Monday, March 29, 2010

What’s Food Got To Do With It? A Critique Based on the No Anorexia Campaigns At Milan Fashion Week 2007-Emily Maple


According to Merrium-Webster Medical Dictionary, the definition of an eating disorder is “any of several psychological disorders (anorexia or bulimia) characterized by serious disturbances of eating behavior”. (1) The full list of eating disorders includes the following: anorexia nervosa, bulimia nervosa, binge eating, and compulsive overeating. Different sources cite the first documented case of an eating disorder around the mid-17th Century, however, long before, it is well-known that Roman purging was standard practice as a course in fine dining. Until a few decades ago, abnormal eating patterns were generally ignored and research related to eating disorders sparse. The 60’s brought with it a new popular body type. No longer was hour-glass-figured Marilyn Monroe the pinnacle of what women wanted to look like, rather Twiggy and the waifs had swept the fashion world and quickly changed the way western cultures would view the form of beauty. Within the next couple decades, high-profile deaths became highlights in the media (namely singer Karen Carpenter and gymnast Christy Henrich) as a direct result of complications from anorexia nervosa. Several celebrities and athletes started talking about their irrational and irregular eating habits, the need to slim down to dangerous proportions in order to compete for jobs or places on teams. The frequency of anorexia and bulimia among the general population and awareness of eating disorders spread. At this point, it became clear that this was no longer a small problem and people began researching the manifestations, causes, and practices of eating disorders. By the mid 90’s with the second wave of ultra-skinny waifs (including the infamous Kate Moss), more publicized deaths had occurred, mainly among professional athletes (namely gymnasts and ballerinas), models, and actresses.

While some people were starving themselves to unhealthy weights, causing irreversible damage and in extreme cases, the obesity rates in the US skyrocketed. In the article “Prevalence and Trends in Obesity Among US Adults, 1999-2008”(2), 2007-2008 results for US citizens with obesity (30 BMI or higher) was 33.8% in a study enrolling 5,555 men and women aged 20 years and older. Although the article points out that there is little increase in prevalence within the last decade, prior to that prevalence rose dramatically between the mid-1970’s and late 1990’s in most or all age groups. While we can not necessarily correlate obesity with an eating disorder, the two are certainly not mutually exclusive.

Issues regarding eating disorders have certainly not gone unnoticed in the media or within society. In the satirical novel Good Omens (3), the authors poke fun at modern society by introducing the personification of Famine, one of the four horsemen of the apocalypse. The character has written a best-selling book “Foodless Dieting: Slim Yourself Beautiful (The Diet Book of the Century!)” which encourages eating small amounts of food lacking any nutrition. At one point in the novel a starving model compliments Famine on the books and said it changed her life. Although fiction, upon reading that passage, it’s natural to get a chill down your spine because of the eerily realistic depiction of how many people have come to live.

While many public health campaigns have attempted to bring awareness of eating disorders and interventions to help those suffering with them, little to no leeway has been made. According to, half of Americans have a family member or close friend who suffers with an eating disorder (4).

Several campaigns have been successful by bringing awareness and help to this situation. However, more remain unsuccessful in bringing down rates and statistics.

Part of the difficulty is the nature of eating disorders. You have to eat, so there is no avoiding food, unlike avoiding bars and liquor stores if alcohol abuse is an issue. Also, as it’s well-documented, eating disorders stem from something greater than an addiction to food or not eating food. Pair this with society’s obsession with thinness and growing obesity and the problem catapults from an individual level to a public health problem, that generally must be dealt with on a very personal level.

One well-known and very controversial campaign took place in 2007 at Milan’s Fashion Week. Billboards and two-page spreads, funded by Italian fashion label Nolita and backed by the Italian Health Ministry, were filled with naked pictures of Isabelle Caro, a French actress, weighing less than seventy pounds. People involved with the campaign claim that was a strong reaction to at least two models who’d been pressured to lose weight had died the year before. While this claim rings true, the manner in which the campaign was executed and underlying motive was questionable. The photographer, Oliviero Toscani has been credited with several other “shock” campaigns, including the Benetton campaign featuring a picture of a man dying of AIDS and was quoted that his intention for this campaign was to graphically bring something to the table in the debate on the fashion industry’s standards of models. (5)

Shocking and grabbing the attention of patrons of Milan’s Fashion Week, as well as the media, was absolutely successful. Many publications applauded and berated the campaign quickly after its release. While that goal was met, any public health goals that could have been met fell short. In this assignment, I will outline the shortcomings and successes of the campaign, as well as how applying socio-behavioral models could easily have made this more successful for the public than just shocking.

Critique Argument 1: Lack of Information

The first issue I saw with this campaign was that there was no information regarding the purpose or what, exactly, except for “No Anorexia” and “No.l.ita.” splashed across the billboard and pages in periodicals. While the catchiness they went for was certainly there, no more information was provided. Just the sticker-shock of a naked, obviously unhealthy woman and a designer’s name. Time Magazine’s opinion of the campaign rawly states “With a shocking photograph of a naked anorexic woman, shot by Oliviero Toscani, the eternal enfant terrible of fashion photography, Nolita's is the latest attempt to employ a formula that Toscani helped invent with Benetton in the 1980s: the use of provocative, socially conscious images to help hawk products. (And, in theory, the images attempt to accomplish the inverse as well: using consumerism to try to raise public awareness.)”(6) While I argue that this campaign was certainly aimed to conjure awareness of anorexia, it certainly suggests that the clothing, not the issue, is the underlying motivation.

One criticism of many public health campaigns is that they provide a daunting amount of information. While reading pamphlets can certainly get tedious, having no information is just as big of an issue. How would one know how to proceed or the gravity of a situation without any background information? “Googling” No Anorexia, you do come upon a website ( However, it appears to have nothing to do with the 2007 campaign and has very little information. The Italian Health Ministry contributed nothing in terms of taking this campaign to the next level and solely put their endorsement behind it.

When I first learned of this campaign years ago my initial reaction was positive. Yet, almost immediately it struck me that this designer was using their name in a way that borders on unethical. While it’s good that a designer did recognize that this is a problem, merely showing that there is a problem does little to help alleviate it.

In every traditional behavioral model that we’ve studied in class, the information as to why this is an issue is an integral part. For example, the Theory of Reason action and the Theory of Planned behavior begin with periods of unawareness of the issue, followed by deciding whether take steps take action, and finally maintenance. This campaign stops at the awareness of the issue, proceeding no further as to whether it’s appropriate to take action on not.

Critique Argument 2: Irrational Campaigns

In a study published in the Journal of Marketing Research (6), the authors examine guilt and shame, and its association with the effectiveness of campaigns related to binge drinking. More specifically that the messages framed depicting binge drinking with negative consequences conjure feelings of guilt and shame and instead increase binge drinking behavior within the population. While binge drinking and anorexia are two different mental issues, campaigns to curb binge drinking and the anorexia campaign criticized are similarly negative in their framing. As we observed with the traditional health behavior models, they assume that rational thought is used when making all decisions. As humans, we know that this is far from the truth. In a linear equation of the 2007 No Anorexia campaign someone would see this ad and not want to look like the skeletal model, thus not being anorexic.

To take a step further into the traditional models, in the Health-Belief Model it is assumed that one’s perceived behavior will have an effect on the outcome of acting out the behavior or not. The Journal of Marketing Research article went on to say that research suggests that shame and guilt share several characteristics with judgment and processing. “Shame arises out of the concern for others’ evaluations of oneself. Shame may be experienced when the self is viewed through the eyes of another an one realizes that the behaviors producing the emotion are not congruous with one’s ideal self. In contrast, guilt is concerned with one’s actions on others (Lindsey-Hartz, Derivera, and Mascolo, 1995). These differences have important consequences for information processing and message framing.”(6)

The No Anorexia campaign attempts to make the disease unappealing to the public, which would affect someone’s decision to eat or not eat. If that tactic worked, eating disorders would probably not be as widespread of a public health problem we see today. The logical thought process of seeing those ads would be that the woman in them is unhealthily thin and one would eat. We’ve seen with countless public health campaigns ranging from safe driving to cigarettes smoking, this scare tactic does not work. This has been especially true with AIDS campaigns in gay communities (which Toscani had actually done a shock campaign for years before). While many have failed, later, I will explain one (of many) that has been successful. Although this ad may look disgusting to majority of the population, it could very well be motivating to those suffering with anorexia.

Critique Argument 3: While Eating Disorder Interventions are very personal, targeting a person won’t work, must target society:

In the correct vein, the No Anorexia campaign succeeded in reaching a large number of people. Not only was it quickly spread through the fashion world, but almost immediately websites and periodicals both praised and berated it. Didier Grumbach, head of the French Couture Federation, lashed out at the fashion house. "I find this absolutely scandalous," he told the AFP. "Winning notoriety through people's illness is painful. What we're seeing here is sensationalism by a label, to the detriment of an extremely serious social problem." (6) Logically, the reaction of the entire fashion industry, had this been successful, should have been to band together, address the obvious industry problem, its contribution to society, and move forward. Instead, this did little to nothing to promote cohesiveness within the community. Although sad, doesn’t come as a surprise.

In an industry where the top paid employees are merely slapped on the wrist for being quoted that “Nothing tastes as skinny feels” (Kate Moss) (8), it should come as no surprise that a major change in attitude will take a while. From Ms. Moss’s quote came an enormous backlash from several advocacy groups as well as the media. But even with the backlash, nothing has been done to change the industry that produced No Anorexia. All public health issues have their hurdles, but many have overcome them. We need to reframe how we’re going about eating disorder campaigns by changing the way we look at irrational eating. Each patient’s treatment is different, as the disease is very personal. However, that’s no excuse for us, as a society, to allow role models to encourage young men and women who look up to them to say things like this without an enormous backlash.

The No Anorexia campaign had nothing but a billboard. As an ad campaign that is protocol but with social issues more information must be contributed towards understanding and resolving the problem. In order for a change to be made, it must take more than billboards and brash comments.

Proposed Intervention:

While there are certainly many flaws in the intervention criticized, it does do a few things well. First, it was clearly successful in the element of getting the public’s attention. The shock of seeing this young woman floors you no matter how you turn it. Second, adding a big name has proven successful in both public health and marketing campaigns. Finally, it is artistically edgy and leaves a lasting effect on the viewer.

For the proposed intervention that I’d like to keep the shock and art value of this project but incorporate information as to the gravity of this situation, not just the picture. However, I propose a spread of bodies in their underwear, as completely nude wouldn’t be published in the US, both healthy and unhealthy side by side so that the public can compare them. We know that Ms. Caro was unhealthy, but also need to show what healthy looks like. Obviously there have already been photos taken of naked women to prove a point. It would be interesting or eye-catching to have the women doing everyday things, not just laying on a chair or a couch. Show the public what women that all of these women are real, not airbrushed, not touched up, and this is what they look like while doing all of the things that we all participate in. Appeal to and help people remember the idea in less of a negative light. As mentioned, an eating disorder is not solely about body image and the person affected, directly and indirectly, are emotionally fragile. While scare-tactics work, making someone feel like an outsider can put the campaign into the wrong frame.

I’d suggest the incorporation of a website where you can go to find out relevant statistics, where to get help, and something similar to the Media Watchdog program (from the National Eating Disorders Association, which is explained below). Most importantly, the web address must be clearly included within the ad and the website must include statistics and how to find resources to help alleviate the problem.

Defense of Intervention: Framing

First and foremost, how any intervention is framed can easily make it a success or a failure. Although shocking, the No Anorexia campaign was framed negatively like many other campaigns. For example, the campaign geared towards child obesity that we watched during class shows what could happen if you participate in those behaviors rather than what you can do to lessen or help the problem. As noted before, many theories assume that people act in rational ways. By shocking or scaring people into behaviors we assume that they will partake in the high road, yet this isn’t the case. As noted above, feelings of shame and guilt can override the desired end result and actually further harm that which we wish to fix.

In “More than a Message: Framing Public Health Advocacies to Change Corporate Policy” (9), they describe conceptual and news frames. They explain conceptual frames as words or images that trigger already existing frames in people’s minds. They used the example in which the New York Times did a poll and obtained two very different sets of responses regarding a political issue in Washington D.C. solely by changing around a few words. More than ever populations receive their information from the media. How the media frames situations can drastically affect the reader’s framing of the situation being written or told about. The authors also use the metaphor that most news frames portraits rather than landscapes. This poses a problem in that they’re only focusing with a narrow, when it should be a broad, view. How difficult to go about influencing people when they’ve already made up their minds? Or someone else has put it in such a way that it’s been made up for them?

The article suggests that you go about framing in the following three steps: 1. What’s wrong? 2. Why does it matter?, and 3. What should be done about it? For this campaign I suggest the answers to be eating disorders in the population of the United States, people are unhappy and even dying unnecessarily, and raise awareness and change what we as a society deem acceptable.

Defense of Intervention: Societal Input

As mentioned above, since this is a societal problem, affected society must get involved. Part of the website containing information and places to get help for eating disorders would include a section where the community could get involved. The National Eating Disorder Awareness website proposes a great idea called the Media Watchdog.

How the Media Watchdog program works.

Media Watchdogs are volunteers across the country who choose to closely monitor various forms of media, commending or critiquing advertisements or programs that positively or negatively impact body image and self-concept. Watchdogs monitor TV, radio, newspaper, magazine and internet ads or programs and send notices of ads or programs worthy of praise or protest to the National Eating Disorders Association office:

Fax: 206.829.8501

You submit, NEDA staff and volunteer Watchdogs review the submissions and decide on the best course of action! It is NEDA’s hope that by reaching out to the leaders of corporations we can educate, inform and build relationships that will lead to lasting changes in advertising. When we write a letter it will be on behalf of all Media Watchdogs which may include an opportunity for you to sign on! Your name and signature may be necessary to express our praise or protest, depending on the submission selected.
In the case of protest letters, NEDA staff continues corresponding with advertisers until they respond to our request to change their advertising strategies and messages.

The Media Watchdog program includes participation from the National Eating Disorders Association staff, the Board of Directors, and over 1,000 volunteer Media Watchdogs – just like you – who have joined this interactive program e-campaign through the internet.” (10)

This program directly involves the public. Although, you originally think of this (with the name Watchdog) as something solely negative, it specifically states that positive images are also requested. This helps to keep a campaign out of the solely negative light and finger-pointing that has plagued so many public health campaigns in the past, possibly evoking feelings of shame and guilt, which was touched on earlier.

Interventions within gay communities with regards to HIV and AIDS have had both positive and dismal results. One study (11) proposed that opinion leaders among the community endorsed safe sex practice and condom use. The writers of the study took polls before and after the intervention to find that there was a decrease in both unprotected sex and proportion of men with more than one sexual partner.

Defense of Intervention: Education

Probably the simplest and most up-front addition to this campaign would be the availability of information easily accessible to the public. Since this is the age of the internet, setting up a simple, yet clear website is both easy and inexpensive.

There are several eating disorders sites and organizations that provide information. However, you have to actively see them out. As we saw with the 2007 No Anorexia campaign, if you get the public’s attention, they ask questions. If we can positively get the attention of the public and directly link it to more information, that’s a good part of the battle of a campaign.

The information included would be clear statistics on eating disorders, the aforementioned Media Watchdog-type way to get involved, and where to get help for eating disorder issue.

As for where people can go to get help should have a few different options. Some people prefer to be face-to-face with someone and feel that more comforting. Others like to remain anonymous when asking questions and seeking help. In an effort to reach as many suffering, directly or indirectly, with the eating disorder, giving these options allows for someone to still act as an individual and not feel like they have only one option.


Taking from the 2007 No Anorexia, a shocking image always grabs the public’s attention and makes them ask just what is going on. However, this campaign fell short of everything but doing just that. With the incorporation of public health and marketing principles, I feel that this campaign could very easily reach many people and shed a positive light on to the issue of eating disorders within our community.

If it were as simple as logic, we could look no further than Maslow’s Hierarchy of Needs, as eating is at the base, and most important part of the pyramid. But as we see, it’s not as simple as that with any public health issue. The way we frame a message, provide information about the message, and then take steps to carry out eradication of a problem is difficult. Part of the difficulty is organizing what, exactly it is that you want to say in the first place, and anticipating what the public’s reaction will be. Some of the factors are controllable, some are not. But one thing’s for sure, if we have a population mixed with people eating and starving themselves to death, there clearly must be some sort of change.


1. Merriam-Webster, Inc. Definition of Eating Disorder. Springfield, MA.

2. Katherine M. Flegal, PhD; Margaret D. Carroll, MSPH; Cynthia L. Ogden, PhD; Lester R. Curtin, PhD. Prevalence and Trends in Obesity Among US Adults, 1999-2008. JAMA. 2010;303(3):235-241.

3. Gaiman, Neil; Pratchett, Terry. Good Omens: The Nice and Accurate Prophecies of Agnes Nutter, Witch. New York, NY: Workman. 1990.

4. Eating Disorder Statistics. United States:

5. CBS News The Early Show. Anorexia Stripped Bare. New York: CBS.

6. Time. Fervor Over an Anorexia Ad. New York. Time Magazine.,8599,1666556,00.html#ixzz0h8u3UsAU

7. Agrawal, Ndhi; Duhachek, Adam. Emotional Compatibility and Effectiveness of Anti-Drinking Messages: A Defensive Processing Perspective on Shame and Guilt. Journal of Marketing Research. (forthcoming)

8. Telegraph. Kate Moss: Nothing Tastes as Good as Skinny Feels. London: Telegraph.

9. Dorfman, Lori; Wallawack, Lawrence; Woodruff, Katie. More than a Message: Framing Public Health Advocacy to Change Corporate Practices. Health Educ Behav 2005; 32: 320-336.

10. National Eating Disorders Association. Media Watchdog. Seattle: National Eating Disorders Association.

11. Kelly, JA; St Lawrence, JS; Diaz, Y E; Stevenson, L Y, Hauth, A C; Brasfield, T L; Kalichman, S C; Smithand, J E; Andrew, ME. American Journal of Public Health, Vol. 81, Issue 2 168-171.

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