Still Skinny in Milan

Talk to any model backstage at a Milan fashion show and this is what they'll tell you: Models are people who are naturally skinny.

They're right. Some models, a lot of models, are indeed naturally skinny. They're teenagers who haven't quite grown into themselves yet.

But for some, chasing the model shape can be fatal. Earlier this month, Eliana Ramos was found dead in her bed from heart failure. The elfin 18-year-old model from Uruguay had watched her sister Luisel collapse and die at a fashion show just last year.

According to the girls' father, Luisel had been eating only lettuce leaves in the months before she died. In November, Ana Carolina Reston, a Brazilian model who apparently ate only apples and tomatoes, died weighing just 88 pounds.

Something had to be done. People outside the notoriously closed world of fashion were beginning to ask questions. And in December -- with fanfare and a flourish -- the Italian government and the big guns of Italian fashion signed what they called a "self-regulating code" to combat anorexia.

There was no legislation, just grand statements. "We are asking the Italian fashion business to at least try and develop a differentiated idea of beauty," said Giovanna Melandri, Italy's minister for youth and sports.

Fashion for Real Women?

Last week came the test, at the first show of Milan's highly anticipated Fashion Week. The models were shapely, voluptuous, you might even say Rubenesque. Had fashion changed its spots?

No. False alarm. The first collection of the show was designed by Elena Miro. She's a specialist who designs for what is, in the fashion world, a niche market: sizes 6 to 22, the so-called "real woman."

It seems like that "self-regulating code" may be toothless. "Nightline" went to some shows and hung around backstage, and from what we saw, most designers think the catwalk still belongs to the size 0.

Backstage at one show, an aspiring model, clutching her portfolio, was asked to open her coat … not to see whether she was too skinny, but to see whether she was too fat.

And why do models have to be thin? Just before her Moschino collection hit the runway, designer Rosella Jardini told us, "Because they make the clothes look better."

At Sao Paulo Fashion Week, organizers made an effort. Models reportedly had to show a medical certificate before stepping onto the catwalk. And in London, leaflets and posters backstage warned of the dangers of dieting. But the fashion world looks to Milan. This is the home of haute couture. Milan sets the industry standard.

'How Can I Know If They Eat or Don't Eat?'

Franca Sozzani, the editor of Italian Vogue, is a guardian of that standard. "We have all agreed that we are not to use girls that have problems," she said. Then she got to the heart of this problem.

"Nobody knows which girls have problems, because how can I know if they eat or don't eat?"

How can you tell whether a model is sick, or just skinny? Backstage at Etro, model Carmen Kass told us, "I don't think just being skinny means necessarily anorexic."

At Madrid Fashion Week, they tried measuring the models Body Mass Index (BMI), and five girls with a BMI below 18.5 were barred. BMI is calculated by dividing weight by height. The World Food Program considers an adult with a BMI under 18.5 to be "malnourished."

Belgian model Elise Crombez, passing the time backstage with Kass, questions such a scientific approach.

"What does it mean? Before the girls get weighed, they just eat loads of things and drink two liters of water," she said. "It's not a trick. It's not a trick because a lot of them are healthy."

"I mean, what about Sumo [wrestlers]?" Kass said. "Why can't we talk about that? Why are they allowed to be so fat and accepted so?"

Japanese Sumo champ Takanohana has a BMI of 46. According to the World Health Organization, he's morbidly obese. If you're a Sumo wrestler, you've got to be big, and apparently if you're a model you've got to be small.

'Models Have to Be Thin'

"Models have to be thin. It's pointless, this whole controversy on anorexia," said Moschino designer Jardini. "Models have always been thin, and they need to stay thin. But not anorexic, obviously."

Top Milan agent David Brown, of d Management Group, likens a slender models of today to a young tree.

"It grows in height first, and then fills out. … I consider these girls like very strong saplings."

"But their girls' bodies are being used to sell adult women's clothes," is the reply from Susan Ringwood, an expert in eating disorders.

When showed footage from Milan, a bracelet on a model's arm caught her eye. "Often you see that on a pro-anorexic Web site," she said. "It's a badge of pride that your upper arm is slender enough to wear a bracelet around it."

Despite such observations, Ringwood does not believe that skinny models are to blame for eating disorders in the population at large.

Her organization called beat -- Beating Eating Disorders -- is a charity that helps people with eating disorders. It recently polled 100 young people who suffer from anorexia and bulimia.

"None of them said, 'I think it made me get ill in the first place.' They didn't say, 'I was trying to emulate the model body,'" Ringwood said.

'How Come It's OK for Them?'

But there's a caveat of sorts.

"They said, 'It makes it so much harder for us to get better when we're surrounded by these images,'" Ringwood said.

"One young girl even said, 'How come it's OK for them? They can be thin. They're on the front of the magazines and famous. But I'm being told I'm dangerously unhealthy. I'm ill. I've got go into hospital.'"

Yes, models have always been thinner than most of us, and at least different from the rest of us. But in the 1980s and '90s, at least they had some curves.

"The supermodels, as we called [them], they were really the … icons," Sozzani said. "They were really the new references for style, for beauty, for everything."

These days the big cosmetic contracts go to the actresses: Uma Thurman, Penelope Cruz, Scarlett Johansson. And the models? Well, most of them are nameless teenagers from Eastern Europe -- girls, not women -- who get paid a lot less than Linda, Cindy or Naomi ever did.

The Last Supermodel

Carmen Kass is now 28 years old, and the closest thing the fashion world has to a supermodel of old. She's a face of Dior and a runway veteran of 15 years.

"It's not really like you have a thing like a supermodel anymore. It's more of a word than a real existence," she said. "I think, also, looking at it from a designer's point of view, at one point maybe they felt the stars took too much attention away from the clothes."

As he soaked up the preshow euphoria, designer Roberto Cavalli agreed. "I didn't like, so much, the big top model…they feel so important, they…arrive one hour late for show," he said. "It's much easier now," he added.

Tonia Molyavko from Ukraine is a good example of the new, more malleable, breed. She was signed by Brown's agency when she was 18 years old.

"She was a little bit larger than normal," Brown said with a nervous smile. "We said, 'You've got all the potential in the world, but if want to be competitive, you'll need to be able to fit the average sizes that are being proposed.'"

So Molyavko started going to the gym, started eating more healthily, and cut back her chocolate intake.

"I feel healthy. Healthy and light," she said. And indeed she does look pretty healthy. Sure she's tall and rangy, but her hair has a healthy gloss, her skin isn't sallow, and she has a smile on her face.

"I realize I have to do the best for myself, and how to do the best for me, in a healthy [way], without damaging my body, killing my body," she said, matter-of-factly.

Still a Glamorous Industry?

How long Molyavko can stay "in" in Italy is up to those in this notoriously fickle industry.

"Sometimes you do one season good, and the next season they don't want you," she said. "You get famous. You are famous for, I don't know, one season, six months, and they they forget, they take another one."

They take another one, a younger one, a cheaper one, perhaps a skinnier one.

Is this still a glamorous profession?

"I think it's glamorous to be beautiful," Sozzani said. "I don't know if it's glamorous to be a model."

Until the fashion industry's idea of beauty really changes, the glamour will always be tinged with an element of danger: Just how skinny is too skinny?