Humans, Not Hangers: Why It's Time to Regulate the U.S. Fashion Industry

"Nothing tastes as good as skinny feels," Kate Moss once responded when asked whether she had any mottos. Comments like these are pervasive in the media and throughout society, and while they are easily brushed off as ridiculous by some, they continuously run through the heads of others, reinforcing a restricted diet that can eventually turn into anorexia, the most deadly of all mental illnesses.

Slender, and even skeletal, women have long been romanticized in the West, largely thanks to the omnipresent fashion industry saturating media of all types -- print, online and broadcast -- with images of rail-thin women. Models who walk the most famous runways -- in Paris, Milan, London and New York -- are referred to as "clothes hangers" -- the less woman inside the outfit, the better. This takes a toll: Many runway models have a body mass index, or BMI, of less than 16, a degree of thinness so severe in an adult that the World Health Organization considers it an indicator of life-threatening starvation.

Not surprisingly, models, including international model Luisel Ramos, have died of the devastating effects of starvation sometimes within minutes of stepping off of a runway. Former Australian Vogue editor Kirstie Clements reported in The Guardian that a top agent once confided in her that the pressure on models to starve themselves had only intensified, revealing, "I've got four girls in the hospital. And a couple of others have resorted to eating tissues. Apparently they swell up and fill your stomach."

It is easy for the industry to shrug this problem off; there is tremendous demand for models who are willing to starve themselves. But in other industries, the principle of worker protection overrides market demand; coal mine, factory, and ship and lumberyard owners, for example, are all required to implement safety precautions even if they increase the cost of doing business. Subjecting workers to unnecessary risk of injury and death is not considered reasonable in a democratic society like ours; except, apparently, if that risk is in the name of "beauty." The industry hides these inhumane working conditions behind a patina of glamour, and we as consumers are often too willing to play along with the charade rather than ask the uncomfortable questions about what is under the gloss.

Applying workplace health and safety standards to the fashion industry would add vital protections for the women and girls -- most models begin working in the industry as children, in their early or mid-teens -- and men and boys, too, who pursue modeling as a career. But the impact of the fashion industry on our society reaches far beyond the hazardous occupational conditions that professional models endure. Given that 70 percent of tween and teen girls according to one study define a "perfect body" based on magazine images, these images of professional models who are coerced into working at the brink of starvation are perpetuating deadly expectations of what women should look like.

Through the mass media and its pervasive influence on setting cultural standards for apparel, particularly for girls and young women, the industry defines, transmits and reinforces cruelly unrealistic standards of thinness. Decades of psychological research show that these images wreak havoc on body image and sense of self in young people in their most vulnerable adolescent years, and increase the risk of eating disorders, which affect 30 million Americans in the most serious of ways: undermining health, education and careers; financially ruining families having to pay for protracted treatment for loved ones; and cutting lives short.

But important changes are beginning to happen. Models are speaking out, sometimes on their own, like Swedish model Agnes Hedengård, who in August, at 19, ignited social media around the globe with her nearly nude You Tube testimonial taking issue with the industry agents' claims that, with a BMI of just over 17, her career was over unless she lost weight.

And sometimes models are joining forces, such as with the Model Alliance, the nation's leading community advocacy group for professional models. Working with legislators in New York State, they helped pass state legislation two years ago to add protections for child models, and they are now working with U.S. Representative Grace Meng on a similar bill, the Child Performers Protection Act of 2015, introduced in Congress this year. Neither piece of legislation tackles the coerced starvation problem head on, but still they are a step in the right direction.

Also earlier this year, legislators in France approved a national bill to prohibit designers and agents from employing models with a BMI under 18. Employers who violate the law can be punished with huge fines and jail time. In an editorial coming out today in the American Journal of Public Health, we call for the federal Occupational Safety and Health Administration to step in to regulate working conditions for professional models to put an end to coerced starvation and other unfair and unsafe conditions models routinely face in our country.

And what's our role in all of this? As parents, teachers, pediatricians and others who care for and about youth, we shouldn't just leave it up to the models -- many of whom are children -- to fend for themselves against the towering fashion industry. We make up the massive multibillion-dollar consumer base for the fashion industry, and without us, the industry would have nothing.

We can start or join protests on social media, like consumers did earlier this year when they forced a Danish fashion magazine to apologize for the image of an emaciated model on its cover and sparked the Reddit thread "Corpse or Model?" We can call on our congressional representatives to support Rep. Meng and the Model Alliance's legislation in Congress. And we can talk to our children, both daughters and sons, about the deception behind the seemingly glamorous fashion images. We can help young people make their voices heard through their own activism to protest these distorted images they see every day in the media. They deserve alternative ways to feel good about themselves and their worth for who they are, not how much they weigh. We can do this for them and for us. After all, we are not clothes hangers.

Katherine Record, J.D., M.P.H., is a collaborating mentor with the Harvard School of Public Health's Strategic Training Initiative for the Prevention of Eating Disorders. She has taught public health law at the Harvard School of Public Health and was a clinical instructor on law with Harvard Law School's Center for Health Law and Policy Innovation, where she focused on the expansion and standardization of mental health courts in the Commonwealth; health care reform implementation; compliance training for health care providers related to consent for HIV testing and disclosure; and implementing state electronic health record databases in compliance with federal and state privacy laws. Prior, Katherine worked on public health law reform, firearms control and global preparation for pre-exposure prophylaxis to prevent the transmission of HIV at the O'Neill Institute for National and Global Health Law at Georgetown University. She currently works in state government on behavioral health integration as part of Massachusetts's ongoing health reform initiatives. Katherine received her J.D., cum laude, and master's in psychology at Duke University; her master's in public health from Harvard's School of Public Health; and her bachelor's, magna cum laude, from Georgetown University. She is licensed to practice law in the State of New York.