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October 02, 2006

Emaciated fashion models and occupational health

Lately, there's been a lot of discussion in the feminist blogosphere about a new Spanish ban on emaciated models at the Cibeles fashion show:

In accordance with the new regulations for this year's Cibeles fashion show 30% of models who appeared on its catwalk last year have been excluded for being too thin.

The models have been rejected because they do not comply with new rules put into place by Madrid's Regional Government demanding that models present a healthy image with a [body mass index (BMI) of at least 18], i.e. they must weigh at least 56 kilos if their height is 1.75[m2]. These figures are approximately what the World Health Organization (WHO) considers to be the minimum healthy weight.

The designer Jesús del Pozo made the announcement in a press conference during which Concha Guerra, Madrid's Vice-Director of Economy and Innovative Technology laid out the new guidelines for the fashion show which starts on 18th September. She said they had taken this unprecedented step because they were aware of the influence the popular Cibeles catwalk had on young girls' perception of fashion and ideal bodies. She explained that the Madrid government were aiming for healthier-looking models and getting away from the wasting-away appearance of many models which was heavily criticised during the last Cibeles catwalk. [Euroresidente]

As a pro-labor feminist and a civil libertarian, I have mixed feelings about the Madrid rule.

The policy is clearly an infringement on the free speech of fashion designers. Design is a form of expression and a fashion show is an aesthetic undertaking. Designing clothes for aesthetic effect is a creative undertaking. If a designer envisions her creations being worn on a certain shape of body, that's her prerogative. Even if we think her aesthetics are indecent or her politics are blinkered and decadent, we should respect her right to realize her creative goal.

Putting on a fashion show is like staging a play or filming a movie. The whole production is engineered to create a particular aesthetic effect for the designer and the collection. A fashion show is also live action ad, which makes it commercial speech.

The Madrid Regional Government's rationale for the new law is very troubling. Their main argument is that fashion shows should be regulated because they present an unhealthy ideal of beauty to the public and therefore constitute a public health risk. I have no doubt this is true, but I don't want the government to suppress ideas just because the larger society considers those ideas to be destructive. I certainly wouldn't want the US government taking any greater liberties on the censorship front.

However, Amanda raises a compelling counterargument at Pandagon. As she notes, the industry standard in modeling is an occupational health risk. A designer's right to design clothes for emaciated models doesn't necessarily guarantee her right to hire actual people to wear these clothes under dangerous conditions.

The average fashion model has a BMI of 16, which well below what most medical experts consider a normal weight for a well-nourished adult. Only a fraction of post-pubescent women have a BMI below 18 for any reason (CDC).

Even for 15-year-old girls, a BMI of 16 is at the 3rd percentile. (That is, only 3% of American 15-year-olds are at or below the average weight of a fashion model.) If you look at the chart I've linked to, you'll see that it doesn't even bother to quantify exactly how rare BMIs of 16 are in women ages 15-20. Look at the curve and you'll see what I mean--we're talking below the first percentile.

Of course, models are hired precisely because they are physically atypical. Still, it's probably a myth that there are large numbers of people who are naturally thin enough to be catwalk models.

Of the women who currently have BMIs of 16 who are of modeling age, a large percentage are probably suffering from anorexia, substance abuse, and/or other health problems. It has been estimated that one percent of all American women suffer from full-blown anorexia nervosa. If less than one percent of 18-year-olds have a BMI of 16 for any reason, and 1% of 18-year-olds are anorexic. There must be considerable overlap because an extremely low weight is a necessary diagnostic criterion for anorexia nervosa. A person won't be diagnosed as anorexic unless they're lighter than the vast majority of people their height.

The fact that the current modeling industry standard is unhealthy for most aspiring models also contributes to an unhealthy professional culture in which even the thinnest models can become obsessive and paranoid about their weight. After all, one of the hallmarks of anorexia is the conviction that one is too fat despite being extremely thin.

The evidence is overwhelming that the current industry standards for fashion models are unhealthy for the vast majority of models. Professional pressure can contribute to the development of anorexia, the psychiatric condition with the highest mortality rate. Simply staying thin enough to be employable as a model can pose health risks, even in people who don't have anorexia. These include decreased bone density, infertility, slowed heartbeat, and in rare cases, death. I don't know if anyone has quantified the risks of long-term professional starvation and compared them to other occupational risks that we regulate. Aggressively dieting to stay 30 pounds underweight for a year probably is at least as unhealthy as working in a bar with second-hand smoke for the same period of time.

If the current industry standard is dangerous for a lot of the people who work in the industry, it makes sense to submit the industry to some kind of regulation. However, the Madrid model would not be appropriate for the United States.

Restricting the aesthetics of fashion shows is an infringement of First Amendment rights. Don't tell me that fashion show free speech is trivial. I won't argue too strenuously that fashion shows make an important contribution to public discourse, but censorship is censorship. The only question is whether the benefit to the workers is sufficient to offset this infringement.

It is also difficult to see how a BMI restriction could fit into the existing legal framework for occupational health and safety regulation. The BMI standard looks at worker's bodies, not at their working conditions. So, the law affects people even if they are not putting themselves at risk in order to achieve a particular look. The health risks of having a BMI=n aren't the same for everyone. Some people can achieve the magic number with zero health risk, or minimal risk, while others can't even get close with life-threatening measures.

The issue is not how many people there are who are naturally and safely thin enough to be fashion models today. The BMI standard is arbitrary and that arbitrariness is problematic. You can't just deprive people of their livelihood because you want to send a larger message to an industry.

Furthermore, if anorexia is a work-induced disease, it seems perverse (and possibly illegal) to make women who suffer from the disease unemployable. It would set a very bad precedent to start making people unemployable because of medical/psychiatric conditions that don't affect their ability to do their job.

The best argument for minimum BMI laws is to rid the modeling community of the ruinous pressure to be ultra-thin. It's not that everyone who is that thin is at risk, it's that the current industry standards require most would-be models to put themselves at risk in order to be competitive. A BMI of 18 is still very thin by "civilian" standards. (The difference between BMIs of 16 and 18 amounts to about 10lbs on a 5'9" model.) So, it's not as if the designers are being asked to sacrifice the slender aesthetic for the sake of public health.

The problem is that the current standards create a never-ending cycle of competition to be thinner. If we could somehow step back and say, okay, thin's fine but we shouldn't allow emaciated models to set the industry standard. All models would be better off if an outside force imposed a reasonable minimum weight for the whole profession. However, I don't see how such a rule could be legally imposed.


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thanks. You said just I was thinking. The American attitude towards freedom of speech is, from an European viewpoint with other historical experiences and another understanding of the state and its duties, very difficult to understand. It is sometimes seen as another form of fundamentalism, analogous to the absolute value of life pro-Life activists act for; detached from the world and real empirical facts about the social effects of free speech resp. restrictions, based on elitist and utopian ideals of individualism, human behavior or opinion-forming. The difference concerning the role of the state is straightforward. It's much more paternalistic. A state, better our state, that isn't capable of interventing and averting collectively dismissed dangerous behavior patterns is seen as weak and powerless, an organization guilty of failing to render assistance.

So the reaction in Europe was completely positive. Actually, the absurd and deadly obsessions of girls and women wearing size 0 (or 00!) trousers we are importing from the US is a raising issue. Especially feminists but also physicians and politicians who are responsible for youth and women's issues welcomed the Spanish rules.

BMI causes me problems. Mine is 17.13, today. It gets as high as 18.31, when I am running heavy (now, when I was sent to Landstuhl, I was unwell, with a BMI of 15.51, but that was a side effect of another condition).

I am healthy. The highest I have ever been was 20.08, and that was fat (honest, not so much as people who didn't know me would notice, but those who do, did).

I think a real test (some sort of physical exam) is the only real way to measure this, since, were I a woman, I'd be at the fine edge of not being employable as a model.

As a man, I am too thin.

My point is that I don't think this strategy for protecting models can work within the US.

I still don't see why. It's perfectly possible (and done) to restrict certain forms of advertising in the US -- particularly at the state and county levels, it appears -- and restriction on advertising is what the Madrid law is most comparable to.

I can imagine it working in Canada where constitutional protections for individual rights aren't as strong as they are here.

Assuming the American constitution is ever resurrected from its sojourn into oblivion, I think it can be legitimately interpreted in ways that don't substantially interfere with the ability to borrow ideas from other countries. Tobacco really is a useful example of an industry where this already happened; the American onslaught on tobacco was inspired by European examples, and survived attempts by the tobacco industry to claim that restrictions were undermining their First Amendment rights. There's no particular reason that fashion industry can't be usefully restricted in certain ways and for similar reasons.

Lindsay's post seems to look at the Madrid rule too much through American eyes. If I understand it, this is a fashion show run by the Spanish government or some local government thereunder. It's not a private fashion show. Those of us in the US (and I know Lindsay is Canadian, but she lives here now) may find it hard to conceive of the US govt running a fashion show, so we might imagine a private show with a free speech issue.

But it looks like Spain doesn't have such constraints, so they have government-run fashion shows. As such, it's their government's duty to promote public health, by using healthy models instead of anorexic ones.

Fair enuf?

Ummm, I can't find any indication that Cibeles is government-run in any way. It looks to me like a fairly bog standard trade show dealing with regulations from the Madrid regional government, since it's operating in their jurisdiction.

I'm just not buying that this is necessarily any more of a "free speech issue" than other forms of advertising standards, which are pretty much as common and unremarkable in the US as elsewhere.

Hm, Dr Slack maybe you're right, I can't tell either. I read the thing a little too fast on first pass. It did come across as some kind govt-sponsored event, the way some governments sponsor their countries' Olympic teams. But there's nothing explicit to that effect.


I'd agree, based on the clear text of the 1st Amendment, that "this couldn't happen here." But I can't see any difference between this and the ban on tobacco advertising--except that this would be more justifiable, if anything, because it's possible to argue that models are directly harmed.

I'd be interested in what you see as the difference, if you see one.


I think that 'none' is missing the point that the post was about the efficacy of imposing regs in the US, which necessarily makes it US-centric.

We have a problem in this country with the way rights are framed, in that it's very hard to create reasonable regulations to manage some of the emergent properties of the ways people exercise their rights. My pet peeve is the difficulty of creating an effective campaign finance reform scheme that removes the burden of constant fundraising (and associated distortions of democracy) from the backs of elected leaders. I think the free speech/workplace safety issue is another of these problems.

Posit a woman that can have a BMI below 16% naturally with minimal to no health risk. An exceptional rarity to be sure, but is it even remotely moral for the government to force her to gain weigh to seek employment?

These women want to look the way that they do and weigh the amount that they do. It seems self evident that it is inappropriate for the state to regulate a person's weight, which is what this is, in effect, doing-- gain weight or change careers. I am both astonished and terrified at the use of increasingly narrowed definitions of freedom. If we do not posess autonomy over our own bodies, what liberty do we possess?

I just did a quick Pubmed search and could find only 1 scientific article on the prevalence of eating disorders among models. I can only read the abstract, but the conclusion seems to be that while models sometimes use anorexia tactics to lose weight, the biggest difference was that models got invited to fancy clubs where they partied all night and used a lot more drugs.

Obviously, there is no data on the health and safety of fashion models to justify a health and safety regulation for fashion models. It is very much unclear if a minimum BMI requirement would safe lives.

As for the reason fashion models are too thin, in my humble opinion it is because they have to look desirable while fully clothed. Somehow swimsuit models or pornstars do not have to be as thin. So unless fashion evolves towards 100% spandex, the problem will remain.

The drug abuse is certainly part of it. Part of the appeal of cocaine and other stimulants is their appetite suppressing effect. Anorexia and substance abuse often go together, for a variety of reasons. Thanks for posting the link to the abstract.

The policy is clearly an infringement on the free speech of fashion designers.

I'm not so sure it's so clear. While fashion designers have a right to design clothes any way they want to, their rights end where the rights of the models to be free from undue occupational hazards begin. IOW, while the designs themselves can be viewed as speech, the demand that the models be dangerously thin in order to make the clothes comply with the vision may not be viewed as speech.

I mean, child pornographers may have free-speech rights in terms of their artistic vision, but few dispute the power of the government to prevent them from using actual children as models, based on a theory that child safety is a greater interest than free speech.

Moreover, speech has always been subject to restriction of one kind or another; the big question is whether the restrictions are reasonable. And one of the factors that go into reasonableness is whether there are competing interests that supersede the individual right to free expression. Public/occupational health concerns may be viewed as sufficiently substantial to outweigh the right of the designer to insist on a skeletal model.

And, Jesus, is there really that big a difference between 16 BMI and 18 BMI such that a decent designer can't dress the 18-BMI cow without compromising the vision?

I always find it interesting that Americans (of whom I am one) find business cultures that impose dangerous ideals "okay", and yet feel government intervention to protect those affected is "bad". We're not talking about banning people from being below a BMI of 18. Anyone who chooses to have a BMI less than 18 still can. Anyone who wants to design clothes for those people still can. We're talking about stopping harm from befalling workers in an industry. When an industry explicitly demands unsafe behavior from employees in order that they maintain their jobs, it is the job of the government, U.S. or otherwise, to step in. Espically when there is a lack of unionization.

Also, I'd like to mention to some posters that the concept of commercial free speech is relatively new in US, barely more than two decades old (first real Supreme Court case was 1976), and is still evolving. Please do some searches on corporate free speech and corporate person-hood before assuming this "right" was drawn from the 1st Amendment. It is highly derivatory in nature, and the legal steps that have produced it are fascinating.

Can't remember where I heard the suggestion that, because everyone buys ready-to-wear nowadays, they will make their choice based on how it looks on a coathanger - I mean, you'll try it on before buying, but if it doesn't look good on the hanger, you won't even bother trying it on - and thus the models who display modern clothing best are those who are the closest physical approximation to being coathangers with nice cheekbones.

You're not talking about preventing people from below BMI-18, you're just telling those in the fashion industry that are that they have to be or lose their means of income. The state should have no right to say that a person who can do a job should not because of their physical characteristics.

This isn't, to me, primarilly about the rights of the designers (though the idea that you cannot hire the person you believe to be the most qualified professional for a position is rather irritating), it's about the rights of the models to the bodies they want, even if they want them for the wrong reason. Plastic Surgery has dangers, too, and is promoted directly by the hiring practices of the entertainment industry-- shall we then ban all actresses who have undergone plastic surgery from the silver screen?

Let me also suggest that there is no small element of schadenfraude to this whole affair-- there is a tremendous resentment of pencil thin models and the unrealistic standard they create for normal women. "About time they got what's coming to them."

Despite all the brouhaha over anorexia, obesity is much more common, and a much more serious public health problem.

This attitude explains the problem in a nutshell, the false dichotomy where if you're not about to die from starvation, you are fat. No in-between.

The state should have no right to say that a person who can do a job should not because of their physical characteristics.

The state also assumes, in some degree, a positive responsibility for public health. In the case of fashion, it's not just a job that happens to attract people with certain physical characteristics: the body image is the core part of the industry's product, and standards are already being enforced by that industry that are (arguably) injurious to the health of the workers and the public. The state is just not essentially obligated to be hands-off about that, although I think it's completely legit to dispute the specific case about health if one wants to. (Though I think arguing that the fashion industry's standards are healthy and unharmful is an uphill battle to put it mildly.)

Incidentally, whoever mentioned that obesity is a more pressing public health concern is spot on, but obviously that needn't imply that concerns about anorexia or bulimia should go unaddressed.

It's clear that the point of rule is NOT to protect the health of the models. '[T]hey had taken this unprecedented step because they were aware of the influence the popular Cibeles catwalk had on young girls' perception of fashion and ideal bodies." The fashion industry selects its models from the very small percentage of women who have certain very rare physical attributes. The whole point is to stop fashion designers from communicating unhealthy ideas to the vast majority of girls who do not possess these physical attributes.

I personally think that's just fine. Others may disagree. But there is no way to avoid the issue by claiming that the regulation is intended to protect the health of the models.

Fair enough. However, it is possible to claim that the health of the models is part of the benefit, whether or not it's the declared motive for the law. I'm fine with public health angle too.

I think JR is right: of course I can't read Lindsay's mind, but it does seem that she's approaching the "occupational hazard" angle as a way of justifying the BMI policy that is more agreeable to her than the "public health" angle. I can understand her discomfort with a policy that seems to ask individuals to sacrifice their careers for the greater good, so she prefers to characterize the measure as something for the models' own good.

But unlike the soot-blackened miners, models (the current crop anyhow) would probably protest the "protections" vociferously as it's, er, taking bread out of their mouths. It seems awfully patronizing to impose restrictions that would end the careers of many, or at least strip them of their current advantage should they decide to gain the weight, on the pretext that it is for their own good. Besides, what's next? If we're really talking about anorexia-causing occupations, ballet is next in the crosshairs.

I think the cigarette advertising restrictions mentioned by some upstream commenters is an apt comparison. Doubtlessly we are also compromising the ability of individuals to capitalize on their talent by restricting cigarette advertising. Perhaps because the work of ad executives seem less "personal" than models' bodies, we don't wigg out about it as much.

By the way, I think it's a complete non-sequitor to remark that obesity is a more serious health problem. You might as well say "by the way, you are more likely to be killed in an aut

(opps, premature post)
...automobile accident as by anorexia". The thing is, Americans aren't dying from obesity because our runway models are too chunky.

Whew, all done.

I think the occupational hazard rationale is legitimate, but the public health/body image rationale is not. I agree that the fashion industry is implicitly promoting an unhealthy ideal, but I don't believe that the fashion industry is the primary cause of poor body image or eating disorders in society at large.

Besides, I think that the fashion industry has a right to implicitly promote whatever aesthetic it wants in a free society.

Ostensibly, the fashion industry is selling clothes, not emaciation. So, I'm not sure a ban on skinny models is analogous to a ban on certain kinds of cigarette advertising. There's an obvious connection between selling people cigarettes and cigarette smoking. Whereas, the connection between skinny models and eating disorders in the general population is much more tenuous.

Of course, fashion isn't the only industry that uses thin female bodies for marketing purposes. Advertising, Hollywood, some segments of the hospitality industry, and countless other enterprises do the same thing. I don't believe in censoring any of them, even if the unattainable and largely artificial images they present contribute, directly or indirectly to women's preoccupation with their appearance and dissatisfaction with their own bodies.

Basically, what you have in the fashion industry is a race to the bottom. The current average weight is so low that a large percentage of models are driven to extreme measures in order to stay competitive. The current average creates a culture that puts everyone at greater risk of eating disorders--even those who can maintain very low weights naturally.

If you raised the average weight by 10lbs, there would be no real change in the body image promoted by the media. These models would still be lithe and willowy with BMIs of 18, and a BMI of 18 would remain beyond the reach of the vast majority of women. Models' function as clothes hangers would not be compromised if the average BMI were to rise to 18 from 16. The fashion industry got along just fine for decades with slightly heavier models.

In practice, I don't know how you would go about imposing a standard on the US modeling industry without compromising free expression.

-Americans aren't dying from obesity because our runway models are too chunky

I don't think its a non-sequitar at all, model eating disorders are simply high profile and the implication is that 'they aren't eating enough'.

But its not a question of 'eating enough', its about what you choose to eat (and whether you keep in down.) People eat (all the wrong things) when they are depressed and as an escape from reality. They eat to 'feel'(good)something and because things that taste good give them a mild physical high. And food companies sell foods based on taste, physical stimulation, which is the exact wrong reason to buy.

Anorexics refuse to eat and Bulimics purge to gain a sense of control... another 'feeling' used to cope with self-esteem issues and depression. Eating/not-eating are both rooted in psychology.

Not eating, eating too much, and eating the wrong things are all 'diet issues' but NONE are that simple.

For most people, being underweight is a health problem, but so is being overweight. Its really the same issue.

The fashion industry selects its models from the very small percentage of women who have certain very rare physical attributes.

And they also demand that even those people to lose weight. Remember, all this came about after a model who'd been subsisting on lettuce and cigarettes after being told by a designer to lose weight dropped dead after stepping off the catwalk.

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