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Increased eating disorder
frequency and body image
disturbance among fashion
models due to intense
environmental pressure: a
content analysis
Nikolett Boga
´r
1
*,Pa
´l Ko
˝va
´go
´
2
and Ferenc Tu
´ry
1
1
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary,
2
Pa
´zma
´ny Pe
´ter
Catholic University, Institute of Psychology, Budapest, Hungary
Introduction: Female fashion models are under intense occupational pressure.
The present study focuses on assessing the lived experience of fashion models
with regards to their dieting and exercising habits, body image perception, eating
disorder-like symptoms, and experience of abuse via self-narrated reports.
Methods: Series of open questions were distributed among international fashion
models (N=84, mean age=23.2 years; mean BMI=16.9) selected by convenience
and snowball sampling. Models from 17 countries participated. The questions
targeted models’eating, exercising, dieting habits, body image perception, and
eating disorder symptoms. The average word count of the transcripts was 2473.9
(SD = 2791.6). Thematic content analysis was performed on the transcripts. A
total of 31 codes were created to address disordered eating and body
image concerns.
Results: Negative body-related claims appeared in 89.3%, and positive claims in
64.3% of the models’transcripts. Negative remarks about eating were made by
45.2% of the participants, and 23.8% positively. Control over their food intake was
exercised by 78.6% of the participants and 40.5% used extreme calorie
restriction. Models who talked more positively about their bodies expressed
significantly more frequently extreme calorie restriction. Extreme sports habits
occurred in 23.8% of the transcripts, obsessive sports habits were claimed by
11.9% of participants. Self-induced vomiting was prominent in 14.3% of the
answers. Criticism from other industry members was experienced by 83.3% of
the participants while 44.0% received body appreciation. Body image disorder-
like symptoms were expressed by 63.1% of models. Such models mentioned
significantly more often content about eating disorders and talked significantly
more negatively about eating. Psychological problems were mentioned by
48.8%, whereas 16.7% took part in psychotherapy. Those who partake in
therapy mentioned significantly more eating disorder content in their
narratives. Abuse was mentioned by 25.0% of the models.
Conclusion: Fashion models are experiencing increased environmental pressure
to conform to the extreme slimness ideal. There is a heightened prevalence of
Frontiers in Psychiatry frontiersin.org01
OPEN ACCESS
EDITED BY
Matteo Aloi,
University of Messina, Italy
REVIEWED BY
Jörn von Wietersheim,
Universitätsklinikum Ulm, Germany
Amelia Rizzo,
University of Messina, Italy
*CORRESPONDENCE
Nikolett Boga
´r
nikolett.bogar@gmail.com
RECEIVED 24 December 2023
ACCEPTED 22 March 2024
PUBLISHED 03 April 2024
CITATION
Boga
´rN,Ko
˝va
´go
´P and Tu
´ry F (2024)
Increased eating disorder frequency and body
image disturbance among fashion models
due to intense environmental pressure: a
content analysis.
Front. Psychiatry 15:1360962.
doi: 10.3389/fpsyt.2024.1360962
COPYRIGHT
© 2024 Boga
´r, Ko
˝va
´go
´and Tu
´ry.Thisisan
open-access article distributed under the terms
of the Creative Commons Attribution License
(CC BY). The use, distribution or reproduction
in other forums is permitted, provided the
original author(s) and the copyright owner(s)
are credited and that the original publication
in this journal is cited, in accordance with
accepted academic practice. No use,
distribution or reproduction is permitted
which does not comply with these terms.
TYPE Original Research
PUBLISHED 03 April 2024
DOI 10.3389/fpsyt.2024.1360962
disordered eating and other weight-controlling behaviours among fashion
models to succeed in their careers. Qualitative research is crucial in
understanding the more subtle dynamics in conforming to and maintaining the
thin beauty ideal.
KEYWORDS
anorexia nervosa, appearance pressure, body image disorder, content analysis, eating
disorders, fashion industry, fashion models
1 Introduction
Data on the prevalence of disturbed eating habits and body image
concerns among fashion models is scarce. This can be due to the closed
structure of the unique profession and the concern over potential
repercussions stemming from disclosure of confidentialities (1,2).
However, with the rise of unrealistic beauty standards (3)andthe
increasing rates of eating disorders (EDs) (4) it is more important than
ever to investigate this specific group.
Professions that necessitate a low body weight and are associated
with appearance, such as ballet dancers, marathon runners, and flight
attendants, are more prone to an increased risk of developing EDs (5).
Models are facing intense pressure to reach and to maintain the size
requirements dictated by the fashion industry (6). Contrary to the
pursuit of bigger size representations, the beauty standards remained
similar in the past decade: height of at least 175 cm, waist circumference
around 60 cm and hip circumference preferably not bigger than 90 cm
(7,8). Even though regulations have been implemented on several
international fashion markets (9), the majority of models appearing on
the runways, e.g. on New York Fashion Week, still has a BMI under 18.5
(10), which is considered underweight (11). These unrealistic
measurement requirements put sociocultural pressure on young
women, both models and non-models, to conform to the thin beauty
ideal (12). According to Rodgers et al. (13), 62.4% of female fashion
models have been asked to lose weight or to change their body shape
and/or size. Presumably due to the intense appearance pressure, models
are at significantly greater risk for developing subclinical anorexia
nervosa (AN) compared to non-models (14).
Peer-pressure, the abundantly displayed strong emphasis on thin
body ideals, appearance related criticism are risk factors for body image
concerns and EDs (15). Body dissatisfaction foresees the emergence of
EDs of clinical severity (16). In the fashion industry, models are often
encouraged by their agents to lose weight, even though they are already
thin (17). In a study, 63.1% of models reported that they would receive
more job offers providing that they were slimmer (13). Weight loss
remains a pivotal element and a major accomplishment in the fashion
industry (18). Such criticism can highly influence body perception, self-
esteem, and cause the feeling of shame which is correlated with
disordered eating habits (19).
Besides the considerable mental health consequences, the lack
of proper nutrition can cause several somatic symptoms, such as
osteoporosis, cardiac complications, brain shrinkage or
amenorrhoea (20–22).
The difficulties of partaking in modelling extend beyond eating and
body image disturbances. The presence of abusive or traumatic
experience is not unusual (18). This might further enhance the risk
for the development of EDs, as both traumatic events and the lack of
psychosocial resources are associated with higher ED frequency (23).
The present study aimed to explore the nuanced relationship
between fashion models and their dietary habits, exercise routines,
body image perception, ED-like symptoms, experience of abusive
nature amongst other factors relevant in the scope of ED
development in the sociocultural context of the fashion industry
via self-narrated reports. We trust that this qualitative research adds
great value to the limited number of existent quantitative findings,
and to better understand lived experience of models. There exists a
significant gap in the literature in the assessment of subjective
experiences influencing ED risk factors. To our knowledge, amongst
all the research conducted about fashion models, only one study has
previously applied qualitative evaluation, specifically interpretative
phenomenological analysis (18). Our research aims to fill this gap,
enriching the understanding of the sociocultural dynamics at play
and providing a grounded perspective on the personal and
professional challenges models face, and contributing to targeted
interventions and policy recommendations within the industry.
2 Materials and methods
2.1 Measures
A series of open questions were distributed among fashion
models, aiming to gather information about their careers, their view
on the fashion industry, their relationship with their agents, and
their attitudes towards their body image, eating, exercising and
dieting habits. The list of questions contained 23 open questions
concerning their health, diets, the requirements enforced by the
industry, and it also touched on their self-perception including
Abbreviations: AN,Anorexianervosa;BN,Bulimianervosa;DSM-5-TR,
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text
Revision; ED, Eating disorder; EDI, Eating Disorder Inventory.
Boga
´r et al. 10.3389/fpsyt.2024.1360962
Frontiers in Psychiatry frontiersin.org02
insecurities about their looks, and all questions were registered at
one occasion. Data was collected about their age, their experience in
the fashion industry, their nationality, height and weight. The
answers to the series of open questions were gathered via e-mail
(N = 73, in a Microsoft Word format) and online video calls (N =
14). Participants were provided the possibility to answer all
questions in free text or free speech, enabling them to fully
elaborate on their experience (see Supplementary Material 1). All
participants received the same questions. The online calls were
recorded, and their transcripts were created within 24 hours to be
analyzed in the same format as the written answers.
2.2 Sample
Data was collected from 87 participants who were recruited with
convenience and snowball sampling method (the first author worked
in the fashion industry as a model for five years). The data collection
took part between 2016 June and 2021 May. Three participants were
omitted from the analysis, since one of them was not an active fashion
model, while two participants’interviews were not recorded in their
entirety. In total, 84 transcripts were analyzed. The mean age of the
participants was 23.23 years (SD = 4.4, range 16 –34 years). Their
average experience in the fashion industry was 6.56 years (SD = 3.67,
range 1 –15 years), and their average BMI was 16.9 (SD= 1.60, range
14 –23.7). It is remarkable that 36.4% of the models reported BMI of
between 17.0 and 18.5, and a further 52.3% under 17.0 (moderately or
severely underweight). Mean height of the fashion models was
177.8 cm (SD= 3.6, range 171–186 cm). Models of various
nationalities participated in the study, from 17 countries, including
American, Canadian, Dutch, English, French, Hungarian, Polish,
Russian, and Spanish subjects, amongst others. The average
wordcount of the transcripts was 2473.9 (SD = 2791.6).
2.3 Thematic content analysis
Before starting the coding procedure, all transcripts was fully
anonymized, and identifierswereomitted.Thecollecteddatawas
analyzed by performing a thematic content analysis (24). After the data
collection phase, the video call interviews were read and transcribed.
After the critical reading of the transcripts a coding booklet was
developed containing coding instructions on 31 codes. This coding
booklet was developed by the authors of the present paper. The codes
were in alignment with our research questions such as attitudes
towards one’s body, weight and exercise. Other codes referred to
symptoms of EDs according to DSM-5-TR, since the goal of our
research was to connect attitudes to various ED-like symptoms. The
codes used in the current analysis are presented in Table 1.Before
manually starting the coding procedure, all transcripts were fully
anonymized, and identifiers were omitted. Only explicit mentioning
of each content category was coded, possible latent contents were
ignored in this analysis for better reliability. One testimony could
receive multiple of the same codes, even contradictory ones (e.g.,
positive and negative attitudes towards their bodies within one
testimony). The level of analysis was semi-sentences.
Coders were recruited from Pazmany Peter Catholic University,
Budapest, Hungary who attended a content analysis course during their
psychology MSc programs. They received no benefits for their work,
and they volunteered to join the codingprocess.Theyhadknowledge
that they participate in research focusing on fashion models’lived
experiences, however they were not introduced to the research goals.
This means that while they were aware of the codes they were supposed
to locate, they had no information as to what kind of statistical analyses
were to be performed after their work. The Coders were trained to use
the coding booklet. A sample was sent out to the coders for training
purposes. The texts were broken into semi-sentences and sent to the
coders in a spreadsheet where each line of the first column contained
one semi-sentence, and every column corresponded to one code.
Coders needed to mark line by line whether it contained the specific
code. The coding was later evaluated by the second author who is an
experienced researcher in content analysis. Coding inaccuracies were
assessed, discussed, corrected and coders were re-trained before
receiving more transcripts. The testimonies were assigned randomly
to the coders, and they were hand-coded by at least two people.
Krippendorff’salphaswerecalculatedusingHayesandKrippendorff’s
(25)KALPHAalgorithm(seeTable 1). Every coding difference was
sorted with the involvement of a third judge with experiences in eating
and body image disorders, who only coded the parts where the two
judges’interpretation differed. Due to the large fluctuations in the
wordcounts, the analyses were conducted using relative frequencies.
The absolute frequency of the codes was divided by the wordcount
corresponding to the transcripts.
2.4 Data analysis
The coding process’resulted in a table containing the frequency
of the codes per transcript. Data analysis was performed on two
levels. Firstly, frequencies of each code were calculated and
transformed into percentages to determine what rate each code
appears in all of the transcripts. Secondly, relative frequencies were
calculated: each code’s frequency divided by the corresponding
transcript’s wordcount. These relative frequencies allowed for the
comparison of the transcripts. Mann-Whitney U tests were
performed using the relative frequencies of the codes as
dependent variables, while grouping the transcripts along various
codes for ex. transcripts with or without signs of overeating.
2.5 Ethical approval
The research is in accordance with the Helsinki Declaration and
was approved by the Regional Research Ethical Board of the
Semmelweis University Budapest (No. 3/2020). Written informed
consent was obtained from all participants included in this study.
3 Results
Table 1 contains the number of models and the percentage of
the prevalence of each code. The distribution of the codes was
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Frontiers in Psychiatry frontiersin.org03
analyzed, and non-parametric Mann-Whitney U tests were
performed using the relative frequencies for each code for a more
in-depth analysis. Due to the extensive number of possible relations
between each codes, only the significant relations will
be demonstrated.
3.1 Body related statements
The mostly referenced code in the current study was statements
about the subjects’body. Negative claims appeared in 89.3% of the
models (‘I felt fat and hated it’) while 64.3% mentioned positive
remarks about their bodies (‘I think that my body is perfect’).
Models who talk positively about their bodies also mention
significantly more frequently extreme calorie restriction (U
(N
posbody
=14, N
negbody
= 70) = 661, z= 2.310, p= .021) and
TABLE 1 Content analysis codes with their brief description, the
Krippendorff’s alpha values of the two independent judges’coding and
their occurrence amongst fashion model subjects (N=84).
Code name
(Krippendorff’s
alpha)
Code description Occurring
statements
(Number
of
models; %)
Weight
(Positive:.545;
Negative:.551;
Neutral:.499)
Every mention of the
participant’s weight.
Positive: 17;
20.2%
Negative: 46;
54.8%
Neutral:
66; 78.6%
Exercise, training,
sport (Positive:.549;
Negative:.732;
Neutral:.746)
Every mention of the participant’s
exercise, training, or sports habits.
Positive: 34;
40.5%;
Negative: 12;
14.3%;
Neutral:
77; 91.7%
Body
(Positive:.547;
Negative:.541;
Neutral:.517)
Every mention of the participant’s
body perception.
Positive: 54;
64.3%;
Negative: 75;
89.3%;
Neutral:
80; 95.2%
Eating
(Positive:.635;
Negative:.618;
Neutral:.391)
Every mention of the participant’s
experiences, habits with eating.
Positive: 20;
23.8%;
Negative: 38;
45.2%;
Neutral:
81; 96.4%
Body appreciation
(.664)
Every mention where the
participant expresses receiving
appreciation toward their body
from other industry members.
37; 44.0%
Body critique
(.634)
Every mention where the
participant expresses receiving
criticism toward their body from
other industry members.
70; 83.3%
Abuse
(.259)
Every explicit mention of abuse
(verbal, physical, emotional, or
other) suffered by the participant.
21; 25.0%
Monotrophic diet
(.391)
Every explicit mention of a type of
diet that involves eating only one
food item.
23; 27.4%
Extreme calorie
restriction
(.487)
Every explicit mention of extreme
calorie restriction.
34; 40.5%
Dietary control
(.618)
Every explicit mention of the
participant’s will to greatly control
their eating habits.
66; 78.6%
Loss of dietary
control
(.667)
Every explicit mention where the
participant admits they lost control
of their eating habits.
19; 22.6%
Liquid diet
(.75)
Every explicit mention of the
participant’s liquid diet.
3; 3.6%
Overeating and
binge eating episodes
(.628)
Every explicit mention that the
participant has significantly
14; 16.7%
(Continued)
TABLE 1 Continued
Code name
(Krippendorff’s
alpha)
Code description Occurring
statements
(Number
of
models; %)
overeaten or had a binge
eating episode.
Self-induced
vomiting, purging
(.731)
Every explicit mention that the
participant has purged themselves
by self-induced vomiting
after eating.
12; 14.3%
Extreme sports
habits
(.532)
Every explicit mention that the
participant has got extreme
sporting habits.
20; 23.8%
Obsessive and/or
compulsive sporting
habits
(.456)
Every explicit mention that the
participant has got obsessive and/
or compulsive sports habits.
10; 11.9%
Consumption of
laxatives
(.896)
Every explicit mention that the
participant consumes laxatives
without a specific medical reason.
6; 7.1%
Fear of gaining
weight
(.343)
Every explicit mention that the
participant has got heightened fear
from gaining weight.
18; 21.4%
Lack of or irregular
menstruation cycle
(.749)
Every explicit mention that the
participant experiences lack of or
irregular menstruation cycle.
16; 19.0%
Body image disorder
(.375)
Explicit signs of body
image disorder.
53; 63.1%
Eating disorder
(.567)
Explicit signs of eating disorder. 31; 36.9%
Psychological
disorders
(.42)
Every explicit sign of
psychological disorders.
41; 48.8%
Therapy
(.698)
Every explicit mention that the
participant underwent or is
currently treated in psychotherapy.
14; 16.7%
Positive or negative valence was added to a code if the participant’s attitude toward the subject
is clearly stated. Neutral code was added if the attitude is not clearly mentioned. The valence is
added to each individual occurrence.
Boga
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Frontiers in Psychiatry frontiersin.org04
monotrophic eating (U(N
posbody
=14, N
negbody
= 70) = 613, z= 1.879,
p= .041). These individuals talked significantly more about body
image disorder-like symptoms (U(N
posbody
=14, N
negbody
= 70) =
715, z= 2.771, p= .006) and psychological disturbances (U
(N
posbody
=14, N
negbody
=70)=673,z= 2.360, p= .018).
Participants who talked positively about their bodies made
significantly more negative statements about their weight (U
(N
posbody
=14, N
negbody
=70) = 682.5, z= 2.425, p= .015). Neutral
statements were made by 95.2% of the models, such as ‘Hmmm, my
measurements. I’m 184 cm tall and 48-49 kg’. Those participants
mentioned significantly more positive statements about their bodies
who did not talk about body image disorder-like symptoms (U
(N
nobodyimagedisorder
=31, N
bodyimagedisorder
=53) = 611.5, z= -1.992,
p= .001).
More than half of the participants, 54.8% had negative opinion
about their weight (‘I was desperate to lose weight’), while only
20.2% of the models said positive affirmations in the same regard
(‘I’m feeling so comfortable, with my body, with my weight’).
Neutral statements of their weight (‘I’m 54 kg.’) were made by
78.6% of the models –most likely due to the nature of the questions.
Negative weight related statements were significantly more frequent
among models who show body image disorder-like symptoms (U
(N
nobodyimagedisorder
=31, N
bodyimagedisorder
=53) = 1151, z= 3.206,
p= .001).
3.2 Eating related statements
Nearly half of the participants (45.2%) said something negative
about eating habits or their attitudes towards eating, e.g., ‘I couldn’t
enjoy food anymore in a normal way’. Positive opinion about eating
(‘I love food and I love cooking.’) were given in 23.8% of the
transcripts. The models who talked negatively about eating
mentioned significantly more body image disorder-like symptoms
(U(N
nobodyimagedisorder
=31, N
bodyimagedisorder
=53) = 1071, z= 2.530,
p= .011). Those who talked more negatively about eating, talked
significantly more often about overeating (U(N
noovereating
=70,
N
overeating
=14) = 710, z= 2.888, p= .004). More than two thirds,
78.6% of the participants, have mentioned that they control their
food intake, e.g., ‘[…] skipping lunch at school, skipping breakfast,
or eat a few slices of apple or crackers’. Monotrophic eating (‘I
started to lose weight by eating 3 apples a day’) occurred in 27.4% of
the answers, and 40.5% claimed to have used extreme calorie
restriction (‘I completely started starving myself. I was like on one
apple a day pretty much.’) through their modeling career. Juice
fasting was occurrent amongst 3.6% of the participants. According
to the answers, 22.6% of participants have lost control over their
food intake. These individuals portrayed significantly more frequent
binge eating (U(N
lossofcontrol
=19, N
nolossofcontrol
=65) = 1033, z=
6.844, p<.000), self-induced vomiting (U= 874, z= 4.507, p<.000),
extreme caloric restriction (U(N
lossofcontrol
=19, N
nolossofcontrol
=65) =
888, z=3.256,p= .001), and obsessive sports habits (U
(N
lossofcontrol
=19, N
nolossofcontrol
=65) = 770.5, z= 2.908, p= .004).
They made significantly less positive remarks about their bodies (U
(N
lossofcontrol
=19, N
nolossofcontrol
=65) = 435.5, z= -1.992, p= .046),
more negative remarks about eating (U(N
lossofcontrol
=19,
N
nolossofcontrol
=65) = 983, z= 4.274, p<.000), more frequent
controlling of food intake (U(N
lossofcontrol
=19,
N
nolossofcontrol
=65) = 865.5, z= 2.665, p= .008) and monotrophic
eating (U(N
lossofcontrol
=19, N
nolossofcontrol
=65) = 857, z= 3.260, p=
.001). Moreover, ED related statements are also significantly more
frequent amongst these models (U(N
lossofcontrol
=19,
N
nolossofcontrol
=65) = 1018, z= 4.948, p<.000) and they engaged
more frequently in psychotherapy (U(N
lossofcontrol
=19,
N
nolossofcontrol
=65) = 856, z= 3.928, p<.000). Binge eating was
prominent amongst 16.7% of the models. Models who stated binge
eating talked significantly more frequently about extreme caloric
restriction (U(N
noovereating
=70, N
overeating
=14) = 674.5, z= 2.493,
p= .013), self-induced vomiting (U(N
noovereating
=70,
N
overeating
=14) = 739, z= 4.911, p<.000), obsessive exercising (U
(N
noovereating
=70, N
overeating
=14) = 626.5, z= 2.913, p= .004), weight
gain (U(N
noovereating
=70, N
overeating
=14) = 692, z= 3.378, p= .001)
and ED symptoms (U(N
noovereating
=70, N
overeating
=14) = 751, z=
3.620, p<.000).
3.3 Sports habits related statements
Statements about exercising were predominantly positive (‘I
love doing Pilates’) or neutral (‘I work out 6 times a week’) (40.5%
and 91.7%, respectively), and negative in only 14.3% of the cases (I
didn’t feel motivated to workout’). Extreme sports habits (‘I worked
out every day for 2 hours’) were portrayed by 23.8% of the
participants. Obsessive sports habits (‘Iwouldn’tleaveuntilI
would burn a specific number of calories’) were claimed by 11.9%
of the participants. The occurrence of codes and their emotional
valence is presented in Figure 1.
3.4 Purging related statements
Self-induced vomiting was prominent in 14.3% of the
transcripts and it appeared significantly more frequently among
models who experienced body image disorder-like symptoms (U
(N
nobodyimagedisorder
=31, N
bodyimagedisorder
=53) = 1007.5, z= 2.833,
p= .005). Laxative abuse was reported by 7.1% of the models
and was mentioned significantly more by those individuals
who talked about body image disorder-like symptoms (U
(N
nobodyimagedisorder
=31, N
bodyimagedisorder
=53) = 914.5, z= 1.931,
p= .050). None of the respondents who made positive statements
about their bodies mentioned the usage of laxative substances.
3.5 Statements about external feedback
on body
Our analysis shows that 83.3% of the participants were criticized
by other industry members (‘My agent told me that I’mugly’), while
44.0% received body appreciating affirmations (‘The sicker I was the
more approval I was getting’). Models who talked more frequently
about external criticism mentioned more body image disordered-like
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Frontiers in Psychiatry frontiersin.org05
symptoms (U(N
nocrit
=14, N
crit
=70) = 637, z= 1.810, p=.050).The
participants who experienced body appreciation talk more positively
about their body (U(N
noappr
=47, N
appr
=37) = 1033, z= 2.099, p=
.036). However, those individuals also talk more about self-induced
vomiting (U(N
noappr
=47, N
appr
=37) = 1059.5, z= 2.813, p=.05),
laxative use (U(N
noappr
=47, N
appr
=37) = 966, z= 1.947, p= .049), and
engagement in psychotherapy (U(N
noappr
=47, N
appr
=37) = 1025.5,
z= 2.165, p= .030).
3.6 Psychological disturbances
related statements
Body image disorder-like symptoms (‘Even when I lost the
weight to 45 kgs [I’m5’11”] I still thought that I was fat’) were
expressed by 63.1% of the participants. Significantly more negative
remarks about one’s body were observed among participants
who reported body image disorder-like symptoms (U
(N
nobodyimagedisorder
=31, N
bodyimagedisorder
=53) = 1165.5, z= 3.186,
p= .001). Models who reported body image disorder-like symptoms
talked significantly more often about extreme caloric restriction (U
(N
nobodyimagedisorder
=31, N
bodyimagedisorder
=53) = 1091, z= 2.812, p=
.005), monotrophic eating (U(N
nobodyimagedisorder
=31,
N
bodyimagedisorder
=53) = 1083, z= 3.086, p= .002), and losing
control (U(N
nobodyimagedi sorder
=31, N
bodyimagediso rder
=53) = 978,
z= 1.980, p= .048). Previous, or active EDs were mentioned by
36.9% of the models. Those models who mentioned body image
disorder-like symptoms mentioned significantly more often
content about EDs as well (U(N
nobodyimagedisorder
=31,
N
bodyimagedisorder
=53) = 1117, z= 3.165, p= .002). Psychological
problems of different sorts (e.g., anxiety, depression, panic attacks,
suicidal attempts) were mentioned by 48.8% of the models, while
16.7% confessed to taking part in psychotherapy. Those who engage
in psychotherapy make significantly more remarks about losing
control in eating (U(N
nother
=70, N
ther
=14)= 723, z= 3.817, p<.001),
and talk significantly more about overeating (U(N
nother
=70,
N
ther
=14) = 734, z= 4.512, p<.001) and self-induced vomiting (U
(N
nother
=70, N
ther
=14) = 779, z= 5.710, p<.001). Furthermore,
those who mentioned taking part in therapy talk significantly more
about weight gain (U(N
nother
=70, N
ther
=14) = 694, z= 3.412,
p<.001) and mention significantly more ED content (U
(N
nother
=70, N
ther
=14)= 699, z= 2.899, p= .004) in their
narratives. Those who do not engage in psychotherapy make
significantly more negative remarks about their bodies (U
(N
nother
=70, N
ther
=14) = 229, z= -3.135, p= .002). One quarter of
the models (25%) mentioned statements referring to abuse (every
content which refers to being subjected to physical or psychological
violence). The occurrence of codes is presented in Figure 2.
4 Discussion
This study was designed with the intention to better understand
the lived experience of fashion models with special regards to their
eating and exercising habits, self-perception, potentially prevailing
psychological disturbances, abuse, and other strongly related
factors. The present study greatly adds to the scarce quantitative
data about fashion models.
Fashion models encounter elevated levels of appearance and
sociocultural pressure linked to symptoms of disordered eating.
This pressure emanates from the prevailing extremely thin aesthetic
in the fashion industry and is exerted by fellow members of the field
(13,26). The pressure to maintain an extremely slender physique,
driven by professional standards and industry expectations, coupled
with unrealistic ideals perpetuated by women seeking success as
fashion models, is proposed to contribute to a more negative body
image within this group (17). Up to this day, fashion runways are
still overpowered by extremely slender models (27,28). Among the
fashion superpowers, France has been particularly affected by the
cult of thinness: ‘Paris thin’has become a concept among models
and agents and refers to the excessive thinness required by the
shows of the haute couture fashion houses (29).
The excessive emphasis on appearance and body weight, intense
competition, and the prevalent use of clinically underweight models
in the fashion industry may exacerbate appearance concerns among
fashion models (7,20,30). The need to do well, to conform to
industry standards, to be financially independent and to succeed at
a young age can even be anxiety-forming (18).
FIGURE 1
Occurrence of codes and their emotional valence among fashion
models (N=84).
FIGURE 2
Occurrence of codes among fashion models (N=84).
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4.1 Discussion of results of eating and
body concerns
4.1.1 BMI values
The average BMI of fashion models was 16.9 (SD= 1.60, range 14.0
–23.7) which is classified as moderately underweight (11). Even though
previous findings also confirm models being underweight, this is a
considerably lower result. Previous data shows self-reported BMI values
of 17.7 (26), 17.4 (13) and 17.0 (31). However, it was suggested that
professional models’perceived BMI is significantly lower than the
experimenter-measured BMI (i.e., 17.0 vs. 18.6) (31). According to
fashion industry standards, the bodyweight of models is insignificant, as
they are judged by the measurements of their height, bust, waist and
hips (17). This proposes that fashion models might be uncertain about
their actual bodyweight resulting in biased BMI results (31). Models
proved better at accurately estimating their body measurements and
overall size compared to non-models using a three-dimensional avatar
(32). Another explanation for the low BMI value could be that our study
group consists of internationally recognised high fashion models,
mostly working at fashion shows where size requirements are stricter
than in the commercial sector, thus they might feel a stronger influence
toobtainanextremelythinphysique(2).
4.1.2 Full or partial eating disorder symptoms
We found that 36.9% of the participants portrayed to experience
EDs either manifested before their modelling career or during the
modelling years, or showed very severe ED-like symptomatology,
including both clinical or subclinical AN and BN. The existing data
on the prevalence of EDs among fashion models is inconsistent and
presents contradictory results (6). Seemingly, professional models are
more prone to develop partial syndrome EDs, rather than their full-
blown forms. The occurrence of subclinical AN is significantly greater
among models, 14.6% (p < 0.001) compared to 2.7% of control subjects
(14). Similar results were published in 2002, 12.7% of fashion models
had partial AN, and an additional 7.9% had partial BN symptoms (26).
In 2008, strictly similar results were found: 12.7% of professional
models fulfilled partial syndrome criteria of AN, but no significant
difference was shown between fashion models and control group in full-
blown ED symptoms (7). Further research states that the prevalence of
EDs is not higher among professional fashion models (1). The current
result is notably higher. The difference could stem from the nature of
questionnaire-based and interview-based evaluations. While fashion
models showed no significant distinctions from their peers on self-
compiled inventories, they were more inclined to acknowledge
symptoms within the spectrum of EDs during face-to-face interviews
(7). We must acknowledge that models were not examined by medical
professionals, and self-reported diagnosis might not be accurate. It has
also been suggested that women predisposed to disordered eating
symptoms might gravitate towards the fashion industry (7).
4.1.3 Body satisfaction
Statements about one’s body becomes very dominant amongst
models. Negative body remarks were the most prominent (89.3%) in
the study group. These results are in alignment with previous findings
of professional models portraying higher drive for thinness and
dysfunctional investment in appearance (30). Interestingly, extended
time period in the modelling profession correlated with enhanced body
appreciation but concurrently showed stronger drive for thinness,
indicating that already underweight models have a strong desire to
maintain their low body weight or become thinner (30). It is
noteworthy that almost two thirds of the models (64.3%) had
positive claims about their physiques in our study, but it was not
correlated with the amount of time spent with modelling.
Such negative body image concerns can lead to manifesting
symptoms of disordered eating (33) and diminished mental health
(34). The current study shed light to some very interesting relations
between certain body controlling behavior in the modelling industry,
providing evidence to previous assumptions. Negative body perception
was in relation with negative claims about eating, more frequent
excessive calorie restriction, laxative abuse and body image disorder-
like symptoms. Thus, the fashion industry has been criticized that it
creates a ‘toxic’environment being the foundation of increasing body
image disorders and EDs (18,20). This statement could be accurate, as
models’higher self-reported BMI is significantly associated with poorer
body appreciation and greater body dissatisfaction (30).
However, contradicting data can also be found in the literature. No
significant differences were found between models and non-models
regarding body dissatisfaction (7) and body satisfaction (35). It has
been proposed that fashion models may possess personality profiles
enabling them to cope better with the pressures of maintaining a thin
figure. Alternatively, certain aspects of the job, such as the boost to self-
esteem derived from conforming to societal or industry ideals, may
serveasadefenseagainstnegativebodyimage(1). Models may
recognize that their adherence to societal standards of appearance,
particularly the thin ideal, could serve as a protective factor mitigating
negative body image (30).
4.1.4 Weight manipulating behaviors
Due to the intense pressure to maintain the size requirements of
the fashion industry, a considerable number of models use weight
manipulating behaviours like restricting food intake, exercising
excessively, using laxatives and even self-induced vomiting (8,13).
4.1.4.1 Dieting
The current study’sparticipantsshowedsometypeofdietary
control in 78.6% of the cases, which aligns with the previous
quantitative findings. It has been previously reported that several
dieting methods are at practice amongst professional models,
including skipping meals (56.5%), dieting (70.5%), fasting (51.7%), or
using weight loss pills (23.6%) (13). Extreme calorie restriction was
used in 40.5% of the cases. In our study, 27.4% of the models portrayed
monotrophic eating, and only 3.6% of the models juice fasted in order
to lose weight, which is much lower than published by Rodgers et al.
(13). Our finding should be understood on a general level as we did not
conduct the study at specific period in the fashion industry (e.g.,
Fashion Weeks), but 46% of models were found to specifically lose
weight for New York Fashion Week Fall’18 (10). Clean eating is also a
form of dietary restrictions (36). Social standards impede the
identification of orthorexia nervosa, potentially resulting in the
escalation of more severe EDsassymptomsadvance(37).
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4.1.4.2 Self-induced vomiting, laxative abuse
Besides restricting one’s calorie intake, self-induced vomiting is
also applied for weight controlling purposes. Twelve participants
(14.3%) used such method. Former studies show both lower (8.2%,
13; 7.5%, 8) and higher (25%, 10) frequencies for temporary self-
induced vomiting. Models are more likely to experience higher
levels of professional pressure during specific periods, e.g., New
York Fashion Week, thus the higher results. Our examination was
not conducted during such period. This further reinforces the
assumption to the ED-forming nature of the fashion industry.
However, after better understanding the answers, the transcripts
revealed that making oneself sickis due to previous food restriction or
intentional starvation. This method usually leads to yoyo dieting and
weight fluctuation (38). We believe that this result underscores the
validity of our hypothesis that many of the fashion models use weight
controlling methods due to external pressure, which leads to rebound
effects and yoyo dieting on the long term. Weight gain was
experienced in 21.4% of the participants. Severe calorie restriction
results in increased urge for binge eating and additionally, in weight
gain, called binge priming (39).
“[…] but after a while we still gain weight and so in fact I especially
imagine when you have not eaten for a very long time, when you eat, you
eat again 10 times more. That’s sure yoyo. So that’s why diets are very
bad but at firstitworks.[…]”(Excerpt from transcript #87)
Laxative abuse is also a form of purging, occurrent amongst
7.4% of the participants, compared to an almost double rate found
by Rodgers et al. (13%; 2017). Losing control over food intake
resulted in significantly more frequent binge eating, self-induced
vomiting, weight gain and ED related statements.
4.1.4.3 Exercising
Exercising was favoured by models, 40.5% of the participants
gave positive statements about sports activities, while only 14.3% of
the models had any negative relation to exercising. For weight
controlling purposes, it was found that 81.2% of the models engage
in physical activities regularly and 69.4% of those models were told
to “tone up”in order to book more modelling jobs (13). However,
such habits can become extreme (23.8%) or even obsessive (11.9%)
due to the intense pressure of the agents and designers.
The restrictive diets, excessive exercising habits, purging,
consumption of laxatives, especially at younger age can cause
serious health consequences. Digestive problems, hair loss,
amenorrhoea, cardiac complications, hormonal imbalances,
osteoporosis are all serious implications of an insufficient food
intake and mannequins are at risk of such outcomes (14). Federal
law was adopted in France, implying that models must obtain a
health certificate from a doctor declaring that they are in good
health (40), however, eating and exercising behaviours are poorly
assessed hindering the intervention for EDs (10).
4.1.5 External remarks about physical appearance
Ourstudyrevealsthat83.3%ofthemodelshaveexperienced
criticism related to their appearance in the fashion environment. These
negative remarks mostly target body measurements, especially hip
circumference, but also extends to skin and hair condition, facial
features, teeth and even clothing style. These types of negative
remarks, that can potentially be considered bullying, are very
dangerous during adolescence (most fashion models are still minors)
as personality development hasn’tfinished yet and such sentences can
lead to low self-esteem, distorted self-perception, body-image disorders
and potential development of EDs (41), moreover, negative weight-
related remarks can be remembered for years, maintaining negative
body associations (42). Such negative remarks concerning losing
weight and changing body size directed to already underweight
models are very frequent among fashion models (13).
Conversely, the occurrence of body appreciation from industry
participants is roughly half of the frequency of body criticism,
namely 44.0%. If we investigate those positive feedbacks in detail, it
becomes clear they mostly appraise models’weight loss. Models
confessed that those appreciative words are usually followed by
criticism or that they seem dishonest.
“[…] they would praise you if it looked like you lost some weight,
and they would quickly remark if by any reason you had 92 cm hips. [
…]”(Excerpt from transcript #56)
“[…] Oh, you lost weight, you look really good, but you know,
for Fashion Week you need to lose a bit more weight! [ …]”(Excerpt
from transcript #16)
Models being negatively criticized by other industry members
talked significantly more often about eating in an unfavorable
manner, however, unpleasant remarks about exercising were less
frequent. This finding is in alignment with the intense drive for
thinness and pressure to use unhealthy weight controlling behaviors
to conform to the extremely thin industry standards. Models might
find comforting exercising to achieve their desired body shape and
to fulfill their drive for thinness, hence the negative relation.
4.2 Discussion of results of other
psychological aspects in fashion models
According to our findings, not only the occurrence of EDs and
body image disorders seemed heightened among professional
models, but also other psychological disturbances and abuse of
different sources are existent in this population. The mental well-
being of models is at great risk and should be better protected.
4.2.1 Psychological disturbances
Due to the intense pressure models must face, the uncertain
working environment, loneliness, and the continuous rejections
brings a mental burden on these young women (43), that potentially
manifest in different kinds of psychological disturbances. Almost half of
the participants (48.8%) reported psychological difficulties throughout
their modelling days. The participants mentioned in their rapport
depression, severe anxiety, insecurities, low self-esteem, sudden mood
swings, excessive crying, insomnia, obsessive-compulsive tendencies,
body dysmorphia, and even suicidal thoughts. It is important to
highlight that the participants only submitted self-narrated reports;
thus, the diagnosis might not be entirely accurate. Uncertainty and the
unpredictable nature of the modelling profession can play a factor in
controlling one’s physical appearance, food consumption, or exercise
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habits (44,45). Each fashion season is unique, and models can be
replaced at any moment (17) and the frequent rejection is described as
“soul-destroying”and even traumatic (18). People with different
personality types react differently to external pressure, and they
develop different coping mechanism to bear those stressors (46),
potentially resulting in maladaptive coping mechanisms such as the
manifestation of EDs or the use of illicit drugs (26).
4.2.2 Abuse
One quarter of models (25.0%) mentioned in our study that
they have experienced some type of emotional, psychological or
physical harassment during their modelling career. Most of the
time, these abuses are of emotional or psychological nature,
targeting body shaming, belittling and humiliation due to models’
body measurements, mainly in front of other actors of the fashion
industry. However, in our present study, agreement between the
Coders was poor in terms of defining abuse (Krippendorff’s alpha =
.259). Models were told 63.1% of the cases by agents that they would
secure more modelling jobs if they lost weight (13), and are denied
receiving financial aid if the measurement requirements are not met
(18). Models are prone to be exposed to abuse of sexual nature, such
as being photographed while changing backstage (10).
4.2.3 Psychotherapy
A total of 16.7% of the participants reported to have engaged in
some form of psychotherapy. This is considerably higher compared
to the 3.5–9.9% range observed by the 2019 EHIS survey (47)and
higher than the percentage observed by the National Center for
Health Statistics with 9.5% of adults reporting to have received
counselling or therapy (48). This is understandable if we consider
the traits of professional modelling, on an international level. On the
one hand, for a successful psychotherapy, frequent therapy sessions
are needed, and even if those sessions are conducted online, the
unpredictability of a model’s schedule and the different time zones
make it difficult to adhere to a well-structured therapy program. On
the other hand, it is questionable how supportive the fashion industry
is towards mentally healthy models. Assertive personalities are
potentially less likely to conform to such abusive and belittling
environment. Having healthy bodily standards is also
disadvantageous in the fashion world, as models might not meet
the extreme size requirements once they adopt healthy lifestyle
choices –both mentally and physically (17). The models engaging
in psychotherapy mentioned more ED related content, more
overeating, more self-induced vomiting and less positive remarks
about eating, suggesting that fashion models mostly seek out
professional help to treat ED symptoms. However, they made fewer
negative remarks about their bodies, more about weight gain and less
body image disorder symptoms which envisions that they were able
to overcome bodily concerns and be more acceptive of themselves.
4.3 Extrinsic or intrinsic pressure?
It has been a debated question whether young women with
already existing EDs or ED like tendencies chose to pursue
modelling as it is an acceptable lifestyle to validate their illness or
if models start to manifest disordered eating habits and body image
problems due to the external stressors (7). Considering all the above
mentioned, the latter seems more accurate. It appears probable that
fashion models manifest increased ED and body image concerns
due to intense environmental pressure deriving from the fashion
industry. This assumption might be further justified if we consider
that agents prefer to choose young women with very slim, almost
anorexic-like body frames to sign modelling contracts (49). It is
questionable whether those girls possess unique natural body
constitutions within genetic variability (35) or must take tedious
efforts to maintain such measurements (13). Fashion models with
higher BMI values show more ED symptoms (31) implying that
aspiring models with normal body constructs engage in extreme
weight loss methods to meet industry standards. Our overall
interpretation of the data is that fashion models experience
immense environmental pressure to conform to the extremely
slim beauty ideal.
To our best knowledge, the current study involved a larger
number of multicultural female fashion models than any previous
qualitative research on the field. Furthermore, this is the first ever
study to use thematic content analysis for the assessment of ED-like
symptoms and body image disturbances in this population, thus we
believe it makes a significant contribution to the existing literature.
Certain limitations must be considered regarding this study. Firstly,
most of the respondents were not native English speaker which could
cause discrepancy due to misunderstandings or in the ability to express
complex ideas. However, the level of linguistic complexity in the
testimonials contradict this assumption. Secondly, some of the
participants were recruited during the COVID-19 pandemic, when
less modelling jobs were available which could also alter their
responses. Furthermore, the self-reported anthropometric data may
differ from the factual values, so the calculation of BMI may be
distorted (50). Thirdly, answers to sensitive questions may have been
biased as we assume that those models participated in our study who
aremoreactiveincreatingchangeinthefashionindustryandwho
disagree with current dynamics. At the same time, it is also possible that
models decided to hide certain details in the hope of protecting their
career, even though complete anonymity was ensured. Furthermore,
underestimation of the symptoms might be possible not only due to
career-protection, but also due to the nature of the questions, as they
were not explicitly asked from the participants. Models were not
examined by health care professionals, and self-reported diagnosis
might not be accurate. The first author’s personal experience as a
former fashion model may introduce an inherent bias to this research,
potentially influencing the framing of questions, interpretation of
responses, and overall analysis, despite efforts to maintain objectivity
throughout the study. Lastly, we have to mention that hand-coding a
big number of lengthy testimonials is an exceptionally strenuous task,
challenging the most experienced codersaswell.Theenduringefforts
might have caused discrepancies.
5 Conclusion
The fashion industry plays a vital role in shaping cultural ideals.
Based on the personal testimonies of fashion models, it can be
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Frontiers in Psychiatry frontiersin.org09
concluded that there is a significant risk for developing EDs within
this specific population, either in clinically severe forms or more
often, manifested as subclinical symptoms. These phenomena can
be occurrent due to the intense environmental pressure towards
maintaining a slim physique. The physical and mental health of
models must be taken into consideration when defining beauty
standards of the fashion industry. There is a need to revise
unrealistic measurement requirements, and agencies should
refrain from pressuring modelsintoengaginginsuchhealth-
damaging behaviours to conform industry standards.
Further studies are required to investigate the risk factors and the
actual frequency of EDs and body image disorders among
professional fashion models. The symptoms assessed should go
beyond AN and BN. The consequences of the environmental
pressure can highly influence the mental health status of the
fashion models. Emotional or sexual abuse, exploitation and
humiliation are also parts of the fashion industry. The results hold
significant relevance in shaping health regulations within the fashion
industry to curb the prevalence of EDs among models and individuals
exposed to model imagery. It is imperative for the fashion industry to
implement alterations that prioritize the physical and mental well-
being of fashion models and to reconceive existing regulation relying
on BMI values as broader mental and physical aspects should be
evaluated for effective preventive measures against eating and body
image disorders amongst fashion models. This entails discontinuing
the promotion of health-detrimental practices enforced by agents or
designers and establishing a system of regular medical consultations.
Data availability statement
The raw data supporting the conclusions of this article will be
made available by the authors, without undue reservation.
Ethics statement
The studies involving humans were approved by Regional
Research Ethical Board of the Semmelweis University Budapest
(No. 3/2020). The studies were conducted in accordance with the
local legislation and institutional requirements. Written informed
consent for participation in this study was provided by the
participants’legal guardians/next of kin.
Author contributions
NB: Conceptualization, Data curation, Investigation, Writing –
original draft, Writing –review & editing. PK: Formal analysis,
Methodology, Writing –review & editing. FT: Supervision, Writing
–review & editing.
Funding
The author(s) declare that no financial support was received for
the research, authorship, and/or publication of this article.
Acknowledgments
The authors would like to thank the numerous professional
fashion models who participated in the current research.
Conflict of interest
The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be
construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors
and do not necessarily represent those of their affiliated organizations,
or those of the publisher, the editors and the reviewers. Any product
that may be evaluated in this article, or claim that may be made by its
manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary Material for this article can be found online
at: https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1360962/
full#supplementary-material
SUPPLEMENTARY MATERIAL 1
Series of open questions used for the present study.
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