Alexandra Shulman, one of the most important figures in the multi-billion-pound fashion industry, has taken on all the largest fashion houses in a strongly worded letter sent to scores of designers in Europe and America. In a letter not intended for publication but seen by The Times, Shulman accuses designers of making magazines hire models with “jutting bones and no breasts or hips” by supplying them with "minuscule" garments for their photoshoots. Vogue is now frequently "retouching" photographs to make models look larger, she said.

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Shulman claims that the clothes created by designers for catwalk shows and subsequently sent to magazines for use in their photoshoots have become "substantially smaller". The garments are typically sent to magazines six months before they appear in the shops and editors have no choice but to hire models that fit the clothes or fail to cover the latest collections from the leading designers.

"We have now reached the point where many of the sample sizes don't comfortably fit even the established star models," Shulman writes, in a letter sent to Karl Lagerfeld, John Galliano and fellow designers at Prada, Versace, Yves Saint Laurent, Balenciaga and other top fashion houses. The supermodel Erin O’Connor described the stand by the editor of Britain's most prominent fashion magazine as "a huge breakthrough".

"The fact that Alexandra Shulman with her enormous influence has opened this conversation means that it will have a huge impact," she said. "It has... made it compulsorily relevant that we address this now."

While the travails of the thin and beautiful almost always make for good copy, we should remember that only about 1 percent of the American population is anorexic, while nearly two thirds of adults are overweight or obese, according to the U.S. Centers for Disease Control and Prevention. So it's not as if skinny models have inspired an epidemic of slimness. In fact, the real danger may be that the contrast between the girls on the catwalks and the girls at the mall is creating an atmosphere ripe for binge dieting and the kind of unhealthy eating habits that ultimately result in weight gain, not loss. "You always [have to] look at the discrepancy between the real and the ideal," says Cynthia Bulik, a clinical psychologist who heads the eating-disorders program at the University of North Carolina at Chapel Hill. "If [kids] see themselves gaining weight and then they see these ultra-thin models, the discrepancy between how they see themselves in the mirror and how they feel they have to look is bigger. And that can prompt more extreme behaviors."

Unfortunately, that gap between the ordinary and the elite is growing rapidly. As American women have gotten heavier, models have gotten thinner and taller. Twenty-five years ago, the average female model weighed 8 percent less than the average American woman, according to researchers. Today, models weigh about 23 percent less than the average woman. Models are also leggier than before. Usually about 5 feet 10 inches tall, they are a good five inches taller than they were 10 years ago. Meanwhile, a typical woman is about 5 feet 4 inches and weighs 155 pounds, according to a 2004 SizeUSA study. The trend is enough to make any woman feel like a hobbit in comparison to what they're seeing in magazines.

Instead, the CFDA guidelines emphasize education — about the warning signs for eating disorders, and about healthy dietary and lifestyle issues. The guidelines discourage models from working the runways if they're under 16. In addition, all models should work limited hours, take rest breaks and be supplied with nutritious snacks and nonalcoholic beverages behind the scenes. They encourage models who do have eating disorders to seek treatment and also recommend that smoking and drinking be banned from backstage areas. The group, which will host New York Fashion Week starting Feb. 2, says their position is "about awareness and education, not policing." They add in a statement: "Other groups have set strict rules about how much (or little) models are allowed to weigh. However, the CFDA is not recommending that models get a doctor's physical examination to assess their health or body mass index to be permitted to work … Eating disorders are emotional disorders that have psychological, behavioral, social, and physical manifestations, of which body weight is only one."

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Whether the models will be able to adjust their behavior is another matter. Every day they are barraged by images of chic women who are ultrathin and Web sites that promote anorexia. The allure of the catwalk is sending dangerously underweight models straight into hospital beds. On these Web sites model wannabes are taught how to stave off hunger pangs by punching their stomachs or drinking vinegar. The Eating Disorders Association warns that there are more than 500 pro-anorexia Web sites that promote the disease as a form of control over one's body. Steve Bloomfield, press officer for the association, explains that these Web sites have a strong impact on sick people as they finally find someone who perfectly understands how they feel and supports them. "Only 1 percent of anorexics feel able to talk to their parents or teachers," says Bloomfield.

Because anorexics refuse to think they are ill, they never associate their health problems with starving themselves. Therefore, they refuse treatment, and as Bloomfield notes, "One in five people who don't get treatment die prematurely." The Great Ana Competition is a Web site that awards a diploma to the girl who eats the fewest calories in a two-week period. The competition has even codified a scoring system: Eat less than 150 calories per day and you are awarded nine points, accomplish a 24-hour fast and you'll be awarded the grand prix.

Vogue Editor-in-Chief Anna Wintour is spearheading the effort to get the session together. "Anna held a symposium on the issue, and she's planning another meeting this week," said one model agency chief. "We would much rather come up with a way of self-policing ourselves than have regulations rammed down our throats." The head of another modeling agency said, "Everyone should take a look at it, and if there's a problem, let's fix it."

Italy's government and its fashion chiefs said last week they're working on a plan to crack down on ultra-thin models who appear to be suffering from eating disorders. The move came three months after Spain passed a law requiring that every model have a body-mass index of at least 18 (a measure of body fat). Last month, Brazilian model Ana Carolina Reston died at age 21 from anorexia. Besides the beauties' health, the fashion honchos fear they'll be blamed for promoting unhealthy body images for generations of teenage girls.

Washington Post fashion writer Robin Givhan says many models today are "pale, almost to the point of translucent, and astonishingly thin. They look positively rickety. Seeing one in a swimsuit can make you shudder. They are not sexy or even particularly pretty. How can they be when they look as though the life has been sucked out of them?" The skinniest seem to come from Eastern Europe. Givhan names Snejana Onopka, Vlada Roslyakova and Sasha Pivovarova.

"Over a typical runway season, the same models appear so often on different runways that it is easy to become immune to how shockingly thin they are. After a while, it seems normal that a model's thighs are the same circumference as a 12-year-old's upper arm," Givhan wrote. "If the industry does not think carefully about the current aesthetic," she warned, "what comes next could be truly ghastly."