Bulimia and Models: Prevalence, Causes & Solutions

Contributor: Michelle Lippey B. Arts (Hons), B. Sci (Psych), Grad Dip. Counselling

asian-413123_640The current appetite for extreme thinness in western media puts unnecessary pressure on the physical and psychological health of models. That pressure trickles down to the especially vulnerable adolescents who aspire to look like the models they see on magazines, billboards and television.

While headway has been made to moderate the impact of the thin-ideal in the sports and dance industries, similar pressure is yet to be applied to the beauty and fashion industries. There is little doubt that the pressure to be thin has seen an increase in eating disorders in recent years and there is much evidence that social norms and ideals can be changed.

In a similar way that the public health discourse of smoking has changed radically in the last 100 years, so too, can discourse around thinness transform to occupy a new and better-informed space in the health debate.

The Overwhelming Pressure to Be Thin

There is little doubt that fashion models are under greater pressure than the average woman to maintain a low body weight. Where the average American woman is 5”4’ and weighs 140 pounds, the average model is 5”11’ and weighs 117 pounds. This means that most fashion models are thinner than 98% of American women (Smolak, 1996).

People within the fashion industry have argued women with a leaner body shape are more likely to be selected for modelling careers. Other spokespeople from within the fashion industry have said that just because models might go to extreme measures to maintain a low body weight (such as restricting, bingeing or purging their food) it doesn’t mean they have a clinical eating disorder.

Studies on the Prevalence of Eating Disorders in Models

Such spokespeople have argued that there is no definitive text, which proves that models suffer with eating disorders in greater numbers than women in the general population. While there may be no one definitive text, there is a dearth of research that supports this idea.

For example, one study by Preti, Usai, Miotto, Petretto & Masala (2008) compared 55 Italian models against 110 Italian non-models from a similar social and cultural background and found that models reported significantly more symptoms of eating disorders than did controls. A Body Mass Index (BMI) below 18 was found for 34 models (54.5%) as compared with 14 controls (12.7%).

Another study by Santonastaso, Mondini & Favaro (2002) found that models from a variety of cultures were more likely to suffer from partial syndrome ED than non-models.

In a third study by Swarmi & Szimigielska (2013), compared a group of 52 professional fashion models with a matched sample of 51 non-models from London. Both groups were compared to the control group on indices of:

  • Weight discrepancy
  • Body appreciation
  • Social physique anxiety
  • Body dissatisfaction
  • Drive for thinness
  • Internalisation of sociocultural messages about appearance
  • Dysfunctional investment in appearance

Professional models showed significantly higher drive for thinness and dysfunctional investment in appearance than the control group.

Discrepancies between Models and the Control Group

A fourth study conducted in Hungary and Transylvania by Lukacs-Marton, R., Vasarhelyi, E. & Szabo, P (2008), compared 128 models from Transylvania and 167 models from Hungary with non-model participants. Eating disorders were assessed using the Eating Attitudes Test (EAT) and the Eating Behaviour Severity Scale.

Tests for the assessment of Body Image included the Human Figure Drawing Test, the Body Dissatisfaction subscale of the Eating Disorders Inventory, the Body Attitudes Test and the Body Investment Scale.

Weight reducing methods, such as dieting, exercise, the use of appetite suppressants and diuretics were significantly more prevalent in the group of models. The mean total score and the scores of the dieting and Bulimia subscales were higher in the group of models in comparison with the control group.

The prevalence of clinical and subclinical eating disorders was higher in the group of models.

Implications for the Focus on Thin

An article by Janet Treasure et al. (2008) considers the implications of the fashion industry’s expectations of extreme leanness on the model’s own health and to put that into the context of public health. First, starvation and purging have extremely detrimental effects on the model’s brains and bodies.

Second, the demand for, and overvaluation of, extreme thinness within a culture of scrutiny and judgement about weight, shape and eating, increases the risk of developing and eating disorder.

Animal models explain how environmental changes might produce eating disorders. For example, if after a period of food restriction, animals are intermittently exposed to highly palatable food, they will significantly overeat. This pattern continues when their weight is restored.

Priming the Need to Binge

This tendency to over-consume, or `binge’, when exposed to palatable foods remains several months after the period of `binge priming’. Not only do these animals overeat palatable food but they are also more prone to show addictive behaviors to the more typical substances of misuse, such as alcohol and cocaine.

Body-related self-esteem is particularly pertinent in young models since it relates to their career success. “Criticism, teasing and bullying focused on food, weight and shape issues increase the risk of developing an eating disorder.

Fashion models are frequently judged and evaluated on these domains and critical and hostile comments, under the guise of professional development, will increase the risk of developing eating disorders.”

Solutions for the Model Industry

couple-498484_640As Janet Treasure states, “Prevention and regulation of toxic environments is not impossible. Progress has been made in sport and dance. High-performance athletes are also at risk of eating disorders especially in those areas in which excess weight is a handicap or where aesthetic factors are judged.

“Concerted efforts have been made in the UK to set forth guidelines for high-performance athletes and their coaches in an attempt to reduce the prevalence of eating disorders, unhealthy weight loss and maintenance practices… Following this template, similar approaches to standardization of care and health for fashion models could be introduced.

“Unfortunately, such initiatives are still to be embraced by the fashion industry, as evidenced by the recent inconclusive outcomes from the UK Model Health Inquiry.”

The AED has a position statement which calls upon the fashion and beauty industries to protect the health and well-being of young workers.

What Can Society Do to Help?

There is much evidence that the pressure models are under puts them at greater risk of developing eating disorders like bulimia. The criticism and body judgement they receive under the guise of “professional guidance” puts them at greater risk again.

It seems like a groundswell of public opinion is needed to change the sanctified position that thinness currently holds in public debate. When it is more widely-acknowledged that health and beauty come in a variety of shapes and sizes, models will be under less pressure to maintain a thin ideal and women in the general population will be under less pressure to live up to the ideals models help to create.

Community discussion – Share your thoughts here!?

What are your thoughts regarding models and the pressures to be thin?


  1. Bulimia Help http://www.bulimiahelp.org/book/bulimia-overview/bulimia-statistics
  2. Lukacs-Marton, R., Vasarhelyi, E. and Szabo, P. (2008). Entrapped by the beauty Industry: eating and body attitudes of those working in the beauty industry. Psychiatry Hungarian, 23, (6), 455-63.
  3. Mientka, M. (2013) `Models’ Recruited At Swedish Eating Disorders Clinic. April 20, 2013. Published: http://www.medicaldaily.com/models-recruited-swedish-eating-disorders-clinic-245142.
  4. Preti, A., Usai, A., Miotto, P., Petretto, D., Masala, C., (2008). Eating Disorders Among Professional Fashion Models. Psychiatry Research 159, 1-2: 86-94.
  5. Santonastaso, P., Mondini, S. & Favaro, A. (2002). Are Fashion Models a Group at Risk for Eating Disorders and Substance Abuse? Psychotherapy and Psychosomatics, 71 (3): 168-172.
  6. Smolak L. (1996). National Eating Disorders Association/Next Door Neighbors puppet guide book.
  7. Swarmi, V., & Szmigielska, E. (2013). Body Image Concerns in Professional Fashion Models: Are they an at-risk Group? Psychiatry Research, 207 (1-2), 113-117.
  8. Treasure, J, L. Wack, E.R. Roberts, M.E. (2008) Models as a high-risk group: the Health Implications of a size zero culture. The British Journal of Psychiatry, 192, 243-244. Doi: 10.1192/bjp.bp.107.044164.

Author Bio: Michelle Lippey

B. Arts (Hons), B. Sci (Psych), Grad Dip. Counselling

I am a qualified Counsellor and member of the ACA (the Australian Counsellors Association). I have worked for Butterfly, Foundation for Eating Disorders in Australia and specialise in my private practice treating Eating Disorders.