TO THE FASION INDUSTRY AS REPRESENTED BY THE BRITISH FASHION COUNCIL
_The following is a letter to the fashion industry by Janet Treasure and EDRU Team in response to fashion's insistent use of underweight models, and the Madrid Catwalk's ban on using Underweight girls. It is a call to the fashion industry to realise their impact on women's psychological state, and to thus act responsibly.__
Eating disorders, anorexia nervosa and bulimia nervosa are common disorders found in nearly 10% of young women. There is a large range in clinical severity. Some cases are mild and transient. However in the clinic we see the dark side whereby the quality of life of the individual and her family shrivels away and the shadow of death looms. These disorders have the highest risk of physical and psychosocial morbidity than any other psychological condition. The costs for the individual, the family and society are huge. Therefore research has focused on trying to prevent these disorders and to identify the factors that cause or maintain them.
Anorexia nervosa has a long history but bulimia nervosa was rare in women born before the 1950’s. The incidence of the binge eating disorders like that of obesity has rapidly increased in the last half of the twentieth century. Most experts agree that cultural factors in terms of eating behaviours and values about weight and shape are important causal and maintaining elements in the bingeing disorders. The internalisation of the thin ideal is a key risk factor. Dieting to attain this idealized form can trigger an erratic pattern of eating especially if it used in combination with extreme behaviours that compensate for overeating.
Studies in animals suggest that persistent, changes in the brain and behaviour like those seen in the addictions result if the pattern of eating is disrupted in critical developmental periods. The paradox can be that a desire to be thin can set in train a pattern of disturbed eating which increases the risk for obesity. So how can this society protect young people from these consequences?
Interesting work in colleges in the USA reported this year has shown that an educational web based intervention promoting a healthy relationship with food and body image can prevent the onset of an eating disorder in those that are at highest risk. Such use of the web can act as an antidote to the pro-ana (pro-anoreixa) web sites which foster toxic attitudes and unrealistic body forms.
Public health interventions may also be warranted. Spain has taken the first step. The Health Authorities of the Region of Madrid and the Annual Cibeles Fashion Show (Pasarela Cibeles) banned extremely thin models from participating in this year’s event. Models with a Body Mass Index (BMI) below 18kg/m2 (30% of the participants) were offered medical help rather than a position on the cat walk. To put this in context, the average BMI for a healthy woman is between 19 to 25kg/m2. To be clearly diagnosed with anorexia nervosa a BMI of less than 17.5 is needed although in most treatment centres people with a higher BMI have levels of clinical severity that warrant treatment.
The issue is not whether we should place the blame of unhealthy eating behaviours on the Fashion Industry or on anyone else. The issue is that Spanish Health Authorities have decided to intervene in a health issue, which is directly affecting the well-being of models as well as affecting the attitudes and behaviours of many young girls and women who may strive to imitate and attain these unhealthy pursuits.
Adopting what Madrid has done is a good first step but the fashion industry, from designer to magazine editors, should not be making icons out of anorerexically thin models. Magazines should stop printing these pictures and designers should stop designing for these models. People may say that clothes look better on skinny models but do not forget there was a time when smoking looked good too.
Janet Treasure and EDRU Team
Professor Janet Treasure, PhD FRCP FRCPsych is Head of the Eating Disorders Service and Research Unit at South London and Maudsley NHS Trust, The Institute of Psychiatry, Kings College London and Guy’s Hospital, London.