The Fashion Industry Has a Health Problem. And That's a Labor Issue.

This post is the first installment in a series on labor rights and health and safety issues in the fashion industry.

The model Amy Lemons, who started modeling women’s clothing when she was 12 years old, reached supermodel status when she scored the cover of Italian Vogue at age 14.  But just a few years later, as she began to fill out physically, her New York agent advised her only to eat one rice cake a day—and, if that didn’t work to minimize her curves, only half a rice cake.  Lemons got the hint: “They were telling me to be anorexic—flat-out.”

Due to their genetics and youth, many models are naturally thin.  And, yet, restricted diets among models are common, ranging from the bizarre (eating cotton balls) to the trendy (juice cleanses).  Models have reported becoming sick; some have even died from complications due to anorexia—in one case, just after stepping off a runway.  Models sign exclusive contracts with their agencies (which, except in the case of supermodels, tend to be one-sided in favor of the agency), and they are often required or encouraged to lose weight to fit the sample size (a U.S. size zero or two).  Some agency contracts stipulate that a model can’t gain centimeters on her hips, and models have been dropped from their agencies and had their earnings withheld for gaining weight.

It is clear that the fashion industry has a health problem–one that is not being adequately addressed through voluntary guidelines, or by featuring the occasional “plus-size” model on the cover of the Sports Illustrated Swimsuit Issue.  The fashion industry’s ideal of feminine beauty is extreme, both in terms of youth and thinness, and without workplace health and safety standards, models will continue to be forced to sacrifice their health for their careers.

The question is what to do about this and how to protect models’ health.

Legislative Interventions

Recently, California Assemblyman Marc Levine took a big step toward protecting the health and labor rights of fashion models in his state.  Levine’s newly introduced bill, AB 2539, would require state regulators to develop appropriate standards to protect models’ health.  The bill also requires that modeling agencies be licensed by the California Labor Commissioner and it clarifies that models are employees, rather than independent contractors, ensuring that models are granted worker protection rights that all employees have in the U.S.

AB 2539 is critically important, not only because it marks a life-saving step forward to protect models, but also because it would regulate modeling agencies.  Though some are better than others, modeling agencies exert substantial control over the models’ working lives, and many agencies have records of sexual abuse, financial fraud and coercion of the very people whose interests they are supposed to represent.

AB 2539 is part of a growing international movement to address worries about models’ health and related public health concerns.  In 2006, organizers of Madrid Fashion Week became the first to implement a code of conduct to ban models deemed underweight according to their body mass index (BMI), a ratio of weight to height, and Italy followed suit shortly thereafter, requiring models to provide a certificate of health before they can work the runway.  In 2012, Israel went a step further by adopting legislation stipulating that fashion and commercial models must meet minimum BMI requirements.  Most recently, in 2015, France’s National Assembly passed a law that requires models to have a medical certificate deeming them fit to work.

Is BMI the right approach?

These efforts abroad have sparked controversy, particularly over the accuracy of using BMI as a measure of individual health.  An early draft of the French health-reform bill, for example, proposed a minimum BMI for models.  “It’s intolerable to promote malnutrition and to commercially exploit people who are endangering their own health,” said the bill’s sponsor, Socialist MP and neurologist Olivier Véran.  “A level of acceptable body mass index must be set and enforced.”  According to French health minister Marisol Touraine, “This is an important message to young women who see these models as an aesthetic example.”

The proposal ignited backlash from modeling agencies and other industry stakeholders, however, who have called BMI an overly simplistic measure of individual health and the assumption that fashion models inspire anorexia in the general population a false premise.  A cross-section of models, from mainstream “straight-size” models to fuller-figured “plus-size” models, have also expressed concerns about a BMI-driven policy.  Model Lindsey Scott advocated a more tailored approach: “Perhaps they should have doctors check for signs of anorexia and bulimia instead of making assumptions based on weight.”  Ultimately, MPs in France heeded the these concerns and agreed to let doctors decide whether a model is too thin by taking into account her BMI as well as other factors, including age, gender and body shape.

While body mass index looms large in the discussion of health, authoritative sources offer conflicting information over its reliability.  Some doctors and eating disorders specialists warn that BMI is not an accurate measure of individual health.  A new study led by researchers at UCLA claims that using BMI to gauge health incorrectly labels more than 54 million Americans as “unhealthy.”  “There have been many misuses of BMI throughout the decades, despite very good evidence, like ours, that shows it’s a flawed measure,” said Dr. A. Janet Tomiyama, director of the Dieting, Stress and Health Laboratory at UCLA.  “Employers, policy makers and insurance companies should focus on actual health markers.”

One the other hand, the Centers for Disease Control and Prevention says on its website that “the BMI is a reliable indicator of body fatness for people.”  BMI charts are widely used by doctors to determine if their patients are underweight, normal weight, overweight or obese, and many U.S. companies use BMI as a factor in determining employees’ health care costs.

And Katherine Record and Dr. S. Bryn Austin, researchers affiliated with the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED) at the Harvard T.H. Chan School of Public Health, argue that the United States – perhaps through the Occupational Safety and Health Administration – should implement a similar policy to France’s.  Record and Austin acknowledge that BMI is not a perfect measure of health, but argue that at the extreme ends of the weight spectrum, “the deficiencies associated with BMI as a metric dwindle.”

(Given that courts have classified anorexia as a disability, some have questioned whether the Americans with Disabilities Act would prevent regulation linked to a person’s BMI.  However, Record, who specializes in health law, argues that setting a minimum threshold would be allowed so long as it was implemented to protect employee health: “Because the proposed regulation seeks to protect employees against anorexia, not discriminate on the basis of anorexia, it is not an ADA violation.”)


Safeguarding the lives of any young, vulnerable workforce by establishing safety and health protections is essential, and it’s doubly important in an industry that has such a powerful, far-reaching effect.  Health care professionals and labor lawyers, in consultation with models who will be directly affected, should drive these decisions going forward.

Most models begin working as minors, but face grown-up pressures in what remains a largely unregulated industry.  Extreme thinness and youth are inextricably linked, and while neither weight nor age gives a precise measure of an individual’s health or maturity, that should not prevent the government from creating standards to protect models’ health and rights.  In doing so, clarifying the employment relationship between the agencies and models in the U.S. will be key.

Whether or not BMI standards would be applied to California’s proposed health and safety standards for models remains to be seen.  In the meantime, the legal community should take a closer look at this mostly young, female workforce whose concerns are legitimate and should be treated as such.

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