Anorexia is an illness – not something we can simply blame on the media

Catwalk size doesn’t affect anorexia as much as you think. Republic of Korea, CC BY-SA

France has joined Italy and Israel in passing laws banning the promotion of extreme thinness in the fashion industry. The health reforms, which include fining agencies employing models with a BMI under 18 and criminalising pro-anorexia web content, have now passed through the upper house of parliament.

An analysis of the reforms by Sarah Jackson on The Conversation suggested that censoring images of ultra-thin models may ease their adverse effects on young women, such as concerns about body image and behaviours such as unhealthy eating.

But while some have been hailing the legislation as a “crackdown on anorexia”, the laws may be unlikely to have any such effect.

Not a lifestyle choice

In western Europe, around 0.5% of adults are thought to be affected by anorexia nervosa. In around 10% of these cases, the sufferers are men. These figures, however, are likely to be an underestimation. It has the highest mortality rate of any psychiatric illness, mostly due to organ failure and suicide.

Yet, the illness is often mistaken by many as a lifestyle choice with an external cause. Despite accounts of the disorder pre-dating the fashion industry, the view that anorexia is caused by comparing oneself to a catwalk model remains popular. Likewise, while pro-ana websites insist that anorexia is a commitment, not an illness, they are highly exclusive online communities, created by and for those already showing signs of the illness. The merely curious are not welcome.

Instead, the link between media endorsement of extreme thinness and the development of anorexia is neither simple nor clear. Research mentioned by Jackson did find that women evaluated their bodies more negatively after viewing images of thin models. However, this effect was small and mostly determined by women’s pre-existing opinions of their figures – women who were already dissatisfied with their body were most affected.

Pre-existing opinions matter. Joana Coccarelli, CC BY

As this effect was only measured at one point in time, the effects of prolonged exposure are not known, but when more images were used there was a tendency for the effect to be smaller. Perhaps, as the authors suggested, these images activated, rather than cultivated, beauty ideals.

Whether the effects of media exposure on body dissatisfaction leads to changes in eating behaviour is also unclear. Another study, also cited by Jackson, looked for a link between a person’s real-life media exposure and eating disorder symptoms. The results were fairly inconsistent, with some factors – such as body dissatisfaction – only corresponding to some types of media, and others – such as self-worth – showing no relationship.

More importantly, the research showed correlation, not causation – it is just as plausible that women already unhappy with their bodies seek out thinness-promoting media more often. After all, if such a simple causal relationship did exist, the pervasiveness of these images in our culture raises the question of why the majority of our population is overweight, rather than underweight.

Model bans but no support

Most researchers currently view the cultural value placed on thinness as a “background risk factor”. Meanwhile, several psychological and biological factors are implicated.

High levels of perfectionism, a need for organisation and a focus on details are often observed in those with anorexia. Recent research suggests there is a lower reward response to food in the brain, even after recovery. Some of these factors seem to be influenced by genetic inheritance. Stressful experiences may then influence whether these existing factors then lead to developing the disorder. More than one risk factor will be necessary.

So the legislation is likely to have little effect on the prevalence of anorexia in the general population, but it also offers no support to the models themselves. The law requires a medical certificate proving that a model has a BMI of at least 18. This is still underweight, according to the World Health Organisation. Regular weigh-ins have been only vaguely suggested and there’s been no mention of an obligation to offer support to a model who fails a weigh-in.

A BMI of at least 18 is still underweight. Fervent-adepte-de-la-mode, CC BY

While there is some debate over whether models are at a higher risk of developing eating disorders, this career certainly encourages unhealthy behaviour. Thinness of this degree has hugely damaging effects on the internal organs, bones and brain. It can cause obsessiveness and social withdrawal even in psychologically healthy people. France has already lost a high-profile model to anorexia – yet the new laws almost encourage agencies to wash their hands of models who fall ill.

In the same way, while pro-ana content is undoubtedly harmful, the new laws punish those who are in need of help. This exclusively punitive approach is likely to drive these sites further undergound.

If the measures are enforced – if spot checks continue, weigh-ins aren’t cheated and other countries are supportive – they may be a positive move. They may be a first step towards a culture that prioritises health over aesthetics – whether that means a dangerously small or unhealthily large body. Nonetheless, this will mostly benefit the worried well – those who, regrettably, are unhappy with their bodies, but are otherwise unlikely to develop anorexia nervosa. Claiming that these laws address one of the most treatment-resistant mental illnesses is far too optimistic.

This article was co-written by Lexie Thorpe, an MSc in Developmental Cognitive Neuroscience at Durham University