Models at Risk for Eating Disorders

The continuing fashionable trend for extreme thinness among female and male models puts their physical and psychological health in jeopardy, according to three eating disorder experts at King’s College, London. It also is a reminder that the risk extends far beyond the modeling industry.

In an editorial in the British Journal of Psychiatry (192:243, 2008), Dr. Janet Treasure and colleagues turn a spotlight on the consequences of extreme underweight, both in the fashion industry and on general public health. They note that starvation affects all body organs, particularly the brain, and has more serious implications if food deprivation occurs during physical development. The second area of concern is that the overvaluation of extreme thinness, particularly in a society that judges individuals on the basis of weight, shape, and eating, increases the risk for eating disorders.

Health consequences of low weight

Restricting food affects many areas of the body, particularly the bones, the brain, and the reproductive system. As body weight falls, so does the level of leptin. This starts a cascade of actions, including irregular menstruation, amenorrhea, and diminished fertility. In addition, maternal starvation during pregnancy and in the neonatal period may lead to increased risk for the infant. Poor nutritional status stunts bone development and reduces bone turnover and repair, leading to osteoporosis. The authors also point out that, in humans, 20% of energy expenditure is for the brain, which also plays a key role in maintaining nutritional balance. In persons with anorexia nervosa, the brain shrinks, and it is still unknown if this is fully reversible with recovery. Starvation also changes drive, thoughts, feelings, and behavior, so those people who are starved become preoccupied with food.

The effects of ‘binge priming’

After a period of food restriction, when animals are exposed to highly palatable foods, they will overfeed to an excess. This pattern continues when their weight has recovered to pre-starvation levels, and has been termed “binge priming.” The underlying changes in behavior can be traced to an imbalance in chemical transmitters in the reward network, including dopamine, acetylcholine, and endogenous opiates. According to Dr. Treasure and her coauthors, the persistent priming of reward circuits by palatable foods bears some resemblance to the phenomenon of reward produced by drug misuse.

When the same patterns of behavior are extended to humans, the authors predict that binge priming from irregular dieting and/or extreme restriction of food, interspersed with a very common pattern of snacks and other highly palatable foods, might lead to permanent changes in our reward system. Two hypotheses are: (1) If binge priming occurs during adolescence when the developing brain is more susceptible to reward, persisting eating problems may follow; and (2) people exposed to binge priming will be more prone to develop substance abuse.

Some empirical evidence supports the first hypothesis. For example, people with eating disorders report eating more highly palatable foods (fast foods and snack foods) and also report having fewer regular mealtimes during childhood. Binge eating is persistent, and binge eating disorder is present for an average of 14 years and bulimia nervosa for 5.8 years. Abnormal eating patterns in early adolescence often precede substance abuse and alcohol use disorders often supersede clinical bulimic disorders.

Social factors

Fashion models are under constant pressure to remain thin, and their careers depend upon this. Body-related self-esteem is particularly important in their success. Since models are usually judged and evaluated based on thinness, they will be at ever-increasing risk of developing eating disorders, under the guise of professional development.

What can be done?

Efforts to better educate the public about the repercussions of extreme dieting are beginning to make some inroads. The progress made in dance and sports offers a model of successful intervention and a way to eliminate the binge-priming environment. In the U.S. and U.K., coaches and their athletes now have practical guidelines to reduce the prevalence of eating disorders, unhealthy weight loss, and unhealthy ways to maintain weight. This is at least a beginning.