Model BMIs: a clinical and scientific health perspective

The impracticality of an 18.5 or above BMI mandate for U.S. fashion models: An Open Letter to the Fashion Industry

 By Laura Cusack, MS, RD 

I write, as a Registered Dietitian and the managing Director of ARDIETY Inc., to alert the fashion industry and the public of clinical and scientific health evidence that weighs strongly against a BMI mandate, and to support the U.S. fashion industry’s self regulated health initiatives.   According to the Jerusalem post, Israel is the first nation to pass a law banning the use of fashion models with a BMI under 18.5.  Israeli lawmakers stated that the bill aims to prevent the use of underweight models within the fashion industry in order to promote a healthy body image and fight the spread of eating disorders among young women. (Siegel-Itzkovich 2013)  In hopes of gathering support for their approach, Israeli advocates for the fashion model BMI mandate plan to come to the U.S. this month. (Mercado 2013)

Aside from the ethical and potential legal issues of weight discrimination, a BMI mandate is scientifically inappropriate for the following reasons:

BMI is an incomplete alternative to directly measuring body fat, and it is only one of many factors used to properly evaluate health status. (Academy of Nutrition and Dietetic 2012)  More specifically adult BMI classifications do not account for an individual’s: sex; age; bone/ frame size; muscle mass or dietary macro- and micro- nutrient intake, which all provide a more complete picture of health and can justify a low BMI.

According to the Center for Disease Control’s (CDC) clinical growth charts, females under the age of 20 can healthfully maintain a BMI under 18.5.  For example an 18-year-old female with a BMI of 17.7 is considered normal. (National Center for Health Statistices, Center for Chronic Disease Prevention and Health Promotion 2000) With many models in the U.S. starting their fashion careers at age 16, and with the focus on the health of young women, a BMI mandate of 18.5 or above is ill fitted.  Furthermore, an individual over the age of 20 with a BMI under 18.5 may have a particularly small bone frame size, a rapid metabolism, and/or an extremely nutrient dense, as opposed to calorie dense, diet.

The Israeli mandate also fails to address other eating disorders like bulimia, which plague developed countries. Bulimia, like anorexia, is often fueled by an altered body image and used to prevent weight gain, but can be hidden by a normal BMI.  Although bulimia is typically a normal weight eating disorder it is equally as prevalent and deadly as anorexia and other underweight eating disorders. (National Institute of Mental Health 2011)

This evidence indicates that an individual with a low BMI may in fact be healthy and taking in proper nutrition, while an individual with a normal BMI may not.

To prevent eating disorders and promote a healthy body image in the U.S. we need to focus on an individual’s overall well being and quality of nutritional intake rather than ambiguously discriminating against models based on an incomplete health assessment or their size alone. More specifically we need to continue to grow the proactive promotion of health, diet and fitness education and counseling as well as eating disorder awareness in the industry.

With assistance from ARDIETY, and other organizations dedicated to promoting health and wellness, the approach taken by the U.S. fashion industry will secure healthy fashion models and help the public understand that models maintain their thin bodies by practicing a healthy lifestyle.  As a result, models can indirectly discourage eating disorders and directly encourage health.

For more information about how ARDIETY plans to aid in the promotion of healthy fashion models please contact ARDIETY Inc. at or visit our website at


Laura Cusack, MS, RD

ARDIETY Inc. supports equality and individuality. We provide scientific based diet and fitness related health resources, promoting personalized health.

Works Cited

Academy of Nutrition and Dietetic . "Understanding Body Mass Index." 2012. (accessed 2012).

Center for Disease Control. "Pediatric and Pregnancy Nutrition Surveillance System ." CDC. Oct. 29, 2009.

Mercado, Jim. "Israel bans overly thin models from working." NBC. Feb 18, 2013.

National Center for Health Statistices, Center for Chronic Disease Prevention and Health Promotion . "2 to 20 years: Girls Body mass index-for-age percentiles." CDC. May 30, 2000. (accessed March 31, 2013).

National Institute of Mental Health. Eating Disorders. National Institute of Health. 2011. (accessed 2013).

Siegel-Itzkovich, Judy. Law against anorexic models goes into effect. The Jerusalem Post. January 01, 2013.