Models as a high-risk group: the health implications of a size zero culture

Increased eating disorder frequency and body image disturbance among fashion models due to intense environmental pressure: a content analysis

Introduction

Female fashion models are under intense occupational pressure. The present study focuses on assessing the lived experience of fashion models with regards to their dieting and exercising habits, body image perception, eating disorder-like symptoms, and experience of abuse via self-narrated reports.

Methods

Series of open questions were distributed among international fashion models (N=84, mean age=23.2 years; mean BMI=16.9) selected by convenience and snowball sampling. Models from 17 countries participated. The questions targeted models' eating, exercising, dieting habits, body image perception, and eating disorder symptoms. The average word count of the transcripts was 2473.9 (SD = 2791.6). Thematic content analysis was performed on the transcripts. A total of 31 codes were created to address disordered eating and body image concerns.

Results

Negative body-related claims appeared in 89.3%, and positive claims in 64.3% of the models' transcripts. Negative remarks about eating were made by 45.2% of the participants, and 23.8% positively. Control over their food intake was exercised by 78.6% of the participants and 40.5% used extreme calorie restriction. Models who talked more positively about their bodies expressed significantly more frequently extreme calorie restriction. Extreme sports habits occurred in 23.8% of the transcripts, obsessive sports habits were claimed by 11.9% of participants. Self-induced vomiting was prominent in 14.3% of the answers. Criticism from other industry members was experienced by 83.3% of the participants while 44.0% received body appreciation. Body image disorder-like symptoms were expressed by 63.1% of models. Such models mentioned significantly more often content about eating disorders and talked significantly more negatively about eating. Psychological problems were mentioned by 48.8%, whereas 16.7% took part in psychotherapy. Those who partake in therapy mentioned significantly more eating disorder content in their narratives. Abuse was mentioned by 25.0% of the models.

Conclusion

Fashion models are experiencing increased environmental pressure to conform to the extreme slimness ideal. There is a heightened prevalence of disordered eating and other weight-controlling behaviours among fashion models to succeed in their careers. Qualitative research is crucial in understanding the more subtle dynamics in conforming to and maintaining the thin beauty ideal.

I'm Skinny, I'm Worth More: Fashion Models' Experiences of Aesthetic Labor and Its Impact on Body Image and Eating Behaviors

The fashion industry has been critiqued for promoting ultra-thin bodies, yet the relationship between models' aesthetic labor and eating disorder (ED) development is unclear. Using interpretive phenomenological analysis, we explored the lived experiences of nine female fashion models including metaphors they used to describe body perceptions and eating behaviors. Four superordinate themes emerged: Shaped for the industry; The body as a market product; Food restriction ("it's almost glamorized"); Toward a healthier modelhood. Models' career trajectories were those of lost childhoods, punitive body rules, inadequate dietary advice, and self-regulated food restriction. Models were "shaped" by agents from an early age to conform to the industry's body rules irrespective of the physiological and psychological consequences. A "toxic" side to this aesthetic industry was depicted; agents were judged callous and money-focused, while idioms like, "feeling like a piece of meat" and "being a hanger of clothes" conveyed a deep sense of degradation and objectification. Ideas instilled at a formative age continued to influence self-image and eating patterns into maturity, pointing to an industrial element to the construction of eating disorders. Our study highlights how infantilization, sexism, and other unethical elements become normalized in poorly regulated industries such as fashion, with dire consequences for the health and wellbeing of employees. Model agencies should recognize the impact of occupational edicts and poor communication on young recruits in a sensitive phase of personality development. Finally, we advocate for more acknowledgment and further investigation into eating disorder construction commercial/industrial side.

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

BACKGROUND

Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality.

METHODS

In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable.

RESULTS

At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide.

CONCLUSIONS

The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.

Using Behavioural Reasoning Theory to Explore Reasons for Dietary Restriction: A Qualitative Study of Orthorexic Behavioural Tendencies in the UK

Orthorexia Nervosa (ON) has gained increased attention in academia since 1997. However, like other “Exia” conditions, there is debate around its inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This study aimed to examine the experiences of those following a diet indicative of ON in the United Kingdom. This information is essential to the development of diagnostic criteria and classification of ON. Behavioural Reasoning Theory was used to explore reasons contributing to the development of ON. Ten individuals (two males and eight females), aged 23–35 years, took part in semi-structured interviews. Inductive thematic analysis was used to analyse the results. Four themes emerged from the data—journey, social, rules/control, and ethical considerations which highlighted contributing factors to the development of ON behaviours, the impact of these behaviours on individuals' social lives, and a strive for control. These findings are the first to suggest that ON involves a more complex set of behaviours than current definitions and proposed diagnostic criteria suggest and highlight the need to consider a variety of reasons for restricted diet when developing diagnostic criteria, screening tools, and classification in the DSM.

The Relationship between Body Dissatisfaction and Eating Disorder Symptoms in Young Women Aspiring Fashion Models: The Mediating Role of Stress

It is widely recognized that body dissatisfaction is an important public health concern. In the past, being a fashion model was almost synonymous with anorexia/bulimia, and even today, there are cases of eating disorders in young women whose ambition is to become a top model. Moreover, stress can play a substantial role within ill health via related behaviors such as smoking, substance abuse, and inappropriate eating. In our study, we examined 112 aspiring fashion models aged between 15 and 24 years (M = 19.5, SD = 2.08) from 32 different countries of the world during an international contest, and 100 students (control group), aged between 16 and 22 years (M = 18.6, SD = 1.39). The purpose of this cross-sectional study was to examine whether stress mediated the relationship between body dissatisfaction and eating disorders. The study included the administration of stress and self-efficacy and the locus of control dimensions, body (image) dissatisfaction, and eating attitude disorder. Results indicated higher scores on body dissatisfaction, stress level, and eating attitudes disorder among the group of fashion models compared to the control. Mediational analyses showed that body dissatisfaction was partially mediated by stress level on eating disorders. Especially in the aspiring fashion models, there are often many possibilities that competitive stress causes candidates to exacerbate attempts to maintain their body weight below normal weight/height parameters. These results indicated that appropriate intervention for the management of stress level could possibly defend against the negative impact of body dissatisfaction on eating disorder symptoms. The presence of skilled health workers in the field of nutrition and psychology can be extremely important in the field of fashion to maintain an adequate quality of life.

What is the relationship between body mass index and eating disorder symptomatology in professional female fashion models?

Low body mass index (BMI<18/18.5) is utilized as a mandated cutoff for professional fashion model employment, based on assumptions that low BMI indicates eating disorder pathology. No previous studies have examined the association between experimenter-measured BMI and eating disorder symptomatology in professional fashion models. We measured BMI and Eating Disorder Examination Questionnaire (EDE-Q) responses in United Kingdom (UK) professional fashion models, and nonmodels. Characteristics were compared using robust standardized mean difference (rSMD) obtained via probability of superiority. Associations between BMI and eating disorder symptomatology were examined using robust regression, controlling for age. Models exhibited lower BMI but higher fat-percentage and muscle mass. On the EDE-Q, models had higher Restraint, Global, Eating, and Weight Concerns, and similar Shape Concern scores compared to nonmodels. BMI was positively associated with eating disorder symptoms in both groups, and all but one of the eight models with clinically significant EDE-Q level had ≥18.5 measured BMI. Lower BMI was not indicative of worse eating disorder symptomatology in models or nonmodels. Thus, using a low BMI cutoff (<18.5) may not be an appropriate single index of health for detecting elevated eating disorder symptoms in models. Different policies to protect models' health should be considered.

Self-determined motivation for eating behavior regulation and sociocultural influences among Romanian fashion models

There is growing interest in understanding the ways in which legislation and policy may help to decrease the risk for body image and eating concerns among fashion models. Romania is one of the few countries in which occupation standards exist for professional models. The purposes of this study were three-fold: (1) to investigate the level of sociocultural risk factors among Romanian fashion models compared with a matched control group, (2) to compare the rates of eating disorders and healthy behaviors, and (3) to compare levels of self-determination for eating behavior regulation and its association with eating disorders symptoms and healthy eating behavior. Results indicated that: (1) fashion models reported lower body shape concerns compared with female controls likely driven by their lower body mass index (BMI), (2) eating disorder symptom rates were similar between the two groups, and (3) autonomous regulation of eating behavior was not significantly higher in fashion models. The findings from this study suggest that in Romania, where occupation standards exist, a large proportion of fashion models report very low BMIs. However, both fashion models and matched controls presented similarly high levels of body image and eating concerns.

Eating disorders among fashion models: a systematic review of the literature

PURPOSE

In the light of recent concerns regarding the eating disorders among fashion models and professional regulations of fashion model occupation, an examination of the scientific evidence on this issue is necessary. The article reviews findings on the prevalence of eating disorders and body image concerns among professional fashion models.

METHOD

A systematic literature search was conducted using ProQUEST, EBSCO, PsycINFO, SCOPUS, and Gale Canage electronic databases.

RESULTS

A very low number of studies conducted on fashion models and eating disorders resulted between 1980 and 2015, with seven articles included in this review. Overall, results of these studies do not indicate a higher prevalence of eating disorders among fashion models compared to non-models. Fashion models have a positive body image and generally do not report more dysfunctional eating behaviors than controls. However, fashion models are on average slightly underweight with significantly lower BMI than controls, and give higher importance to appearance and thin body shape, and thus have a higher prevalence of partial-syndrome eating disorders than controls.

CONCLUSION

Despite public concerns, research on eating disorders among professional fashion models is extremely scarce and results cannot be generalized to all models. The existing research fails to clarify the matter of eating disorders among fashion models and given the small number of studies, further research is needed.

Research-to-policy translation for prevention of disordered weight and shape control behaviors: A case example targeting dietary supplements sold for weight loss and muscle building

New approaches to universal eating disorders prevention and interventions targeting macro-environmental change are greatly needed, and research-to-policy translation efforts hold promise for advancing both of these goals. This paper describes as a policy-translation case example an academic-community-government partnership of the Strategic Training Initiative for the Prevention of Eating Disorders, Multi-Service Eating Disorders Association, and the office of Massachusetts Representative Kay Khan, all based in Massachusetts, USA. The partnership's research-to-policy translation project focused on dietary supplements sold for weight loss and muscle building, which have been linked with serious injury and death in consumers. Youth and people of all ages with eating disorders and body dysmorphic disorder may be especially vulnerable to use these products due to deceptive promises of fast and safe weight loss and muscle gain. The research-to-policy translation project was informed by a triggers-to-action framework to establish the evidentiary base of harm to consumers, operationalize policy solutions to mitigate harm through legislation, and generate political will to support action through legislation introduced in the Massachusetts legislature to restrict sales of weight-loss and muscle-building dietary supplements. The paper concludes with lessons learned from this unique policy translation effort for the prevention of disordered weight and shape control behaviors and offers recommendations for next steps for the field to advance research and practice for universal, macro-environmentally targeted prevention.

Results of a strategic science study to inform policies targeting extreme thinness standards in the fashion industry

The appearance pressures experienced by fashion models have been criticized as harmful to their health, as well as increasing eating disorder risk among youth by promoting ideals of extreme thinness. Given recent legislation to protect models, we undertook a strategic science study to assess professional fashion models' perceptions of the potential impact and feasibility of seven policy proposals. A sample of 85 female fashion models, mean age = 22.7 years (SD 3.7) completed an online survey assessing unhealthy weight control behaviors (UWCB), perceived pressure from agencies to lose weight, as well as the perceived impact and feasibility of seven potential policy actions. Chi-squared analyses and multivariable logistic regressions compared UWCB among models who were asked to lose weight and those who were not. Friedman and Kendall's W tests were conducted to examine differences in impact and feasibility ratings across the seven policy proposals. Models reported high levels of pressure to lose weight, which was associated with higher odds of engaging in UWCB. The policy approaches rated as most impactful were those to increase worker protections, though they were rated as only moderately feasible. Requiring employers to provide food and a 30-min break for jobs longer than 6 h was rated as both impactful and feasible. Imposing restrictions on minimum BMI was rated as the least impactful. Approaches providing employment protections and healthier working conditions are most supported by professional models. These findings help to illuminate viable policy approaches from the perspective of key stakeholders.

Emaciated mannequins: a study of mannequin body size in high street fashion stores

BACKGROUND

There is concern that the body size of fashion store mannequins are too thin and promote unrealistic body ideals. To date there has been no systematic examination of the size of high street fashion store mannequins.

METHODS

We surveyed national fashion retailers located on the high street of two English cities. The body size of 'male' and 'female' mannequins was assessed by two blinded research assistants using visual rating scales.

RESULTS

The average female mannequin body size was representative of a very underweight woman and 100% of female mannequins represented an underweight body size. The average male mannequin body size was significantly larger than the average female mannequin body size. Only 8% of male mannequins represented an underweight body size.

CONCLUSIONS

The body size of mannequins used to advertise female fashion is unrealistic and would be considered medically unhealthy in humans.

Understanding Eating Disorders in Elite Gymnastics: Ethical and Conceptual Challenges

Eating disorders and disordered eating are more common in high performance sports than the general population, and particularly so in high performance aesthetic sports. This paper presents some of the conceptual difficulties in understanding and diagnosing eating disorders in high performance gymnasts. It presents qualitative and quantitative data from a study designed to ascertain the pattern of eating disorder symptoms, depressive symptoms and levels of self-esteem among national and international level gymnasts from the UK in the gymnastic disciplines of sport acrobatics, tumbling, and rhythmic gymnastics.

Fatty liver disease and lifestyle in youngsters: diet, food intake frequency, exercise, sleep shortage and fashion

BACKGROUND & AIMS

Fatty liver is associated with alcohol habits and/or overweight/obesity. We challenged several lifestyle features associated with fatty liver and, particularly, with non-alcoholic fatty liver disease (NAFLD). Among them, sleep shortage as a result of nightlife habits and a preference for plus-size fashion were assessed. The latter consists of fashionable plus-sized clothing for actual individuals' size and reflects a frequent attitude of some social or age groups, conceivably indicating more global and widespread trend and behaviour.

METHODS

We studied a group of 708 non-diabetic youngsters, 458 women and 250 men, 21.72 ± 3.71 years old (range 15-35 years), referred for minor digestive ailments for clinical assessment, ultrasound detection of fatty liver and nutritional counselling. Details of personal history regarding lifestyle, food intake frequency and alcohol intake, dietary and physical exercise profile, sleep duration and clothing preferences were recorded.

RESULTS

The prevalence of NAFLD in this cohort of youngsters is 67/708 (9.4%). Even if it is quantitatively very low in both groups, the average alcohol intake, always below 20 g/day, is greater in NAFLD subjects (5.83 ± 4.32 g) vs. subjects with normal liver (2.02 ± 3.20 g). The number of meals/day and adherence to a Mediterranean diet profile are smaller in NAFLD subjects. By multiple regression, BMI, sedentary life, plus-sized clothing for their actual size, sleep shortage and lower frequency of daily food intake are associated with the presence of NAFLD.

CONCLUSIONS

Onset and continuation of fatty liver disease, beyond food and exercise quantity and quality, with their effects on obesity, may also be associated with other aspects of lifestyle.

A review of cognitive neuropsychiatry in the taxonomy of eating disorders: state, trait, or genetic?

A greater understanding of neuropsychological traits in eating disorders may help to construct a more biologically based taxonomy. The aim of this paper is to review the current evidence base of neuropsychological traits in people with eating disorders. Evidence of difficulties in set shifting, weak central coherence, emotional processing difficulties, and altered reward sensitivity is presented for people both in the acute and recovered phase of the illness. These traits are also seen in first degree relatives. At present there is limited research linking these neuropsychological traits with genetic and neuroanatomical measures. In addition to improving the taxonomy of eating disorders, neuropsychological traits may be of value in producing targeted treatments.

Body image concerns in professional fashion models: are they really an at-risk group?

Although professional models are thought to be a high-risk group for body image concerns, only a handful of studies have empirically investigated this possibility. The present study sought to overcome this dearth of information by comparing professional models and a matched sample on key indices of body image and appeared-related concerns. A group of 52 professional fashion models was compared with a matched sample of 51 non-models from London, England, on indices of weight discrepancy, body appreciation, social physique anxiety, body dissatisfaction, drive for thinness, internalization of sociocultural messages about appearance, and dysfunctional investment in appearance. Results indicated that professional models only evidenced significantly higher drive for thinness and dysfunctional investment in appearance than the control group. Greater duration of engagement as a professional model was associated with more positive body appreciation but also greater drive for thinness. These results indicate that models, who are already underweight, have a strong desire to maintain their low body mass or become thinner. Taken together, the present results suggest that interventions aimed at promoting healthy body image among fashion models may require different strategies than those aimed at the general population.

The changing profile of eating disorders at a tertiary psychiatric clinic in Hong Kong (1987-2007)

OBJECTIVE

To examine the clinical profile of Chinese eating disorder patients at a tertiary psychiatric clinic in Hong Kong from 1987 to 2007.

METHOD

Data on 195 consecutive patients were retrieved from a standardized intake interview by an eating disorder specialist. Patients seen between 1987-1997 (n = 67) and 1998-2007 (n = 128) and fat-phobic (n = 76) and nonfat-phobic (n = 39) anorexic patients were compared.

RESULTS

Patients were predominantly single (91.8%), female (99.0%), in their early-20s and suffered from anorexia (n = 115; 59.0%) or bulimia (n = 78; 40.0%) nervosa. The number of patients increased twofold across the two periods. Bulimia nervosa became more common while anorexia nervosa exhibited an increasingly fat-phobic pattern. Nonfat-phobic anorexic patients exhibited significantly lower premorbid body weight, less body dissatisfaction, less weight control behavior, and lower EAT-26 scores than fat-phobic anorexic patients.

DISCUSSION

The clinical profile of eating disorders in Hong Kong has increasingly conformed to that of Western countries.