Jane Morris: Making the glorification of anorexia a crime

jane_morrisI make a point of telling students that an eating disorder is an illness, not a crime. It’s a more controversial statement these days. Some of my patients continue to argue that anorexia is their lifestyle choice rather than an involuntary illness, and I’ve just learned that the lower house of the French Parliament has approved legislation that would make the “glorification of anorexia” a crime punishable by large fines and even imprisonment.

Olivier Véran, a rather dashing young socialist politician, who is also a neurologist at the University Hospital of Grenoble, has amended health minister Marisol Touraine’s wider health bill to include two key measures on anorexia.

Firstly, models in France would have to present a medical certificate showing that their body mass index (BMI) is at a certain level (Véran previously suggested a BMI of 18 or above) before they can be employed. If agencies or fashion houses employ a model below that level, they could face up to six months in prison and €75 000 (£54 000; $81 000) in fines if convicted. Israel, Spain, Italy, Chile, and Belgium have already imposed regulations based on models’ BMI.

What’s more, websites that encourage people to “seek excessive thinness by encouraging eating restrictions for a prolonged period of time, resulting in risk of mortality or damage to health,” would face up to a year in jail and fines of up to €10 000 (£7000; $11 000).

Marisol Touraine comments: “This is an important message to young women who see these models as an aesthetic example.” I applaud her earnest wish to give healthy messages to the young (although this is not purely a women’s issue). Véran goes further, asserting that “the prospect of such a punishment will have the effect of regulating the entire sector.” I wonder.

Of course, France isn’t proposing to make it a crime to suffer from anorexia, only to glorify it. This maybe puts it on a par with laws that allow personal consumption of cannabis but not peddling the drug, or which permit the sale and consumption of cigarettes but only in plain packages. (There’s a thought—only allow thin models in plain t-shirts, with health warnings printed on them? It might become fashionable.)

Véran’s laws would ideally discourage modelling agencies from demanding that models become emaciated in order to get work—although it does nothing to protect athletes from coaches who drive them to dangerous overexercise and undernourishment. Nor does it protect obsessive young students from the triggering effects of well meaning “healthy eating” lessons in school, which lead them into restrictive diets. Our health promoting institutions have yet to get to grips with the need to balance prevention of obesity on the one hand, with promotion of eating disorders on the other.

Have French politicians followed the posts of campaigners against images of emaciated models in the media? Too often the model and her spokespeople become defensive, saying the model has been falsely “accused,” that she is “naturally thin,” eats well, and perhaps the photograph misrepresented her shape.

Will imposing a minimum BMI upon models make much difference? My patients know that weight is very easily faked, and easily lost quite speedily after a formal weighing for the purposes of getting a certificate. Most young people know that IDs and certificates are readily faked too.

Furthermore, BMI is only one index of adequate nutrition, and not very reliable in the under 18s. Depending on growth patterns, a BMI of 18 might be compatible with good nutrition in young teenagers, but dieticians say that BMI in adults needs to be considerably higher than 18 in most racial groups.

And when all is said, done, and certificated, photographic technology can easily reshape bodies to look thinner, fatter, or taller on the glossy page or screen than in the studio. Indeed, many magazine and web images don’t showcase professional models, but display “celebrity bodies” for purposes of scrutiny, scorn, or assumed concern. So for all we might hope to protect models themselves, we may still expose viewers and readers to the glorification of anorexia and to a culture of scorning bodily imperfection.

So who are the “criminals” here and who are the “victims?” In my experience, they are all too often the same people. It’s perhaps more realistic to see anorexia and bulimia nervosa as a religion or a cult rather than a crime. The most powerful influence is a body image obsessed “cult” of peers: in the classroom, in the playground, on Facebook. Most of the web based shrines to anorexia and bulimia are built by the sufferers themselves, and they engage together in the worship and service of thinness. It’s no accident that in ancient times anorexia was strongly linked with religion and especially female saints.

The French believe that they will be able to distinguish between the “mutual support” materials and frankly pro-ana sites, but I doubt this. Competitive displays often masquerade as “support” and sufferers themselves admit that most stories of recovery— books, articles, or Youtube videos—are devoured as manuals for people developing eating disorders.

You can call my criticism quibbling, and so it is. Anorexia is almost by definition an obsessive, quibbling state of mind. My patients clamour to be given precise rules and laws so that they can work out how to obey the letter of those laws while evading the spirit. It is part of the tragic self-sabotaging of their illness. And yet, in spite of all my doubts, I can’t help admiring Véran for trying to enshrine in the law of his land that the glorification of anorexia nervosa is an evil thing.

Jane Morris trained in Cambridge and London, but has spent nearly all of her working life in various Scottish cities. She has higher psychiatric training in medical psychotherapy and in child and adolescent psychiatry. She now specialises in eating disorders, chairing the Faculty of Eating Disorders for the Royal College of Psychiatrists in Scotland.

Competing interests: None declared.