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There’s no simple story about what causes anorexia or bulimia and our stereotypes about who does or does not get eating disorders are often wrong. Research has documented elevated rates of anorexia and bulimia among members of professions that emphasize extreme thinness, like ballet dancers or jockeys. But when it comes to a focus on thinness, no industry has captured the attention of eating disorder researchers like the fashion industry. Despite pushes for greater body size inclusivity, fashion models (particularly those who do runway work) remain overwhelmingly thin, often dangerously so.
Much research has documented the extent to which seeing images of these ultra-thin models contributes to body image struggles or eating disorder symptoms in women. However, less work has focused on the ways in which modeling’s demands for extreme thinness affect rates of eating disorders among women who work in the industry. New research published in The European Eating Disorders Review finds that despite recent movements to limit the hiring of dangerously thin models, a high proportion of professional models are extraordinarily thin. However, only a subset of these models report engaging in high levels of eating-disordered behaviors.
Fashion models often face explicit demands to lose weight or maintain an extremely low weight. These demands frequently come from agents and designers, who emphasize that a very thin body is both the key to getting hired and essential for fitting into the tiny sizes typically provided for runway shows. In new research led by a team of scientists in Hungary, nearly 200 models, all women, from 36 different countries completed an online survey about eating disordered attitudes and behaviors. They were matched with a sample of similarly aged women who were not pursuing modeling. The survey was distributed through the social networks of fashion models and by several non-profit organizations that work to protect models.
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To examine body size, the researchers calculated surveys’ body mass indices (BMI) 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 bound of a “healthy” BMI is considered to be 18.5. In the interest of combatting anorexia, several countries have now banned models with BMIs below 18. However, fashion models are often unusually tall and thin genetically; a low BMI does not always mean a model is in poor health or experiencing 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 measures of disordered eating that assessed 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 clinician. In this study, the researchers simulated these eating disorder diagnoses based on questionnaire responses and BMI. For example, a simulated diagnosis of anorexia was based on having a BMI below 17 combined with an extremely high score on a measure of drive for thinness.
A simulated diagnosis of bulimia was based on reporting at least one binge per week and at least one compensatory behavior (like vomiting), combined with high scores on the drive for thinness and other symptoms of bulimia. The researchers also identified women who could be classified as having what’s called a “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 full diagnostic criteria.
Overall, the researchers found that the fashion models were extraordinarily thin. Around 45 percent had BMIs between 17 and 18.5; an additional 21 percent had BMIs below 17, which is considered severely underweight. As a comparison, only 4 percent of the women in the non-model group had BMIs below 17. In terms of simulated diagnoses, 4 percent of the models met the criteria for anorexia, with an additional 15 percent meeting the criteria for subclinical anorexia. The higher rates of both full syndrome and partial syndrome anorexia held even when the researchers statistically adjusted for the fact that the models tended to be taller and thinner than women in the non-model group. Bulimia was less common among the models, with around 2 percent meeting the full criteria and 6 percent in the subthreshold category for bulimia. Overall, bulimia was not more common in the group of models compared to the non-models.
Extreme thinness is a diagnostic indicator for anorexia, but not for bulimia or binge eating disorder, which was not assessed in this study given its focus. Those who struggle with the symptoms of anorexia but are not underweight are often diagnosed with having an “other specified” form of anorexia commonly referred to as “atypical anorexia.” While the fashion industry is certainly guilty of promoting unhealthy levels of thinness among women, eating disorders are not limited to those who are underweight.
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Overall, this study suggests that fashion models remain substantially thinner than age-matched women, and are often dangerously underweight. These results also lend support to the frequent claim that simply being a fashion model increases the risk for anorexia. Will fashion houses ever embrace a wider variety of body types on the runway? Evidence is mixed. The most recent New York fashion week included appearances by 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, models remain overwhelmingly thin.