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The Fall-Winter 2023 fashion season concluded with a striking absence on runways in New York, London, Milan, and Paris: plus-size models. This scarcity arrives alongside a surge in the availability and discussion surrounding prescription weight loss medications, including Wegovy, Ozempic, and Rybelsus, raising questions about evolving beauty standards and representation within the industry.

In recent months, injectable medications like Wegovy and Ozempic – both containing semaglutide – have garnered attention for their use in Hollywood for weight loss, despite Ozempic being primarily intended for treating Type 2 diabetes. Comedian Chelsea Handler publicly discussed receiving a prescription for Ozempic, even as Elon Musk announced his use of Wegovy last year. The increasing accessibility of these drugs, with six now available by prescription in the US and two approved in the UK, is prompting debate about their impact on body image and the pursuit of thinness.

Fashion commentators and diversity advocates have criticized the Fall-Winter 2023 runways as a step backward, contrasting with the limited progress made in recent seasons. In 2020, Fendi featured Jill Kortleve and Paloma Elsesser, models who typically wear sizes outside the traditional sample range (US 0-4). British label Erdem extended its size range to a UK size 22 (US 18) in 2021, and Valentino showcased a diverse range of body types during its January 2022 haute couture display. Although, this season saw a noticeable decline in the representation of larger bodies.

According to data from fashion search engine Tagwalk, the number of mid and plus-size models appearing on runways decreased by 24% compared to the Spring-Summer 2023 season. A size inclusivity report conducted by Vogue Business found that 95.6% of all looks presented for Fall-Winter 2023 were in a size US 0-4. This contrasts sharply with industry data from 2015, which estimated that 68% of American women wear a size US 14 or above, according to Plunkett Research.

“It was a definitive backslide,” said Mina White, an agent at IMG Models who represents plus-size and curve models including Ashley Graham and Paloma Elsesser. “It was frustrating to see some of these designers not using curved bodies where they had in the past.” White noted the dissonance of seeing designers utilize the image and social media following of plus-size models like Graham without extending that representation to their runways.

Fashion journalist Amy Odell characterized the shift as more than a simple setback, writing in her Substack newsletter that the industry’s commitment to inclusivity was never substantial. “No one needed any data to understand that representing a wide array of body shapes and sizes in runway shows or in fashion imagery is not a priority for the industry,” she wrote.

Despite the overall trend, some brands prioritized inclusivity. In London, labels like Di Petsa, Karoline Vitto, and Sinead O’Dwyer showcased size-diverse lineups. New York Fashion Week saw inclusivity at Christian Siriano, Coach, Kim Shui, Collina Strada, and Bach Mai, while Belgian brand Esther Manas presented a refreshingly diverse runway in Paris. Off-White and Michael Kors similarly featured a limited number of mid- and plus-size models. At Harris Reed’s debut for Nina Ricci, Precious Lee opened the show, joined by three other plus- and mid-size models.

The logistical challenges of creating sample sizes for a wider range of bodies remain a barrier. Fashion houses often prioritize a single sample size to streamline the fitting process and reduce costs. White explained that she proactively provides brands with the measurements of her models months in advance of runway season to avoid this issue. “I want to be ahead of that,” White said. “So I’m never told ‘Oh, we wanted to create it work, but we didn’t have her size’ or whatever that conversation might look like.” Despite these efforts, she frequently encounters resistance, with brands citing financial constraints.

White also expressed frustration with the practice of creating custom pieces for celebrities while claiming a lack of resources for inclusive samples. London-based stylist and editor Francesca Burns highlighted a separate issue: the inconsistent sizing of sample garments. In 2020, Burns shared an experience on Instagram where none of the five looks sent by Celine fit the size UK 8 (US 4) model booked for a shoot, an incident she described as “horrifying.” Celine declined to comment on the incident when contacted by CNN.

While representation on runways has lagged, inclusivity in fashion campaigns, magazine covers, and editorial shoots is growing. “I see the options rolling in for the plus-sized talent, and they’re great offerings,” said White. “Great, strong editorials and covers and campaigns. But I do feel like without the clothes, we are going to go back to see more naked curve stories, or lingerie curve stories or a curve girl in a trench coat. That’s what I don’t want.”

British Vogue’s April issue, unveiled March 16, featured Elsesser, Lee, and Kortleve on the cover, hailed as “The New Supers.” Editor-in-chief Edward Enninful commended the models for “leading the way” and “holding powerful space” in the industry. However, online commentary pointed out that some dresses from Saint Laurent’s Spring-Summer 2023 collection, modeled by plus-size women, are not widely available in those sizes.

Enninful himself expressed disappointment with the Fall-Winter 2023 runways in a social media post, stating, “I thought I had gotten into a time machine… one prescribed notion of beauty prevailed again, and it felt like the reality of so many women around the world were being ignored.”

White believes that industry-wide standards are needed to drive change, suggesting a call to action from organizations like the Council of Fashion Designers of America and the British Fashion Council, as well as key editors at major magazines. Burns echoed this sentiment, emphasizing the responsibility of larger fashion houses to lead the way.

On March 8, Wegovy was approved in the UK, becoming the second injectable weight management medication available via the National Health Service (NHS) in approximately three years. The US has approved three such injections: Wegovy, Saxenda, and IMCIVREE, with medications like Mounjaro and Ozempic sometimes prescribed off-label for weight loss. While these medications offer a potential tool for those struggling with weight, concerns exist regarding their potential for misuse and the pursuit of unrealistic body standards.

The active ingredient in Wegovy and Ozempic, semaglutide, mimics a hormone that regulates appetite. Clinical trials have shown an average weight loss of around 15% over 68 weeks when combined with lifestyle changes. However, the European Medicines Agency issued a warning on March 13 regarding an Ozempic shortage, urging doctors to prioritize prescriptions for diabetic patients.

Despite the medical requirements for prescription, access to these medications is being sought by individuals primarily focused on aesthetic goals. One American woman, who wished to remain anonymous, described searching online forums for ways to obtain Wegovy before ultimately deciding against it due to the cost and potential side effects. Dr. Robert Lash, an endocrinologist, cautioned against using these drugs without medical supervision, citing potential health risks.

For Burns and White, the fashion industry has a responsibility to promote a more inclusive vision of beauty. “There’s a very archaic way of looking at women over a size 16 and just assuming that they’re unhealthy or uneducated or unstylish,” said White. “The reality is the same women these brands are alienating in their fashion space are the same women running out to buy their handbags, shoes, perfumes, cosmetics and skincare.”

Ester Manas and Balthazar Delepierre, whose Fall-Winter 2023 collection championed size diversity, summarized their perspective in their show notes: “The body is not the subject. Because, obviously, at a wedding, everybody is invited. And all to the party. That is where the designer duo Ester and Balthazar take their stand.”