This post is a few months due, but I was too busy to write my thoughts when this was more of a relevant topic. Bear with me.
In April, France joined Israel, Spain and Italy, in banning the use of models with a BMI < 18. Use of underweight models, in France, will come with a chance of up to 6 months in jail and a fine of up to $82,000 (USD). Because France is a major hub of fashion and in fact influences a lot of trends and thoughts about clothing and the female body image, I was thrilled about this ban. In my opinion, the media does play a huge role in body image distortion for many young women; I’d go as far as saying your TV, Radio, magazines, books, websites and newspapers could be some sort of risk factor for developing eating disorders.
There are some deficiencies in broadly applying BMI as a unit of measuring healthy weight. A number of theories exist: BMI may underestimate obesity in metabolically obese normal weight people (often referred to as skinny fat people), or may over estimate obesity in shorter people like with people in lower socio-economic classes or also in people with far east Asian heritage… or my personal favourite, BMI overestimates obesity in some athletes, so that lean Olympian with lots of heavy muscle seems more obese than your neighbourhood couch potato if you assessed by just BMI. These theories and truths aside, I do believe this was a great positive message to send to healthy weight girls that forcing yourself into looking like this>>
… neither is it fashionable or beautiful.
I actually think this portrayal of ultra-skinny femininity as an ideal, is in fact a public health concern.
I got to wondering about which women (because this is more prevalently a women’s issue) might be influenced by the ban. Though Anorexia nervosa is a rare condition, I wondered, if most Countries implemented this ban, would it have a truly global impact in spreading knowledge about healthy body images?
In case you are unaware, I’ll let you in on a well-known, but often ignored secret … There is some temptation amongst immigrants to label certain diseases and conditions, as a problem only for “developed countries” or western societies or in particular Caucasian people in higher socio-economic classes in developed western societies. Pretty much all mental health conditions and eating disorders happen to fall into this box.
There is even a theory about why Anorexia Nervosa might be just a developed society’s problem:
“The age-related obesity hypothesis: posits that the otherwise normal tendency by women to seek a youthful appearance can become maladaptive and lead to anorexia nervosa in environments in which thinness becomes the primary indicator of youth, such as in modern industrialized societies”1
Hmmmmm….An interesting sociological determinant of health….
Truth is in most western societies, there exists an obsession with weight loss, staying skinny and attempting to reach crazily unattainable and unhealthy physical attributes displayed by actors and models. This preoccupation unfortunately gets tied into many young adult’s self-esteem and self-image with concomitant psychological effects. Where I’m from, being curvy, voluptuous even fat was an attractive feature (this fact is changing with increased influence of globalization and spread of western media influence), so it is tempting to assume, no one is anorexic in Nigeria. I found exactly 2 case studies of Nigerians in Nigeria diagnosed with anorexia nervosa, which might indicate gross under diagnosis of the condition or the assumption that it is not an African problem or may be related to the fact that most Nigerians still consider fuller figured women as beautiful. Anorexia Nervosa is definitely not exclusive to Caucasian people in Western developed societies, however an increase of this condition has been associated with urbanization and the spread of media – exposure promoting western ideals of beauty.2-5 So, once again, I’ll say I’m pleased that France, Israel, Spain and Italy are making baby steps in altering this particular risk factor.
I know this is not a highly prevalent condition, but I wonder about ethnic minorities in Canada? Are there equivalent rates of anorexia nervosa amongst our ethnic minorities in Canada as in the general population?
I could not find a solid answer to that question. So, maybe you physicians who get to deal with this more often can share thoughts?
- Lozano GA (2008). “Obesity and sexually selected anorexia nervosa”.Medical Hypotheses 71 (6): 933–940. doi:1016/j.mehy.2008.07.013.PMID 18760541.
- Eating pathology in East African women: the role of media exposure and globalization. Eddy KT, Hennessey M, Thompson-Brenner H, J Nerv Ment Dis. 2007 Mar; 195(3):196-202.
- Nasser M. Eating disorders across cultures. 2009;8(9):347–50. doi: 10.1016/j.mppsy.2009.06.009.
- Becker AE, et al. Social network media exposure and adolescent eating pathology in Fiji.Br J Psychiatry. 2011;198(1):43–50. doi: 10.1192/bjp.bp.110.078675.
- Pavlova B, et al. Trends in hospital admissions for eating disorders in a country undergoing a socio-cultural transition, the Czech Republic 1981–2005.Soc Psychiatry Psychiatr Epidemiol. 2010;45(5):541–50. doi: 10.1007/s00127-009-0092-7.