industry was varied, but many governments seem prepared to pick up Spain's cue, as the enforcement decision spread through news outlets around the world.

British Culture Minister Tessa Jowell publicly applauded the move to comply by the organizers of Pasarela Cibeles, Spain's premiere fashion event, while Letizia Moratti, the mayor of Milan, Italy, threatened a similar ban on too-thin models if the city could not negotiate voluntary terms with fashion designers and agencies.

India's Health Minister Anbumani Ramadoss said his country is also concerned with stick-thin models and their admirers, and hoped Madrid's move "makes young girls focus more on being healthy and lean rather than starving and skinny."

Edinburgh, Scotland, announced it would follow Madrid's lead, banning any model with a BMI of less than 18. A BMI of 18.5 or below is considered underweight by the World Health Organization, anything 25 or over is considered overweight. The average BMI for top models is 16.3, according to data from the National Eating Disorders Association. Top U.S. designer Michael Kors also jumped into the fray.

"Thin is fine but it has to be healthy," Kors said at a press conference last week. "When I see a model come in and I can tell this is not naturally how they're supposed to look, we won't book them."

Other Shows Stick to Status Quo
Madrid is considered a major player on the European fashion scene and is no stranger to controversial shows. But the city lacks the clout of fashion capitals like Paris, London and New York, where the topic has been hotly debated in the last two weeks. All three cities went ahead with plans for their fashion weeks without imposing any weight restrictions.

While some within the fashion world chafed at the industry being made a scapegoat for contributing to a rise in eating disorders, New York-based DNA Models' Chief Executive David Bonnouvrier said during New York's fashion week that the industry standard should focus on "beauty and luxury, not famished-looking people that look pale and sick."

Cathy Gould, North America director for New York agency Elite, told journalists the ban was "outrageous and discriminatory" to naturally super-slim models and designers though she appreciated the sentiment behind the move.

For decades health care professionals and eating disorder specialists have expressed concern over changes in the fashion, media and entertainment industries and their contribution to triggering eating disorders.

In 1965, models weighed an average of 8 percent less than the typical woman in the United States; the average model now weighs 23 percent less than the average woman, according to the National Eating Disorders Association.

"No one is saying fashion causes all eating disorders, but the industry does set the standard young girls are holding up as an ideal, and that can have a real effect on those who are vulnerable to eating disorders," says Grefe.

Eating Disorders Have Doubled
In the United States the number of eating disorder sufferers has more than doubled since the 1960s, according to the Washington-based American Academy of Child and Adolescent Psychiatry, with an estimated 10 million girls and women and 1 million men affected by anorexia nervosa, bulimia nervosa, binge-eating and other eating disorders.

Anorexia is a mental illness that progressively damages the body, is fatal to between 15 to 20 percent of sufferers, and causes more deaths among females aged 15 to 24 than all other causes combined. Forty-seven percent of U.S. females in fifth through 12th grade say they want to lose weight because of magazine pictures and 60 percent say magazines influence their ideas of desirable body types, according to the Philadelphia-based Renfrew Center Foundation.

"The worst part is that the images being portrayed in popular culture are completely unrealistic, airbrushed, manipulated . . . while putting a lot of pressure on young people to look a certain way," says Grefe. "Simply put, this is dangerous."

Eating disorders drive many sufferers into isolation, overcome by feelings of deficiency in the single-minded obsessive pursuit of perfection. To allay the ensuing loneliness, many young people turn to the Internet where scores of Web sites are devoted to their friends "Ana," "Bella" and "Mia," cyberspace nicknames for anorexia and bulimia. While anorexia proponents cite the Web pages and communities they spawn as places to draw strength, health care advocates have spent the last decade condemning them.

Scouring through magazines, clothing catalogs, newspapers, television and the movies, some eating-disordered women seize upon super-skinny celebrities for "thinspiration," a term used on pro-anorexia Web sites to describe admiration for their role models.

Supporters post pictures of their thinspiration favorites on Internet sites and community discussion boards. Popular thinspiration celebrities include movie star Keira Knightley, tennis star Anna Kournikova, and models Kate Moss and Oksana Pautova. Even those like Mary-Kate Olsen and Victoria "Posh Spice" Beckham, who have publicly admitted to their battles with eating disorders, are held up as templates for success.