Social Marketing – Anti-Anorexia Campaign (Italy) X444 Background While there has been much attention focused on the obesity problem in the developed world, another serious health issue is anorexia nervosa. There is tremendous pressure in the developed world for women to be extremely thin. The current ideal female body is impossible to achieve for the majority of women and is markedly different from the classical ideal dating back to the Greeks and even as recently as the 1950s and 1960s. By today’s standards, Marilyn Monroe and Raquel Welch would be considered “fat.”

Venus de Milo Ancient Greece

Marilyn Monroe 1950s

Raquel Welch 1960s

Keira Knightley 2000s

While obesity is certainly unhealthy, the social pressure for women to be extremely thin is also unhealthy. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD) (2007), in the U.S. 7 million women and 1 million men suffer from eating disorder mental illness. Lauter (2008) quoted Marleen S. Williams, a psychology professor at Brigham Young University in Utah who said studies show fewer eating disorders in "cultures that value full-bodied women."

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Health impact of eating disorders (ANAD, 2007, except as noted below) o Physical § 20% fatality rate (CBS, 2007) § Malnutrition § Dehydration § Ruptured stomach § Serious heart, kidney, and liver damage § Tooth/gum erosion § Tears of the esophagus o Mental § Depression § Low self-esteem § Shame and guilt § Impaired family and social relationships § Mood swings § Perfectionism § "All or nothing" thinking

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Financial impact of eating disorders o Treatment for anorexia nervosa and/or bulimia is often extremely expensive and can extend for several years. o The cost of inpatient treatment can be $30,000 or more a month. o The cost of outpatient treatment, including therapy and medical monitoring, can extend to $100,000 or more.

It seems bizarre that as the incidence of obesity rises, the social “ideal” of the female figure becomes increasingly thin. In the past, when obesity was not a problem, the ideal female figure was healthy and realistic. It’s like some sort of social schizophrenia. Personally, I feel the current idea is so unrealistic it may be discouraging overweight women from even trying to lose weight, as the ideal just seems so out of reach.

The Campaign In light of the huge influence of the fashion, beauty, and entertainment industries on women, Italy’s health minister approved billboards in Milan, Italy, during Fashion Week 2007 to highlight the dangers of anorexia. The photographer was Olivieri Toscani, noted for other controversial social campaigns, including HIV/AIDS. The billboards featured photos of an emaciated anorexia sufferer, Isabelle Caro, age 27, who is 5’5” and weighs only 68 pounds (CBS, 2007; Castina, 2007).

Photos retrieved from http://style.popcrunch.com/italian-designer-nolita-no-anorexia-ad/

Market Segmentation/Targeted Group The primary target of this campaign was the fashion industry and fashionistas attending Fashion Week in Milan. In addition, the campaign was targeted at Italian women in general, to raise their awareness of the dangers of anorexia. Due to the controversial photos, the campaign reached a global audience through media coverage (CBS, 2007). Identify Product and Price • Core Product – by raising awareness of the dangers of anorexia, and stimulating discussion, the fashion industry will stop using overly thin models. Actual Product – create awareness of the dangers of anorexia through “shock value” and stimulate discussion. “Health officials here say it's about opening a discussion (CBS, 2007).” Isabelle Caro, the model, wants people to know she almost died from anorexia in 2006 (CBS, 2007). Augmented Product o For the fashion industry – By using healthier models and encouraging a healthier body image among the general female population, the fashion industry might design more clothes for normal and full-figured women and they would probably sell more clothes! In addition, there would be an opportunity for lingerie manufacturers and retailers, as women might wear more undergarments, as they did prior to the 1960s. There has been a huge upsurge in control undergarments such as “Spanx.” In my mother’s day, they were called girdles and in the 19th century, they were called corsets. o For women - even for women who do not suffer from anorexia, if the fashion industry uses models with more realistic bodies, it could improve body image among the general female population and help women to focus on health and avoid crazy and dangerous diets. This could stop women from being convinced that they need to starve themselves in order to be beautiful. In addition, maybe fashion designers will design more clothes for women of normal body weight, so normal women would feel better about themselves and have more wardrobe options. Perhaps these disturbing images will spur some women to seek help, or family and friends of women with eating disorders will help them get treatment. • Price Variable o For the fashion industry – the self-policing already increasingly practiced by the fashion industry does require time and effort (see below). Models in Italy are required to obtain certificates of good health. In addition, there could be financial costs from changing the model selection process, changing sample sizes, and potentially from designing clothes that will show well on models that are not “stick thin.” There is also tremendous peer pressure within the

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fashion industry itself. Designers and models have been conditioned that “one can never be too thin.” Changing this mindset can be difficult and designers that use normal weight women could fear negative peer and industry reviews of their collections. They might also have to spend more money to feed their models. Sarcasm aside, the industry might need to help models with eating disorders get appropriate treatment. Models might fear loss of employment if they are not thin enough. o For women - there is tremendous social pressure on women, especially young women, to be thin. A woman who has a more realistic body weight can face peer pressure, rude comments, and fewer fashionable wardrobe options. In addition, dieting is often a social activity among younger women in particular, so a woman eating a normal meal could face rude comments from her friends. Financially, women might spend more money on food. They might also have to buy new clothes if they gain weight. It is psychologically very hard for people to admit they have a problem and they may fear the stigma associated with having a mental illness. In addition, a woman who does have an actual eating disorder, and recognizes she needs help, faces a long and financially expensive treatment, as discussed above. How will the new behavior be inspired? • Benefit and/or cost strategy? This campaign used a “cost” strategy by showing shocking photos of an anorexia sufferer to highlight the dangers of eating disorders. Are they trying to change behavior through social influence? Yes, the purpose was to influence the fashion industry’s model selection, which in turn exerts tremendous social influence over women in general. Women view models and actresses as beauty role models. Internal and/or external efficacy? This campaign relies on internal efficacy within the fashion industry and individual women. The government did not outlaw using models with eating disorders or mandate healthy weights for women. The campaign was designed to influence the fashion industry to voluntarily change their industry behavior and use healthier models. According to Mancini (2007), even before this campaign: Italy's fashion-trade organization . . . and the Italian government drafted a set of guidelines intended to get fashion houses and magazines to use healthier-looking models. Those included asking that models produce a doctor's certificate attesting that they are in good health and limiting the use of models under age 16. It also recommended that models with a body-mass index of 18.5 or less be banned from the catwalks. The World Health Organization considers anyone with a BMI of less than 18.5 to be underweight.

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Interestingly, a few months later, the French assembly passed a bill making it illegal for anyone – including fashion magazines, advertisers and websites – to promote extreme thinness. This disturbing campaign was cited by sponsors of the bill. “Under the proposed law, judges would have the power to imprison and fine offenders up to $47,000 if found guilty of inciting others to deprive themselves of food to an "excessive" degree” (Lauter, 2008). Where would you expect to find this campaign? This was a temporary campaign for Fashion Week. Large billboards displayed these images all over Milan, Naples, and Rome. Double page ads were placed in Italian and French newspapers (Mancini, 2007). In addition, inadvertently, due to the controversy, extensive global media coverage resulted via TV, the internet, and women’s publications. Not only did the global media cover this particular campaign, they also provided additional information and coverage of eating disorders in conjunction with this campaign. The Italian Publicity Control Institute banned the posters in October 2007 (BBC News, 2007). However, the Italian Ministries of Health and Sports then launched a $1.5 million campaign to combat rising rates of anorexia and other eating disorders in 2008. The campaign targets schools and the media, providing guidelines on discouraging unhealthily thin ideals (Italy launches, 2008). Sponsorship and Strategic Partnerships • Nolita sponsored the campaign. Nolita designs and manufactures mid-range apparel for women. According to Mancini (2007): Mr. Toscani [the photographer] said in an interview that Nolita called on him to develop a campaign for fashion week but didn't try to impose any requirements. "I don't work that way; I'm an artist," he said. He came up with the anorexia theme on his own and presented it to the company. "This is a subject that needed light shined upon it. Art in general has to provoke," he said, adding, "I think it's wrong that fashion glorifies women who are too thin, and this is an example of someone who has taken it to an extreme." The CEO of Nolita stated that the company was primarily trying to call attention to a serious health issue, but did not deny Nolita was also using the campaign to promote their brand. Interestingly, they admitted their own models were also very thin (Mancini, 2007). Given the nature of this campaign, I doubt Nolita realized any additional sales as a direct result, although the controversy probably did increase brand awareness. The images don’t exactly put one in the mood to go shopping.

Most of the articles I reviewed didn’t even mention Nolita, and credited Olivieri Toscani for the campaign, so while the campaign received global coverage, Nolita did not. In fact, when I first came across these images on the internet, I thought “nolita” was Italian for “no life” or something to that effect. I had to read several articles before learning that Nolita was the company sponsoring the campaign. The images are so shocking that the Nolita name is not really noticed. However, looking at the images, what sticks in the mind is “No,” which is in the upper left hand corner, in “anorexia,” and in “Nolita.” The shocking image is effectively associated with “no.” Not being a marketer, I wonder if this would actually create a subconscious association of “no” with the Nolita name. • Government - the Italian health minister initially approved this campaign, and a few months later, the Italian government launched its own anti-anorexia campaign. As indicated above, the French government may pass a law against encouraging anorexia, so government intervention in other countries may increase in the future. As discussed above, the industry has been working with the Italian government to selfpolice with regard to this issue. The fashion industry – this campaign certainly achieved its goal of stimulating discussion within the industry, but did not have any industry organization sponsorship. As indicated above, the industry has been trying to self-police with regard to this issue. Based on the potential anti-anorexia law in France, the fashion industry is realizing it must work with government health agencies to address this issue. While some fashion designers reacted negatively, many supported the campaign. Future anti-anorexia campaigns should try to obtain sponsorships or partnerships with fashion industry organizations or individual designers. According to CBS (2007), “Italy's most famous fashion designer, Giorgio Armani, calls the billboard campaign "crude but appropriate . . . it's not just the fashion world. It's the whole system." He's ready for change. "Skin and bones," he says. "It gives me the creeps, too." Another leading designer, Rosita Missoni, argued that the campaign was right. "It's not to be hidden," Missoni says. "We have to talk about it and try to find a way to fight it." Mancini (2007), quoted Diane von Furstenberg, president of the Council of Fashion Designers of America: "It's a horrible picture, but I think it may be very good in the end," she said. "Anorexia is definitely something that should get as much attention as possible. It affects a lot of people." • Healthcare organizations – the campaign did not involve eating disorder nongovernmental organizations (NGOs), such as a European equivalent of ANAD. Given that Europe generally has single-payer healthcare systems, perhaps such partnerships are unnecessary there, although they could be helpful in the U.S. Other – the campaign did not include sponsorships or partnerships by other organizations, but future campaigns should consider alliances with healthy food producers and retailers, undergarment manufacturers, sports organizations and female athletes, and perhaps popular full-figured celebrities like Queen Latifah or Jennifer Hudson or a normal weight role model like our own First Lady, Michelle Obama.

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References BBC News. (2007, October 20). Italy bans ‘no anorexia poster. Retrieved from http://news.bbc.co.uk/2/hi/europe/7053725.stm Castina. (2007, September 25). Italian designer Nolita ‘no anorexia ad.’ Message posted on http://style.popcrunch.com/italian-designer-nolita-no-anorexia-ad/ CBS News. (2007, September 26). Anorexia stripped bare: Milan Fashion Week campaign stirs debate. Retrieved from http://www.cbsnews.com/stories/2007/09/26/earlyshow/health/main3300268.shtml Italy launches anti-anorexia campaign. (2008, March 27). Retrieved from http://feminist.org/news/newsbyte/uswirestory.asp?id=10905 Lauter, D. (2008, April 15). French pass anorexia law. Retrieved from http://www.healthzone.ca/health/article/414632 Mancini, R. (2007, September 27). Controversy as a fashion statement. The Wall Street Journal. National Association of Anorexia Nervosa and Associated Disorders (ANAD). (2007). Facts about eating disorders. Retrieved June 17, 2009 from http://www.anad.org/22385/index.html