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　　With model's death, eating disorders are again in spotlight

　　By Kimberly Conniff Taber

　　International Herald Tribune

　　11/20/2006

　　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 Paolo 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."

　　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 in a telephone interview. The fashion industry, images of celebrities, relationships with parents and other environmental factors load the gun. Emotional distress pulls the trigger.