Hats off to the Madrid authorities for banning ultra-skinny models from this week's Cibeles fashion show! After last year's show created a chorus of disapproval from health and women's organizations due to the extreme emaciation of some of the participants, the city government, which finances Spain's most important fashion show, took matters into its own hands, instituting a weigh-in for the models. The cutoff was set at a body mass index of 18, still in the "underweight" range. This criterion has been estimated to exclude almost a third of the women who walked in Madrid's fashion week last year.

Body mass index, or BMI, is a calculation that allows an assessment of weight-for-height. Based on studies of health, a BMI less than 18.5 is considered underweight, and confers medical risks. The Madrid regional government provided a little wiggle room, setting 18 as the cutoff for walking the runway. This means that a 5 foot 9 inch fashion model has to weigh at least 122 pounds, and a 6 foot tall model, 133.  Still sounds pretty skinny to me!

So why does an ob/gyn care about the weight of fashion models?  For one, I take care of girls whose unhealthfully low body weights bring them to my office for irregular or absent menstrual periods. When normal bodily functions are impeded by body weight, we have evidence that the weight is not healthy. The system is logical: if you are malnourished, it is obviously not a good time to reproduce. Low body weight interferes with ovulation, disrupts normal hormones, and leads to complications of low estrogen levels-including absent periods, infertility, sexual difficulties, osteoporosis, and stress fractures. I believe that our modern standard requiring thinness for beauty plays a role in distorted self-images, and the positive social responses girls get for being underweight. I'd like a non-distorted standard of beauty for my patients, so they can feel lovely at weights that don't interfere with their normal physiology.

The other issue is occupational health for the models themselves. I can't look at most of the bodies in the fashion magazines without wondering if these women get normal menstrual periods. (Sorry, that is how we doctors think...) If one of these women walked into my office, I'd evaluate her for malnutrition and disordered eating. Fashion models are under pressure to keep themselves underweight, because unnatural thinness is required in the industry. Shifting the standard would reward healthy behavior, instead of reinforcing restrictive eating. Although I love the new Dove soap ads featuring full-figured actresses, I am not talking about a vast change. But avoidance of the emaciated "heroin chic" look would be a step.

I read that the mayor of Milan wants to follow Madrid's lead, and set a lower limit for models' BMIs at the next Italian show. Of course it would be better all around if the fashion industry policed itself, but I can't quite picture Miranda Priestly (of The Devil Wears Prada) changing her standards for something as seemingly irrelevant as the fashion model's health, so maybe that is unrealistic. We may have to count on public officials showing leadership in this public health arena. C'mon Milan, let's see you keep up with Madrid! Next stop, Paris!