02/20/2008 03:49 pm ET Updated Nov 17, 2011

There's No Accounting for Fashion

With the end of the 2008 spring fashion Season in Paris coinciding with Eating Disorders Awareness Week next week, it seems a good time to ask what became of the international designers' grand promises to replace the look of starvation with a glow of health on the catwalks.

Last year, if you will recall, the anorexia-related deaths of two runway models (since followed by at least one more) prompted fashion week organizers on both sides of the Atlantic to vow with great fanfare to promote "the message that beauty is health." Milan's Chamber of Fashion issued a non-binding "manifesto" stating that design leaders had a responsibility to "creatively and constructively transmit positive aesthetic models as an instrument of prevention" of eating disorders. In order "to give value to a healthy, sunny, generous Mediterranean model of beauty," mannequins working Italian runways were to have a minimum body mass index, or BMI, of 18.5. That's about 127 pounds for the minimum runway height of 5' 9 1/2".

The Council of Fashion Designers of America issued its own "Health Initiative," stressing voluntary measures to "create an atmosphere that supports the well-being" of models. Unfortunately, the key word was not health or well-being, but voluntary. The CFDA actually specified that it would not recommend models be required to have a physical or body-mass assessment.

In its defense, the CFDA stressed that fashion alone does not cause eating disorders. But that's like saying that Las Vegas does not cause gambling.

It's true that certain people are biologically predisposed to eating disorders, just as alcoholics and compulsive gamblers have a biological vulnerability to addiction. But modeling lures those prone to eating disorders the same way casinos attract high rollers. At least 40 percent of fashion models struggle with anorexia or bulimia. These disorders, however, have a higher mortality rate than craps or roulette -- or, for that matter, alcoholism, depression, or schizophrenia.

The problem extends far beyond the runway. Of the 10 million American women and girls who develop eating disorders, many avidly study glamour shots of skeletal models for "thinspiration." This is the real reason why the size of models matters.

So what happened to all that bold talk about designers' responsibility?

I serve on the advisory board of the Academy for Eating Disorders. Earlier this month several of my AED colleagues called on CFDA president Diane von Furstenberg, CFDA Executive Director Steven Kolb, and Nian Fisch, chair of the CFDA Health Initiative, for an update on their implementation of the Initiative. We have yet to receive an answer.

"Their failure to respond underscores that the CFDA health panel was all for show--just lip service and empty promises," said Cynthia Bulik, PhD, past-president of the AED. "If there's no accountability, there's no action."

In Europe, supermodel Marvy Rieder, whose marVie Foundation aims to create a healthier working atmosphere for aspiring models, has noticed that designers are showing clothes even smaller this year than last. One model who dropped to a European 34/36 (equivalent to a U.S. 0) in order to qualify for the Milan shows was told she still was "too fat."

"Agencies often do not agree on the strict measurements made by the designers," Rieder told me, "but they don't want to be put out of business so they tell the girls to lose weight if they want to do the shows."

Of 14 recommendations made last year by the Model Health Inquiry chaired by Baroness Denise Kingsmill, the British Fashion Council has chosen to implement just four: London Fashion Week will ban models under 16; no more backstage drugs, smoking, or champagne; models will be allowed to rest between shows at a staffed apartment; and maybe by next September's Fashion Week, the Council will begin model health certification.

Susan Ringwood, chief executive of the British eating disorders charity Beat, is fed up. "We want the fashion industry to put its words into action, to just get on with it."

In a world where real women wear an average size 14, why does the fashion industry mount such resistance to more substantial models? When asked, most designers reply bluntly that skinny girls make their clothes look better.

Here, then, is the ugly truth that each of us should consider whenever we open the latest Vogue or check out what's new on the catwalk: in the world of fashion today, looks matter more than people do. Style is literally to die for.