Luisel Ramos was a young, pretty Uruguayan. She had been told by friends and co-workers that she could “really make it” as a model and have an international career. All she needed to do was become thinner.

      Ms. Ramos complied. For months she subsisted on lettuce and diet coke. On August 2nd, she appeared triumphant on the catwalk in Montevideo, at the weight and shape required. Then she walked off the catwalk and died. She was twenty-two.

      Officially, Luisel Ramos died of heart failure. She actually died from trying to be too thin.

       Ms. Ramos’ death, unlike those before her, was not unremarked. Government officials on Madrid did what had previously been unthinkable. They changed the rules for Madrid Fashion Week. A body-mass index of 18 was required to appear in the fashion shows. Suddenly most of the world’s “supermodels” were no longer eligible. Other countries proposed new rules, including undefined “medical certificates” before models could appear in public.

      Why in a world undergoing an unprecedented obesity epidemic, are women and men starving themselves to be thought beautiful?

The Lure of Extremes

      In the 1960’s, ultra-thin British model Twiggy was considered an aberration. Today she might be considered a bit “too thick.” Models in magazines have relentlessly narrowed in the last thirty years. Quite a few well known models are now pre-pubescent 14 and 15 year olds. On reaching puberty, they usually gain weight. They are then forced to choose – a model’s lifestyle, with its fame and luxury, or a return to normal life. For many the choice is made for them, by parents and modeling agencies.

      In the United States, the population has grown fatter every year for decades. Now a full two thirds of adults are overweight by already loose government standards. Yet we want our beauties thinner and thinner, and young. The pressure is mainly on women. Graphics software routinely elongate movie stars for magazine photos. The wives of billionaires and CEOs are notably more slender than their husbands.

      Part of this fascination with thinness may reside in compensation for an ever widening population. There is also a long standing trend towards fantasy. Young women working longer hours in insecure jobs may fantasize about appearing six feet tall and one hundred twelve pounds. Yet the vast majority will never appear that way, even wearing strappy shoes with impossibly high heels that previously would have been featured only in bondage magazines.

Punishment for Performance in Fashion and Sport

      The truth is that the business of beauty hurts. There are people who naturally fit the fashion industry’s ultrathin, ultralight required form, but they are very few. Most fashion models must try other means.

      Smoking is often tried first. Based on the clinical experience of myself and colleagues, many in the fashion industry smoke merely in the belief that it will prevent them from gaining weight. The next methods often involve vomiting and purging, sometimes progressing to anorexia and bulimia. Quite a few go further towards drugs, especially cocaine, in order to remain thin.

      Recently supermodel Kate Moss was found to publically use cocaine. Shock and horror were duly registered, with many media pundits pronounced her career finished. Within months she was more successful than ever, garnering multi-million dollar contracts, and following her rock star boyfriend on his latest tour, once he left rehab.

      Professional sports all too often involves punishment for performance. With millions of dollars and international fame separated by tenths of seconds, people go to the wall to succeed. Floyd Landis won the Tour de France riding with what must have been a horribly painful necrotic hip, only to lose his title and his career when found to be doping himself with male hormone. Originally saying his high testosterone level was due to a night of “too many beers,” the sad irony is that testosterone is not considered by most experts to enhance performance at all. And what kind of comment is it on America’s favorite sport when Tampa Bucs’ quarterbook Chris Simms has to leave the field the field for the ICU, his spleen removed after too many hard hits?

Health and Beauty

      The fashion world may be fun to satirize, as in “The Devil Wears Prada,” but the overall effects on the nation’s health are less amusing. About half of teenage girls in the U.S. and Britain will actively try binging and purging to lose weight. Millions will end up anorexic or bulimic. However, the death rates from anorexia and bulimia pale compared to those from tobacco. Millions of Americans smoke as a way to stay thin. For about half of them, it will help cause their death. And it is much harder to gauge the quest for thinness’ psychological effect on young people when obesity rates are skyrocketing.

      Is government intercession, as in Spain and Britain, the way to go? That is unlikely. American politicians don’t even want to legislate against torture. Perhaps we can hope for better from the fashion industry. First, they can start a national anti-smoking campaign, starting with models like Christy Turlington who are already prominent in that fight. They can also build on the idea of medical certification, making certain that drug abuse is not tolerated in models appearing in public.

      The fashion industry itself can also began selling, as they have so often, a different image of beauty. It’s already starting in parts of Hollywood, where thinness is losing out to fitness. Pencil arms and stick legs are not required to appear beautiful in films. As even Anna Wintour may know, there are many, many ways to be beautiful – and healthy.

Dr. Matthew Edlund, M.D., M.O.H., director of The Center for Circadian Medicine, is an expert on applied public health, sleep medicine and psychiatry. A former professor at Brown and University of Texas medical schools, he can be reached via email to DocME@DoctorEdlund.com. And CLICK HERE to subscribe to our new Fitcast, via the iTunes Store.