Source: Stephoccitan / Wikimedia Commons
There is no simple story about what causes anorexia or bulimia, and our stereotypes about who has an eating disorder or not are often wrong. Research has documented high rates of anorexia and bulimia among members of professions that emphasize extreme thinness, such as dancers or jockeys. But when it comes to focusing on thinness, no industry has caught the attention of eating disorder researchers like the fashion industry. Despite the pushes for greater body size inclusiveness, fashion models (particularly those who work on the runway) remain remarkably thin, often dangerously.
Much research has documented the extent to which seeing images of these ultrathin models contributes to body image struggles or symptoms of eating disorders in women. However, less work has focused on how modeling demands for extreme thinness affect eating disorder rates among women working in the industry. New research published in The European review on eating disorders notes that despite recent moves to limit the hiring of dangerously thin models, a high percentage of professional models are extraordinarily thin. However, only a subset of these patterns report engaging in high levels of disordered eating behaviors.
Fashion models often face explicit demands to lose weight or maintain extremely low weight. These requests often come from agents and designers, who point out that a very slim body is both the key to being hired and essential for adapting to the small sizes typically provided for runway shows. In new research conducted by a team of scientists in Hungary, nearly 200 models, all women, from 36 different countries completed an online survey on disordered eating attitudes and behaviors. They were matched with a sample of women of a similar age who weren’t modeling. The survey was distributed through the models’ social networks and by various non-profit organizations that work to protect the models.
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To examine body size, the researchers calculated the respondents’ body mass indices (BMIs) from self-reported height and weight. BMI is far from ideal when it comes to assessing an individual’s health, but it can provide a rough metric of extreme thinness. In general, the lower limit of a “healthy” BMI is considered to be 18.5. In the interest of fighting anorexia, several countries have now banned models with BMI below 18. However, fashion models are often unusually tall and genetically lean; a low BMI does not always mean that a model is in poor health or suffering from an eating disorder. Given the focus on extreme thinness, the researchers did not include “plus-size” models in this study.
The women in the study completed disordered eating measures that assessed the drive for thinness, purging, and body dissatisfaction. Their BMIs were calculated based on self-reported height and weight. The actual diagnosis of an eating disorder typically requires an interview with a doctor. In this study, the researchers simulated these eating disorder diagnoses based on the questionnaire and BMI responses. For example, a sham diagnosis of anorexia was based on having a BMI below 17 combined with an extremely high score on a measure of drive to thinness.
A sham diagnosis of bulimia was based on reporting at least one binge per week and at least one compensatory behavior (such as vomiting), combined with high scores on thinness and other symptoms of bulimia. The researchers also identified women who could be classified as suffering from what is called “partial syndrome” or subclinical eating disorder. Partial Syndrome Eating Disorders are basically cases where someone is experiencing significant eating disorder symptoms but does not meet the full diagnostic criteria.
Overall, the researchers found that the fashion models were extraordinarily subtle. About 45% had a BMI between 17 and 18.5; a further 21% had a BMI below 17, which is considered severely underweight. By comparison, only 4% of women in the non-model group had a BMI below 17. In terms of sham diagnoses, 4% of models met the criteria for anorexia, with a further 15% meeting the criteria for subclinical anorexia. The higher rates of both complete syndrome and partial anorexia syndrome remained even when the researchers statistically adjusted for the fact that the models tended to be taller and leaner than women in the non-model group. Bulimia was less common among models, with approximately 2% meeting all criteria and 6% in the subthreshold category for bulimia. Overall, bulimia was no more common in the model group than in the non-models.
Extreme thinness is a diagnostic indicator for anorexia, but not for bulimia or binge eating disorder, which was not evaluated in this study due to its focus. Those who struggle with the symptoms of anorexia but are not underweight are often diagnosed with another “specified” form of anorexia commonly called “atypical anorexia”. While the fashion industry is certainly guilty of promoting unhealthy levels of thinness among women, eating disorders aren’t limited to those who are underweight.
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Overall, this study suggests that fashion models remain substantially leaner than women of the same age and are often dangerously underweight. These findings also support the frequent claim that simply being a model increases the risk of anorexia. Will fashion houses ever embrace a wider variety of body types on the runway? The evidence is mixed. New York’s most recent fashion week included the appearances of 48 plus-size models, after only six plus-size models appeared in the fall of 2021. But when it comes to the biggest fashion houses, the models remain remarkably slim .