What the U.S. Can—and Can't—Learn From Israel's Ban on Ultra-Thin Models

A new Israeli law prohibits fashion media and advertising from using Photoshop or models who fall below the World Health Organization's standard for malnutrition.

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Aya Barazani, who suffers from anorexia, points at Israeli fashion models Noga Dekel, left, and Shira Amikam, as fashion photographer Adi Barkan looks on during a photo shoot in his studio for a campaign promoting anorexia awareness. / AP

On Monday, March 19, the Israeli parliament passed legislation ubiquitously known in the country as the Photoshop laws. The new regulations on the fashion and advertising industry ban underweight models as determined by Body Mass Index and regulate Photoshop usage in media and advertising.  Abroad, the laws have opened new discussion on a government's right to intervene in these two industries.

The legislation focuses on two elements of the fashion industry that have long drawn criticism for their effects on women and, especially, girls: ultra thin models and the use of Photoshop to make women appear impossibly thin in advertisements. The measure has been controversial within Israel for raising the question of where free speech bumps up against the fashion industry's responsibility -- and its possible harm -- to its customers' psychological wellbeing. It has also raised the question of whether other countries might consider similar measures to address what many activists consider a root cause of an epidemic of anorexia and other eating disorders.

Rachel Adato, an Israeli parliament member with a background in medicine, as well as prominent photographer and fashion model agent Adi Barkan, championed the law.

Barkan has been working to help girls with eating disorders since he discovered the epidemic firsthand in 1997, when a 15-year-old girl named Caty asked to meet with him to understand what a "model should look like." She arrived at the meeting five-foot seven-inches, weighing 79 pounds. "It was obvious she required hospitalization," Barkan told me over email. Caty was hospitalized for 5 months, during which time Barkan says he visited daily.

A few months after Caty was released, Barkan appeared as a guest on an Israeli lifestyle TV show to discuss his work. "During the interview the hostess told me she had a surprise for me," he recalled, "a girl who claims I saved her life, and then Caty came in and told her story."

"The following morning there were 174 messages on my answering machine from anorexics and bulimics asking for help. I met all of them."

An icon in the fashion world, Barkan tried to deal with the issue from the inside: appealing for change within his beloved industry, to an overwhelmingly negative response of doubts, jabs, and apathy.

"I became immersed in this world very quickly. I gave up the agency and photography and delved into the dark world of anorexics and bulimics," he said. "I realized that only legislation can change the situation. There was no time to educate so many people, and the change had be forced on the industry. There was no time to waste, so many girls were dieting to death."

Working with members of the Israeli parliament, he met Adato. The pair spent two and a half years working on the legislation: presenting scientific articles to the Israeli parliament and demonstrating the connection between media portrayals of peoples' bodies and eating disorders. The law forbids underweight models from working on advertisements. A doctor must certify that a model can be employed by measuring him or her and determining that the model's Body Mass Index (BMI) is at or above 18.5, which the World Health Organization defines as indicative of malnutrition. A five-foot, seven-inch individual, for example, must weigh at least 118 pounds to work as a model in Israel. On March 19, the bill was easily passed by the majority of the parliament.

Adato explained the legislation and its easy passage simply: eating disorders are an epidemic in this small country, and the government had the responsibility to take action to protect the vulnerable.

"In Israel, there are 1,500 new cases of eating disorders every year, and 10 percent of teenagers suffer from eating disorders," she told me. Israel's population is only 7.5 million, making the high rate especially alarming. "We also know that the first cause of death in the age group of 15-24 is anorexia, so when you hear those numbers, they're frightening."

There's a big difference between health and weight, as Adato was quick to note, and the BMI value, though imperfect, is the best way to define a an underweight individual across international standards. "It's easy for me to adopt the international value that was adopted by the WHO as a physician and as parliament number. I don't talk about health; I'm talking about underweight."

Unsurprisingly, there's been backlash from some modeling agencies in Israel. "Agencies say 'all of our models are eating perfect they're just skinny' but it's not true and we know it's not true," Adato insisted. "Only 5 percent of girls that are under 18.5 BMI are girls that are eating well in Israel."

The new law also stipulates that any ad which uses airbrushing, computer editing, or any other form of Photoshop editing to create a slimmer model must clearly state that fact. Advertising campaigns created outside of Israel must comply with the legislation's standards in order to appear here.

The first legislation of its kind, this law and its architects have gained an extraordinary amount of international media attention. Within six days of the bill's passage, Adato says she received 456 media inquires from all over the world. "According to interest, I'm sure this will make some change," she told me. "I'm sure we'll change the attitude all over the world, that this is a disease and people are dying from anorexia and people need to keep this in mind and in public view."

Daniel Le Grange, professor of psychiatry and director of the eating disorder program at the University of Chicago, believes that Israel's legislation on Photoshop could have an even greater impact than its BMI regulations. "No one is that perfect, no one has Photoshop on their faces all day long," he said, frustration clear in his voice. "It's very discouraging for our patients who for one reason or another desire that perfection, and they page through every magazine and see every face that's perfect. It's easy to get scooped up that, 'I should look perfect because they all look perfect.'"

Unrealistic portrayals of beauty in fashion spreads may not be the ultimate cause of the eating disorder epidemic -- but they are a contributing factor.

"Developing an eating disorder is a complex process in terms of specific constellation of personality traits that one's born with," La Grange explained. "Genetic, environmental, societal things have to come together in a vulnerable individual, so it's not just one piece that makes it possible."

"What this [legislation] can achieve is that this vulnerable individual is protected from environmental things -- she may not develop [an] eating disorder, but since they are so complex it will be difficult to say," Le Grange explained.

The media buzz surrounding the new legislation may be one of its biggest benefits, argued David Herzog, a professor of pediatrics at Harvard Medical School and director of the Harris Center for education and advocacy in eating disorders at the Massachusetts general hospital. "I think the more attention to this area the more likely we are to the change."

Still, turning that talk into action -- especially government action -- can be tricky and controversial. What is the state's role in regulating images that reinforce socially harmful perceptions? At what point does an image become too dangerous to publish? Where is the line between the public interest and the free speech rights of media and advertisers?

"I'm supportive of government intervening to provide better health for public but I also want to be careful about what we're asking the federal government to legislate," Herzog said. "So how do you try to limit the negative forces? I want to keep the dialogue going, they're onto something that's important, we want to do things that support the healthy development of our nation."

Donald Downs, a professor at the University of Wisconsin and an expert on the First Amendment, says that it would be very tough to pass something like Israel's law in the U.S. Congress. "In the U.S., it would be hard to justify this type of law on either legal or normative policy grounds," he said. "The Israeli law is paternalistic in that it prohibits something because of the effect it might have on others in the longer term."

The complexity of eating disorders can make it difficult to justify complete legislation. "In addition to the legal aspect of the case, such a law would be in tension with American cultural support for free speech in cases in which the harm is not direct or clear," Downs went on. "We are much more wary of giving the state the power to prohibit expression in such contexts because the harm is not usually direct."

The more accepted approach for activism in the United States has been to put public pressure on the fashion industry to change, without government intervention. Some have answered the call for change, such as Dove, which launched the Campaign for Real Beauty in 2004 and a viral video entitled "Evolution" in 2006, which shows the unbelievable transformation of an "ordinary" woman into a Photoshopped super-woman. Its model of positive advertising has brought the brand attention, but it doesn't appear to have caught on in the wider advertising or media industries, which are still Photoshopping away.

In 2007, an industry-wide fashion trade association called the Council for Fashion Designers of America (CFDA) formed a health initiative that, according to its website, "is about awareness and education, not policing. Therefore, the committee does not recommend that models get a doctor's physical examination to assess their health or body-mass index to be permitted to work. Eating disorders are emotional disorders that have psychological, behavioral, social, and physical manifestations, of which body weight is only one."

The CFDA, spokespeople for which did not return requests for comment, epitomizes the failure of the fashion industry to protect their employees from within, which is what Barkan rallied for -- and also failed to achieve -- in Israel before pushing legislative action. Why educate models and designers about the existence of these diseases and then explicitly not recommend a visit to the doctor?

"I believe this small movement that began in Israel is like a stone thrown into the lake. The waves can reach very far," Barkan said. "I went against my industry, this is clear. And no matter how high the cost I personally paid, it was worth everything. No commercial success for my agency can be compared to saving lives. I'm not talking about a drastic change, only a small difference between thin and too thin, between life and death."

According to a 1999 study published in Pediatrics, about two thirds of American girls in the fifth to 12th grades say that magazine pictures influence their image of an ideal body; about half of girls in those grades said the magazine images made them want to lose weight. A 2009 American Journal of Psychiatry study determined that the mortality rates for anorexia nervosa and bulimia nervosa are about four percent, the highest rates for any mental disorder. When a 14-year-old girl delivered a 25,000-signature petition this week to Seventeen asking them to curb their use of Photoshop, the magazine issued a press statement that congratulated the girl on her ambition but was conspicuously silent on changing their editorial practices. Maybe Israel's BMI-indexing, Photoshop-regulating law isn't right for the U.S., with our established speech protections and anti-regulation sensitivities. But, if not that, then what?