Slim Pickings

As a policy, I don't like to criticize until I understand.

So with my colleagues from the three leading eating disorders organizations, I attended Fashion Week in New York early this month to try to get an inside glimpse of the fashion industry and how it works.

While there, I was invited to be a silent audience member for a panel discussion titled "Health and Beauty in the Fashion Industry," which was organized by the Council on Fashion Designers of America.

What did I see?

First, I saw some beautiful fashion. I was fortunate to attend shows for Tracy Reese, Diane von Furstenberg and Carolina Herrera. There is no question that fashion is wearable art, and the creativity of the designers was brilliant and inspired.

Yet for me, as the director of the University of North Carolina Eating Disorders Program, I was more interested in the girls and women who were modeling this art.

The "Skinny Model Issue"

Nian Fisch, the creative director of KCD, a New York-based public relations firm leading the CFDA panel, confirmed that some of the thinnest models had been "pulled" from the shows because of the furor about what she called the "skinny model issue."

My first thought was, "How sad. Did they just pull these models and then they were out of a job? Did they refer them for an evaluation or just say, 'You can't work this week because of the uproar about skinny models?'"

Also rejected was the call by the eating disorders organizations for the CFDA to require yearly physicals for models -- physicals that include a comprehensive assessment for eating disorders. Why? "It's not our responsibility," the council said. "It's the agents' responsibility."

Meanwhile, the agents say it's the families' responsibility.

Who will take responsibility for the health and well-being of these young girls, most of whom have no idea about the long-term consequences of extreme dieting and unhealthy weight control practices?

Cynthia M. Bulik is director of the Eating Disorders Program at the University of North Carolina Hospitals, vice president of the Eating Disorders Coalition, and the past-president of the Academy for Eating Disorders.

Low BMIs "Healthy?"

The most astonishing moment for me came during the panel discussion. One panel member stated that someone could be perfectly healthy at a body mass index of 14.

BMI is a measure of weight accounting for height. When the BMI is calculated in youths, age and sex are also taken into account. I knew because of my work that the risk of sudden cardiac death increases with a BMI of 13, and shuddered to think that people were being advised that one BMI point above that could be "perfectly healthy."

So I checked out the BMI calculators at the Centers for Disease Control and Prevention's Web site.

I typed in the values for a BMI of 14 for an adult and a 16-year-old girl. For an adult, with a height of 5 feet 9 inches, this means weighing 96 pounds. This prompted a warning from the Web site that said: "Your BMI is 14, indicating your weight is in the underweight category for adults of your height. Talk with your healthcare provider to determine possible causes of underweight."

A 16-year-old girl who is 5 feet 6 inches tall and has a BMI of 14.0 weighs only 87 pounds. When I typed this information into the CDC Web site, the warning I received said: "Based on the height and weight entered, the BMI is 14.0, placing the BMI-for-age below the 1st percentile for girls aged 16 years 0 months. This teen is underweight and should be seen by a healthcare provider for further assessment to determine possible causes of underweight."

This hardly sounds perfectly healthy to me!

Taking Responsibility for Model Safety

At the panel discussion, model Natalia Vodianova talked about how she had developed anorexia nervosa after moving from Russia to Paris to model. She said her hair got brittle and fell out.

The BMI that the panel called "perfectly healthy" was below the BMI that Vodianova had when she had anorexia nervosa, which was 16.1.

Vodianova talked about the extreme pressures to be thin that were new to her in this alien environment -- so different from what she knew in Russia. If annual checkups had been part of the picture, her illness would have been detected and she could have gotten both help and an explanation for the scary things that were happening to her.

She was alone, in a foreign country, facing extreme pressures to be thin in order to work, and afraid to admit what was happening for fear of losing work.

Who will take responsibility for girls like her?

Cynthia M. Bulik is director of the Eating Disorders Program at the University of North Carolina Hospitals, vice president of the Eating Disorders Coalition, and the past-president of the Academy for Eating Disorders.

At one point, von Furstenberg stated quite emphatically: "There should be guidelines but no enforcement." How does she expect that to work? What does the CFDA have to lose in requiring annual checkups?

The designers can't be expected to diagnose eating disorders. The designers aren't trained to diagnose or refer people for treatment. If they suspect an eating disorder or other unhealthy behaviors at the castings, they'll just send them away with no job -- and no help.

One of the new CFDA guidelines that purports to deal with this issue encourages designers to provide plenty of water and healthy snacks for the models backstage, while forbidding smoking and drinking. Yet, during a stroll outside in 11 degree weather, I saw many skinny, shivering young women smoking away outside the tents at Bryant Park.

The CFDA is not taking this issue seriously enough. The guidelines that the council has proposed have no teeth.

More models will die, and more of the many young girls who look up to them will die.

Yearly physicals are an important next step that will help the girls remain healthy, help their parents feel more comfortable with their daughters' choice to model, help the designers make wise casting choices, and lead to a safer work environment.

Cynthia M. Bulik is director of the Eating Disorders Program at the University of North Carolina Hospitals, vice president of the Eating Disorders Coalition, and the past-president of the Academy for Eating Disorders.