We’re thrilled to be joined by model-turned-activists Madeline Hill and Miranda Frum and Harvard Chan School of Public Health professor Dr. Bryn Austin to talk eating disorders. From subtle reminders to “tone up,” to being told to “shed inches off your face,” Hill and Frum explain the pressures they faced and how eating disorders in the modeling industry aren’t just an issue of media and representation, but are a workers’ rights issue and, fundamentally, a human rights issue.

SARA: Madeline and Miranda, what’s your background in the modeling industry?

MADELINE: I worked as a model for six years. Initially, I was working as a high-fashion model and booked editorial work. I was taller than many of my counterparts, meaning that my hips were a bit wider. My agency was constantly asking me to “tone up” and suggesting odd diets for me to try.

MIRANDA: I worked as a model for five years. Like Madeline, I worked as a high-fashion model, but I also booked a lot of catalogue work, which allowed for me to be a little “meatier” than say, my Fashion Week colleagues. I worked mainly in Europe and Asia, spending most of my time in Tokyo, Paris and Tel Aviv.

SARA: Have you personally suffered from an eating disorder?

MADELINE: Well, when I worked in Japan, my agency suggested that I eat rice balls and walk around the block to lose two inches from my hips. In fact, all of the agencies I was signed with constantly pressured me to lose weight, in subtle ways. I felt like there was always a set of eyes watching what I ate and how much I worked out. A high schooler shouldn’t be spending their free time reading the back of nutrition labels.

A high schooler shouldn’t be spending her free time reading the back of nutrition labels. – Madeline Hill

MIRANDA: I was scouted when I was 14, or 15 and was unable to secure representation at the time because my face was ‘”too round.” The agencies—multiple—recommended I return to them when I “shed some inches off my face.” I started working professionally as a model later in life (I started at 21), and I resolved never to receive the humiliating rejection of being “too large” ever again. This was the beginning of my unhealthy thinking, my relationship with food and my body. I would eat only one meal a day. I would drink water and black coffee and I chain smoked cigarettes to eliminate hunger pangs. Note that because of this fasting, I was unable to work out. I had no strength or energy to spare.

Over time, I adjusted to my meal a day regimen, and it became easier for me to fast for longer periods. My friends would make jokes about feeding me. I took these as compliments. If I had dinner at my parents’ home, my father would pile food on my plate. “You need to eat something,” he would say, half jokingly, half sternly. I would wave my parents concerns away. They didn’t understand, I told myself. And, after all, I was still booking work. More work than I had booked when I started. No one was telling me I was too big. No one was telling me I was too thin either - or maybe they did, and I tuned it out. I was still working. That was what counted, I thought.

MADELINE: Being thin isn’t the only extreme in the industry. After realizing that it was unrealistic for me to maintain a small size, my agency told me that I was “plus-sized.” This label felt odd, because I was a size six. How was I supposed to be the model for other “curvy” women when I couldn’t even fit into the standard plus-sized samples? To combat this problem, my plus-size agency suggested that I “bulk up.”

No matter which end of the spectrum a model is on, the pressure to conform to a specific set of measurements doesn’t go away. This needs to change. Models shouldn’t be forced to be at one end or the other. Beauty comes in all shapes and sizes. The models we see in the pages of magazines should also reflect the diverse world we live in.

SARA: Bryn, tell us about your background.

BRYN: I’m a public health researcher and educator. My specialty area is adolescent and young adult health, especially around body image, healthy eating and exercise, and eating disorders prevention. Media and the fashion industry, especially for girls, are incredibly powerful influences on teens as they strive to fit in and figure out who they are and what their place in society will be. We’ve known for a long time that the excessive value in media  and the fashion industry placed on extreme thinness for girls and young women sends them the wrong message about what should be important in their lives and what matters most about them to the people around them. Simply put, starting from a very early age, girls get the message they should measure their value as human beings based on the number on the scale.

So for a long time, my colleagues and I had been talking about the harm done to girls and young women by these messages and trying to figure out what could be done to change the situation. But what about the models themselves? The majority of professional models are teen girls and young women, and they are  the ones living in the belly of the beast in terms of the pressure to maintain extreme thinness day in and day out to keep their jobs. So this is not just an issue of media and representation, it is also a workers’ rights issue and fundamentally a human rights issue. In what other occupation in the U.S. would we allow employers to compel children to starve themselves as a condition of employment?

In what other occupation in the U.S. would we allow employers to compel children to starve themselves as a condition of employment? – Dr. Bryn Austin

MIRANDA: Last summer I worked in Tokyo, where the measurement requirements for models are very, very small. Once a week, models were dutifully measured and weighed, in the agency’s office as opposed to privately, to ensure that they maintained their exact dimensions while working.

If the measurements changed, the model’s visa could be cancelled, and they would be immediately sent home. If the model hadn’t met their contract’s financial obligations (e.g. making a certain amount of money within a certain amount of days), there was the possibility that they wouldn’t be fully paid (if at all). The agency would then absorb the model’s earnings.

The notion of expulsion and the looming threat of measurement day contributed to my unhealthy anxieties. My measurements were small, though, and my agency was sensitive to my weight. They would gently recommend healthy local restaurants. They only measured me once.

One friend only drank water and hot tea in the two days leading to Measuring Day. My measurements had gotten smaller while I was in Tokyo. At the time, I weighed 98 pounds. I’m 5’8”.  Why were we all so nuts? Theoretically, you would be paid well, if your measurements were up to par.

And so, the process there continues: wrists, waists, hips all carefully measured, dutifully marked down and placed in a folder, filed away with a copy of one’s visa and a scanned copy of a passport. There was the promise of good money for dieting, and severe punishment for a flunk of this test.  

Body dysmorphia has been a big struggle for me. It’s hard to see pictures from when I was size 0. I have to remind myself to eat healthily, to avoid fasting when I feel uncomfortable or anxious. To remember that healthy is beautiful. Nutrients are important. Spend less on Vitamin C Serums, and eat more oranges. There are more important things to worry about. But recovery is a process. It’s something I actively think about, every day.

There are more important things to worry about. But recovery is a process. It’s something I actively think about, every day. – Miranda Frum

SARA: Bryn, tell us about how you became involved with the Model Alliance.

BRYN: It was a colleague of mine, Katherine Record, a health law specialist at Harvard Law School at the time, who opened my eyes to the truly outrageous labor injustices that professional models face. That’s when my research team and I reached out to Model Alliance to see if there might be a way for us to join forces.  Together, we have been able to do research to get hard data on the problems Model Alliance knew well and communicate those findings to lawmakers and community leaders with a goal of catalyzing change in the industry. Our team brings in the research skills, but it’s Model Alliance that knows the right questions to ask, the real implications of our findings, and the most compelling ways to share the results with decision makers to keep the conversation going in the right direction on how to protect models’ health, safety, and rights in the most effective ways.   

SARA: Let’s discuss the research and our findings to date. In your view, what were the key takeaways?

BRYN: For our first study together, we surveyed 85 women working as professional models in the U.S. The vast majority of the models in our study were medically underweight, and yet over 60% of them told us they had been asked to lose weight or change their body shape or size by their modeling agency, casting agent, designer or other person involved in the modeling industry in the past year. And among those women, well over half were explicitly told they would not be able to find more jobs if they didn’t lose weight or their agency would stop representing them unless they lost weight.

We also found that very unhealthy weight control behaviors and frank eating disorder symptoms were more common than typically seen in young women: More than half routinely skipped meals and went on fasts, cleanses or detoxes, a quarter used diet pills, which we know can be very dangerous, and almost one in 10 made themselves throw up to try to lose weight. Not one of these strategies for weight loss is considered even remotely healthy or advisable for anyone at any weight – and most definitely not for people who are medically underweight, which most of the women in our study were. Clearly the working conditions these women face are putting their health and lives in danger, and now we have some hard data to show just how rampant the problem is.  The real questions now are, what can we do to fix the problem and who in the industry is willing to step up and help?  

SARA: Why is extreme thinness the ideal? How is this an issue of power?

BRYN: This is a question that cultural historians have been grappling with for quite a while – how is it that extreme thinness became the societal ideal for girls and women? Of course it wasn’t always that way throughout history and it is certainly not universally the ideal across cultures either. Is it at its core an issue of power, a way to control girls and women and their appetites, both literally and figuratively? Absolutely. And many great feminist scholars have made this argument very eloquently.

Is it at its core an issue of power, a way to control girls and women and their appetites, both literally and figuratively? Absolutely. – Dr. Bryn Austin

But I don’t want to lose sight of the issue of abuse of power and human rights in the most concrete sense in the lives of professional models: Lax regulation and enforcement of workplace safety standards for models in the fashion industry create a vast power imbalance, where employers can compel fellow human beings to starve themselves or else risk not being paid or being fired outright. Every single day that goes by without this power imbalance being exposed and redressed thousands of models are forced to choose between food or a job. It sounds pretty barbaric put that way, but that’s the reality.

The good news is that we are starting to see cracks in the resistance to change in the industry. More and more of the influential players in the industry are speaking out and insisting on treating models fairly and humanely. That gives me hope that change is on the horizon.   

SARA: People working in other industries have occupational health and safety protections. Why not models? What are the hurdles to bringing about change?

MADELINE: People who don’t work in the industry assume that models are living very glamorous lives, when, in fact, we know that’s the opposite. Models are often treated as disposable hangers and are not given basic occupational health and safety protections they deserve. Pre-conceived notions about the lives of models need to be debunked. Most models are not living in huge apartments in SoHo, being flown around the world in private jets.

People need to understand that models deserve basic protections like any other worker. If agents get protections through their employer, so should the models.

MIRANDA: I think Madeline is right on. I can only think to add that it’s important to come together and discuss these issues. To keep an open channel of dialogue, so a realistic plan for change can be mapped out and acted on. I think labor legislation to protect and support working models is important and necessary. But I guess the real question is, how does one create legislation for this sort of health issue?

MADELINE: In order to create legislation that protects models, we need all stakeholders on board. This is a multi-billion dollar industry that is highly political. We need the influential players to come forward and speak out. Without the support of these different facets of the industry, it will be hard for models to get basic worker protections.

MIRANDA: I agree. But how to motivate? How to create incentive? I’m a believer that a lot of the health initiatives taken by other countries have been totally unhelpful. In Israel,l one is supposed to get a doctor’s note, proving the model’s BMI is in an acceptable place, but for the most part this seems to be a practice for show. In Paris, all the models are very petite, and not necessarily naturally. How does one motivate an industry that is, for the most part, happy with the status quo?

MADELINE: This process is very political. In order to really have an impact, individuals in positions of power need to get their hands dirty and work together to create meaningful change in the industry.



Madeline Hill is a former model. She graduated from The University of Georgia with a degree in Sociology. She spent part of her academic career at Oxford University, studying Human Rights through a sociological perspective. In addition, she completed research under Dr. William Finlay on the modeling industry in Japan, which was conducted with oversight from the Institutional Review Board at UGA. In addition to advocating for models, she is a digital media strategist for brands and publications.


Miranda Frum has worked as a fashion model and journalist. Her writing has been published in the Daily Beast, the Tower Magazine, Maclean's Magazine, New York Daily News, and the Huffington Post. As a journalist, she has covered labor laws in the fashion industry, issues affecting working fashion models in the United States and internationally, in addition to the conflicts in the Ukraine, Israel, and Syria. 


Dr. S. Bryn Austin is an award-winning researcher, teacher, and mentor. She is Professor of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health and Professor of Pediatrics at Harvard Medical School. She is also Director of Fellowship Research Training in the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital. She directs the Strategic Training Initiative for the Prevention of Eating Disorders: A Public Health Incubator (www.hsph.harvard.edu/striped) and directs the Sexual Orientation, Gender Identity and Expression Research Working Group (http://www.hsph.harvard.edu/sogie/). She is President of the Board of Directors of the Eating Disorders Coalition and Secretary of the Board of Directors of the Academy for Eating Disorders. She is a social epidemiologist and behavioral scientist with a research focus on health disparities, especially those affecting socially marginalized adolescent populations and has received numerous grants funded by the U.S. National Institutes of Health and foundations to support her research. She leads two primary research programs: One focuses on policy, social, and physical environmental influences on eating disorders risk, nutritional patterns, and physical activity in school and community settings, with a special emphasis on public health approaches to eating disorders prevention. The second focuses on determinants of sexual orientation and gender identity disparities in a range of health domains, including disordered weight-related behaviors, substance use, violence victimization, and other health risk indicators.

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