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, the 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."
To read the rest of this story, click over to In These Times. As one model explains the problem, "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."