Anorexia: is this the cause or the cure?
Isabelle Caro, 27, knows that her self-starved body "arouses repugnance", but this terribly ill young woman's naked form, captured by controversial photographer Oliviero Toscani, is now being displayed on billboards across Italy, put there by a fashion company which claims it is highlighting the problems of anorexia.
Flash & Partners, the Italian clothing company behind the posters for its label Nolita, says it is running a "campaign" to raise the issue of the fashion industry's responsibility for anorexia, and has received the backing of Italy's health minister.
However, the firm is now facing accusations of cynically exploiting a serious condition for marketing purposes, while eating disorder experts say the pictures of Caro, who weighs just 4st 12lb (31kg), could encourage other anorexia sufferers to try to lose even more weight. Meanwhile, big-name designers, including Giorgio Armani, have added their voices to the debate, protesting that anorexia has nothing to do with the fashion industry.
Whatever the motivation, the images have further fuelled the argument over fashion's role in the apparently increasing number of young women suffering from this cruel illness.
Caro herself does not blame the fashion industry for her disease, from which she began to suffer at the age of 13, owing, she says, to a "difficult childhood". She seems sincere in her hope that allowing her emaciated naked body to go on public display will help dispel any "romantic" ideas young girls might have about the condition.
The young Frenchwoman, who writes a blog about her illness, says: "I've hidden myself and covered myself for too long. Now I want to show myself fearlessly, even though I know my body arouses repugnance. I want to recover because I love life and the riches of the universe. I want to show young people how dangerous this illness is."
Yet, if Caro's motivation is honourable enough, the reasons behind the brand's decision to use her are open to question. Founded in 1998 in Italy, it takes its "street" inspiration from the small Italian community in Manhattan, New York, known as North Little Italy (No.L.Ita). Aimed at young people it has been described as "Marni meets Diesel" and numbers Jessica Simpson among its fans. So why the sudden pang of conscience about thin models?
A statement from Flash & Partners says: "The new Nolita campaign realised by Oliviero Toscani for the fashion brand of Flash & Partners leaves little room for doubt. The subject chosen to convey this message, in particular for young women who follow fashion, is that of a young girl who has fallen victim to the sickness.
"Toscani has literally laid his subject bare, to show the reality of this sickness to all through this naked body, a sickness that in most cases is caused by the stereotypes imposed on women by the fashion world." Perhaps, but is this depiction appropriate?
Fabiola De Clercq, head of the Italian organisation Association for research into Anorexia and Bulimia, says not. Describing the photos as "excessively crude", she adds: "(Young women) could feel envious of the anorexic model photographed in an ad and think that they too can get thinner. Done this way, this campaign has no sense."
It may make "no sense" to an anorexia expert, but in the world of fashion marketing, sensibilities are rather different and Caro would not be the first vulnerable young woman, anorexic or otherwise, "laid bare" by those in the fashion industry to promote their own interests. A relatively unknown brand last week, Nolita is suddenly the talk of Milan Fashion Week, and its name is the focus of much attention in the wider Italian media. Although the picture was published by Italian newspaper La Repubblica, the country's top selling daily Corriere della Sera refused to run it.
From the point of view of Italian health minister, Livia Turco, who has backed the campaign, such publicity is a good thing. "The disturbing image of Isabelle Caro could open an original channel for communication and encourage people to shoulder their responsibilities in the area of anorexia," she said.
However if this was truly the aim of the campaign, it does not appear to be working very well. Responding to the images of Caro yesterday, no-one in the Italian fashion industry seemed prepared to shoulder responsibility for anorexia, and many seemed confused as to the message the billboards were trying to get across. Domenico Dolce and Stefano Gabbana said: "Finally someone is saying the truth about anorexia - that it has nothing to do with fashion but is a psychiatric problem. We have always maintained this despite all the political campaigns on the argument. The biggest problem - and the most evident one is that of obesity but certainly anorexia is also a social problem both are linked to psychological problems. Both obesity and anorexia are problems that we should be fighting against but they are not strictly linked to fashion - in fashion women have always been thin even in the 50s and 60s."
Roberto Cavalli also denied fashion had a role to play in encouraging eating disorders: "It's easy to blame fashion for the serious problem of anorexia," he said. "Thinness and avoiding food is linked to the fact that today's youngsters are ill at ease, they are lonelier and they are also denied an adolescence or are at a frenetic pace which makes them unstable."
And while Giorgio Armani said he thought such shocking imagery was "opportune" as a way of making people face up to the dangers of anorexia, he also said the problem was far more complex than the use of this models, adding: "Anorexia has reasons which are not linked to fashion. Even people who take no notice of fashion get anorexic. I would like to meet this girl to understand the motives that made her anorexic, it's a phenomenon which perhaps has not been explored to the bottom."
So, while the Italian press may be disturbed by these stark images, the designers still acknowledge no real connection, despite the fact authorities in Madrid and Milan have recently banned the appearance of ultra-skinny models on catwalks by forcing models to carry certificates proving they are healthy.
Indeed even Toscani himself appears to be taking a fairly neutral stance. The photographer, whose work for Benetton gained him notoriety during the 1980s and 90s has never shied away from showing the body in the most vulnerable conditions. One of his most famous campaigns is that of a man dying of Aids, lying in a hospital bed, surrounded by his grieving relatives.
Speaking of his latest project, Toscani said: "I have been interested in the problem of anorexia for years. Who is responsible? Television? Fashion? It's interesting that finally an actual fashion house has understood the importance of the problem, they have taken it consciously and with courage they are displaying themselves in this campaign." Accepting he was likely to come in for criticism, he added: "There is beauty in tragedy. The paradox is that one is shocked by the image and not by the reality. As always I have done my job as a reporter, I have been a witness to my times."
In Britain, where last week's London Fashion Week saw the publication of a report by the Model Health Inquiry make 14 recommendations, including requiring models to pass medical checks before being allowed on the catwalk and barring appearances from those under 16, the Nolita campaign has been met with cynicism.
Tracey Lea Sayer, the fashion director at fashion website handbag.com, said: "I am deeply shocked by the image in the Nolita ad campaign. Flash & Partners are simply using the controversy that surrounds the fashion industry as a PR tool to gain media coverage. I find this is way below the belt and an unsuitable way for the Nolita label to gain exposure. Why is she naked? Surely she would look just as terrible dressed in their clothes? Though obviously this might have had an adverse affect on sales. What has it to do selling clothing? Nothing.
"I find it ridiculous the blame for an illness such as anorexia is pinned on the fashion industry. Anybody who thinks Isabelle Caro, the girl in the campaign, looks in anyway good obviously has many more issues than being jealous of a few size 8 girls on a catwalk. Blaming this condition on fashion only makes light of a very serious disease."
Gordon Macmillan, editor of the Brand Republic website, said: "To claim this is fighting anorexia is just misleading. We've all seen images in the media of very anorexic people. Showing people who are very thin is not going to make people stop being anorexic. This is shock advertising. It is about grabbing headlines and acres of free publicity."
However, he said, from a marketing point of view: "The thing about shock advertising is that people remember the image but they don't tend to remember much about the brand itself".
Jess McCabe, the editor of UK feminist website thefword.org.uk, said the problem of anorexia and fashion needs to be seen in the wider context of our ideas about women's bodies.
"Ultimately, women would benefit more from messages which stop putting so much pressure on how big or small our bodies are. The way this photo is posed, with the woman arranged like a model and the decision to have her pose naked, means the shock value is connected to the idea that anorexia, and being very thin, is not sexy. It's obviously not enough to have an image showing that it is not healthy. That worries me."
• With additional reporting by Nick Pisa in Rome