Too Rich, Too Thin

Women think about their weight the way many men think about sex: all the time. So when is thin, TOO thin?

Just these last few weeks too thin has been selling Hollywood gossip rags. In Touch magazine apparently photoshopped out Angelina Jolie's (32) protruding arm veins for its May cover. The normal body fat that gives a smooth contour to the flesh is missing. Her emaciated arms reflect a significant weight drop while grieving her mother's death this past January. And Keira Knightley (22) is in and out of the tabloids. She has long denied eating-disorder rumors and in January of last year she sued a British tabloid for implying she lied about not having anorexia after losing weight during the grueling Pirates shoot. She probably is telling the truth. Neither woman appears to have a pathological relationship to food.

Last February former supermodel Tyra Banks was on the cover of People after having made a huge internet splash in an unflattering bathing suit. The very same month she was featured inside Vanity Fair channeling Audrey Hepburn. At 5’10” and 161 lbs. Banks's BMI is 23.1 and well within the range of normal health. It should surprise no one that the same woman can look fat in a paparazzi shot and stunning in a photo shoot. We all can.

Body Mass Index (BMI) is sophisticated way to calibrate height & weight (BMI=kg/m2) and do away with the "big boned" excuses. Here are the standards used in medicine:

Less than 18.5 = underweight
18.5-24.9 = normal
25-29.9 = overweight
30-39.9 = obese
40 or more = morbidly obese

We are a fat country and getting fatter. Approximately 33% of adult Americans are obese and an additional 32% are overweight. Yet we also have an peculiar national body dysmorphia, where female celebrities are ruthlessly pilloried for appearing at a normal weight. So from where does this national body distortion arise?

One finger points to the fashion industry. Unlike cigarettes and liquor, American is not protecting it's young from the influence of underweight image marketing. For example, Tyra Banks (33) began modeling on the catwalk at age 18 with a BMI of 16.2; by age 20 as she finished puberty she was curvy enough that her agency pressured her to lose 10 lbs. Instead, she switched to underwear/swim suit modeling in 1995. By 1997 she was the first black woman to be featured on a Sports Illustrated cover, then going on to Victoria’s Secret stardom – all with a BMI 18.8! That's just within the range of normal.

Drugs, diet pills, fasting, laxatives are rife in the image industry – very, very few of these women are that underweight by nature. After a spate of anorexic models died or fell ill last year, Madrid Fashion Week city council organizers enacted ground-breaking legislation: mannequins with a BMI of less than 18 (5'9" 123 lbs.) would be banned from the catwalk. About a third of the models who appeared the previous year won't qualify under the new guidelines, top models such as Brazil's Fabiana, Spain's Esther Canadas, Britain's Kate Moss and Estonian Carmen Kass. But Madrid is alone in treating this as a public health issue. The really big fashion venues – Milan, Paris, New York, London – aren't buying in.

"We worked hard to restrict advertising for alcohol and tobacco because of the potential dangers to our young people, and fashion is now the only major industry without health guidelines." –Lynn Grefe, CEO, National Eating Disorders Association

One study found 47% of school girls 5th-12th grade want to lose weight because of magazine pictures – pictures which are photoshopped out of reality (there are whole websites devoted to exposing this.) The print and film media are actively engaged in a manipulation of public perception. The female image school girls buy into is a simulacrum, an unsatisfactory imitation of, a substitute for real womanhood."Even I don't look like Cindy Crawford when I wake up in the morning," admits the famous supermodel.

How serious is it? It’s a mental illness that progressively damages the body, fatal to 15-20% of sufferers. It precipitates more deaths among females aged 15 to 24 than all other causes combined. (It caused Terri Shiavo's heart failure and brain death.) And eating disorders have doubled since 1960s. An estimated 10 million girls and women, as well as 1 million males suffer from anorexia nervosa (starves, obsessive, body dysmorphia, compulsive exercise) or bulimia nervosa (normal weight, binge/purging cycles). There is some evidence of altered brain chemistry that makes it hard to stop. For more information check ANRED.

Of course there are some famous dead Hollywood anorexics, like Karen Carpenter (32) and Margaux Hemingway (41), along with the aforementioned Audrey Hepburn (61). Several stars lived through it and talked afterwards: actress Jane Fonda (69) suffered from bulimia from age 13 to 37.

The current crop of Hollywood sufferers includes many. Nicole Richie (25) repeated bouts of fainting underscore her eating disorder/drug problem. In November, Richie told Us Weekly: "I'm not in rehab, and I don't have an eating disorder. I'm getting the help I need and taking care of my health." Denial ain't just a river in Egypt. Mary-Kate Olsen (21), Kate Bosworth (24), Victoria Beckham (33) all share the disease.

There are a few stars in Hollywood speaking out against the pervasive thin image. Cameron Diaz (34) has said:

“We get ideals from images that we see and there certainly should be more responsibility put on those people who are putting those images out into the world. Let’s be a little bit more responsible to what’s realistic.”

Kate Winslet (31), nicknamed 'Blubber' in school, has unapologetically appeared nude in six films. She describes the trend as "unbelievably disturbing." After being Photoshopped into an approximation of supermodel perfection for the cover of a GQ magazine Winslet veraciously complained: “the retouching is excessive. I do not look like that and more importantly I don’t desire to look like that.” Listen to what the GQ editor said in response and take it to heart – and tell your children:

"These days you only get two kinds of pictures of celebrities - paparazzi pictures or pictures like these which have been highly styled, buffed, trimmed and altered to make the subject look as good as is humanly possible. We do that for everyone, whether they are a size six or a size 12. It hasn't a lot to do with body size. Practically every photo you see in a magazine will have been digitally altered in this way."

Want this look? It can't be had surgically, but recovery in a facility can be expensive and ongoing.

HDTV & Adult Acne

All right, Mr. DeMille, I'm ready for my close-up.

We all know what happened to Norma Desmond in Sunset Boulevard and we of the 21st century are definitely not ready for our HDTV close-up. Broadcasting in the hot new digital technology makes TV faces look as crisp and sharp as...the real thing and we viewers aren't used to seeing the real thing in Hollywood. Just as talkies and technicolor redefined Hollywood stardom in the past, so too will high-definition, where every feature is in IMAX and in your face.

High definition televisions can display two million pixels, nearly 10 times the resolution of a regular, old-style TV set, on a screen the size of your dining room table. If an actor is aging or if they've got any skin damage, it just pops out at you. Additionally, more colors are used in HDTV, including some new shades of red: all the blotches, zits and tiny nose-veins can be presented with the brutal clarity of a dermatology textbook!

High-def is, in essence, a medium peculiarly unsuited to dissembling.

Who do you think is scary in high-def? Various lists name Teri Hatcher (42) and Rosie O'Donnell (45), underscoring that too little fat in the face looks skeletal and too much can't camouflage coarse skin. And broadcast news may suffer ala Tim Burton's Batman: Meredith Vieira (54) of the Today Show looks her age without botox and airbrushing. On HD-tv older definitely looks older. And it's guaranteed you'll never feel the same about It's Only Rock 'n' Roll after seeing Mick Jagger and Keith Richards on high-def. Both 63-year-old men are walking morality tales for the ravages of drugs, age, and rock 'n' roll.

High-def is particularly unforgiving of bad facial plastic surgery, young or old. It would have long ago spelled the end of tv roles for Michael Douglas (63), Burt Reynolds (71), Cher (60), Joan Rivers (73), Mary Tyler Moore (70), Faye Dunaway (66) and the like.

You can just as easily get slammed in HDTV for having imperfect skin. Many accomplished screen actors have relied on heavy makeup to blend into their parts and erase a legacy of acne, yet makeup artists are ham-strung with this new technology. Bill Murray (56), Tommy Lee Jones (60), Lawrence Fishburne (45), and Cameron Diaz (34) will never again pass for scar-free on television.

It's not enough to be merely young (though it helps). Britney Spears, everyone's favorite pop tart, looks 10 years older on HDTV, her face puffy and blemished with pucker wrinkles marking her two-pack-a-day cigarette habit. To truly look great in this new technology you need smooth skin and a healthy complexion.

Acne is a condition of the sebaceous glands, the glands attached to hair follicles which produce an oily substance called sebum. A lesion forms the hair follicle becomes plugged with sebum and dead cells.

Twenty-five percent of all adult men and 50% of adult women experience acne at some point. That's 1 in 5 women between ages 25 & 40. Male acne normally starts at age 12, gets worse at 16, and is outgrown by one's early 20s. Girls often breakout earlier but not so violently and continue to have flare-ups longer (witness Britney Spears, Lindsay Lohan, and Jessica Simpson all of whom endorse an overpriced OTC acne treatment line).

In adult acne, hormones, stress, and bad habits all contribute. Less commonly, chafing pressure (sports equipment) and some medications (anabolic steroids, anti-epileptic or anti-tuberculosis drugs, lithium and iodine-containing Rxs) can be the reason.

The pathogenic (disease-causing) events in the sebaceous glands are believed to be due in large part to changes in levels of androgenic (male) hormones in the body. This is why pregnant women often experience acne on their chest and back. It also explains the mid-40s onset when a woman's female hormonal levels drop, leaving endogenous androgens unopposed.

When under stress, the adrenal glands (which are located above the kidneys) overproduce cortisol as well as androgens in both men and women. These hormones in turn stimulate the sebaceous glands to secrete more sebum, which ultimately results in the formation of zits and yet more stress! It's also been established that psychological stress can decrease the wound healing capacity of immune systems by up to 40%. This factor doubles the impact of stress on acne.

And last, but not least, are the things we do to ourselves. Picking, rubbing, and scrubbing all aggravate acne-prone skin. The biggest science breakthrough in acne care has been the development vitamin A treatments, both topical formulations and oral (Accutane). Some of the best OTC products were developed by the scientist behind Retin-A, Dr. James Fulton and are readily available on the internet.