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David Baxter PhD

Late Founder
Models' deaths put spotlight on eating disorders
New York Times Syndicate - November 21, 2006

Thin ideal is viewed as one of many factors

PARIS: The death of a 21-year-old Brazilian model from complications of anorexia has reignited debate about the fashion industry and eating disorders at a time when various cities around the world are considering banning the ultrathin from the catwalk.

For health experts, images of severely underweight models are just one element in the gestation of eating disorders like anorexia and bulimia. The determining factors, they say, are biological and psychological.

Ana Carolina Reston, who weighed just 40 kilograms, or 88 pounds, when she died in S?o Paulo on Nov. 14, was the second model in recent months to succumb to an eating disorder. In August, Luisel Ramos of Uruguay died of heart failure during a fashion show, prompting Madrid to ban severely underweight models from the city's fashion week this autumn.

That move was universally applauded by people who treat anorexia and bulimia, and the fashion industry is facing pressure to follow suit elsewhere. Last week, Giorgio Armani urged designers to stop using ultrathin models.

But specialists in eating disorders warn that the focus on fashion implies that the illnesses are primarily caused by the desire to look like a model.

"This grossly oversimplifies the issue," said Eric van Furth, president of the Academy for Eating Disorders, an international organization based in Northbrook, Illinois, and clinical director of the National Center for Eating Disorders in Leidschendam, Netherlands.

Emphasizing the catwalk, van Furth said, "helps to trivialize and stigmatize the illnesses, and can prevent people from getting help." While cultural images can play a role, he added, images of emaciated models are mainly dangerous to people already predisposed to developing an eating disorder.

Van Furth and other specialists say that many factors can contribute to anorexia, which is characterized by self-starving and excessive weight loss, and bulimia, a dangerous cycle of binge eating and purging.

According to Dr. Susan Ice, medical director of The Renfrew Center, an eating-disorder treatment facility in Philadelphia, these factors can include genes; early environmental influences; temperamental factors like low self-esteem; perfectionism; obsessiveness and anxiety; family variables; and often a "precipitating event," like abuse or the loss of a loved one.

"Any one of these things is not enough," Ice said. "In every girl I've seen, the course of development is slightly different." Many researchers in the field use the metaphor of a gun to explain what leads to the onset of an eating disorder. According to this description, first coined by Dr. Cynthia Bulik of the University of North Carolina at Chapel Hill, genes load the gun and the environment pulls the trigger.

Aimee Liu, author of Gaining: The Truth About Life After Eating Disorders, to be published by Warner Books in February, has expanded the metaphor. Genes create the gun, she said by telephone. The fashion industry, images of celebrities, relationships with parents and other environmental factors load the gun. Emotional distress pulls the trigger.

"It has nothing in real terms to do with looks," she said.

"Looks are a tool, a mechanism, that gets used by the eating disorder." Some experts caution that while banning emaciated models may send a positive message to young women at risk, it can also lead people to think that eating disorders are "behaviors of choice." "One doesn't become anorexic because one wants to," said Gerard Apfeldorfer, a Paris psychiatrist who specializes in eating disorders and is the author of several books on the subject.

There is a growing body of research to support the genetic and biological pieces of the puzzle. A 2005 study conducted by the University of North Carolina at Chapel Hill and the University of Pittsburgh School of Medicine identified six core traits that appear to be linked to genes associated with both anorexia and bulimia: obsessive behavior, age at first menstruation, anxiety, lifetime minimum body-mass index, concern over mistakes and food-related obsessions.

A study of twins with anorexia, carried out at the University of North Carolina and the Karolinska Institute in Stockholm and published in The Archives of General Psychiatry in March, concluded that genetic makeup could account for more than half the risk of developing an eating disorder.

Currently under way is a $10 million international study to look for specific genes that lead to a susceptibility to anorexia. The research, involving up to 400 families, is being funded by the U.S. National Institute of Mental Health.

Whatever the genetic factors involved, cultural influences clearly can play a role in eating disorders. In a media landscape saturated with images of Lindsay Lohan, Keira Knightley and other stick-thin stars, girls are bombarded with messages that thin is in.

"They never feel like they might meet the criteria of what they should look like," said Lynn Grefe, chief executive of the National Eating Disorders Association, a nonprofit advocacy group based in New York and Seattle.

But the key, experts say, is that the seeds of an eating disorder are there before obsessive behavior takes hold. If eating disorders "were all about culture," Grefe said, "every one of us who reads a fashion magazine would have one."
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