A terrible force: Extreme thinness has replaced the body positive.
Extreme thinness is the first significant surge in the "skin and bones" trend after the so—called heroin chic of the 1990s and early 2000s. His followers do not take into account that with a critically low percentage of body fat, metabolism is disrupted, the "settings" of the reproductive system are disrupted, and appearance suffers. What dangers lie in wait for those who intensively lose weight for the sake of fashion — in the material of Izvestia.
Body positive or slimness
The trend towards excessive thinness is considered a response to an order of tired body positivity. It is called "ozempikovaya" after the name of the drug, with which fashionistas in the West lose weight, and then struggle with many side effects. Problems begin when any extreme, be it exhaustion or advanced obesity, is declared the norm, says Ekaterina Sakhnova, an endocrinologist and nutritionist at the Scandinavian Health Center.
— There is a healthy grain in the idea of a body positive — respect for your body and rejection of bullying for your appearance. But if we compare the risks of obesity and thinness, then they are serious for both sides. Obesity increases the risk of type 2 diabetes, hypertension, and heart disease, and it should be treated like any chronic disease. The higher the weight, the more likely the risk of death is, but too low body weight is also associated with increased mortality, the expert warns.
Excess weight harms slowly, over the years, and severe exhaustion is dangerous "here and now." People with an average body weight have the best chances of a long life, the Izvestia interlocutor notes.
Why does the reproductive system suffer when losing weight?
Drastic weight loss is especially dangerous for women, as it can put an end to motherhood.
— The female reproductive system is arranged like a chain. The hypothalamus (the part of the brain that controls hormones) releases the hormone gonadoliberin in impulses. It plays a key role in the regulation of the reproductive system. In response, the pituitary gland secretes LH (luteinizing hormone) and FSH (follicle—stimulating hormone), which trigger follicle maturation in the ovaries, the production of estrogen and progesterone (after ovulation), comments Ekaterina Sakhnova.
This whole chain is sensitive to how much energy the body has, and fats are its source. The main mediator in the functioning of the reproductive system is the hormone leptin, which is produced by adipose tissue.
— As long as there is enough fat, leptin tells the brain that there are enough reserves for life and pregnancy. When the fat goes away, leptin drops. Through the neurons that secrete kisspeptin (a kind of trigger signal for gonadoliberin), the brain mutes the impulses. LH and FSH levels decrease, the follicle does not mature, there is no ovulation, estrogen and progesterone fall, and menstruation disappears," says the endocrinologist.
Doctors call this condition functional hypothalamic amenorrhea. In men, the same lack of energy affects testosterone. In this case, the state of the body is very accurately described by the expression "emergency mode".
— The body directs energy consumption only for survival and turns off everything that can be lived without: reproduction, growth, part of the metabolism. At the same time, the level of cortisol (the stress hormone) is increasing, the active thyroid hormone T3 is decreasing, but its inactive form is forming more. Hence the chilliness, a rare pulse, loss of strength, and dry skin. Pregnancy with such a deficiency is considered an unacceptable luxury by the body, and from the point of view of biology it is logical," explains the interlocutor of the editorial board.
Problems may appear before the weight becomes critical. The energy balance decides everything here: if a person consumes noticeably fewer calories for a long time than they spend, especially against the background of training and stress, then the hypothalamus "sounds the alarm" when the indicators are still normal.
According to the doctor, hypothalamic amenorrhea is reversible in most cases.
— When weight and nutrition are restored, both menstruation and ovulation return. In women who have received full-fledged treatment, the chances of having a child in the end are comparable to the chances of their peers. Other changes are also reversible — for example, with exhaustion, even the volume of gray matter in the brain decreases, and after regaining weight, it mostly returns," the specialist explains.
However, it is not always possible to restore female functions promptly. It takes time for the hormonal system to make sure that hunger is over.
— Some women don't get their periods even at normal weight. Then a gynecologist-endocrinologist and a reproductologist are involved in recovery — ovulation in such a situation can be started with medication. The prognosis is worse for those who started starving before their first menstruation or in the first years after it, so the risks are higher for schoolgirls than for adult women, the doctor warns.
Skin and bones
Ekaterina Sakhnova sees the point of no return to her former health primarily in the problem with bones. The strength of the skeleton, which the girl did not understand in her teenage years, is not fully restored.
— Estrogen maintains a balance between the destruction of old bone tissue and the building of new ones. When there is little of it, destruction takes over, and the bone loses its density. In case of exhaustion, high cortisol, lack of protein, muscle loss and a decrease in IGF-1 (insulin-like growth factor; growth hormone acts through it) are added to this. The impact on the skeleton comes from several sides at once," the doctor explains.
Again, adolescence and adolescence are considered the most vulnerable, since during this period a margin of safety is made for life. The peak of skeletal bone mass occurs around the age of 20.
— If a girl is starving and lives without a cycle, then she is running out of this supply. Hence osteopenia and osteoporosis at a young age, fractures from loads that a healthy bone can usually withstand. Even after weight recovery, density deficiency often remains, and such a woman enters menopause from a deliberately low point," the endocrinologist comments.
The expert emphasizes that the risk group is primarily those for whom thinness has become part of a profession or sport: ballerinas, gymnasts, synchronized swimmers, long-distance runners, athletes of weight categories. This list, according to the editorial interlocutor, also includes models and everyone whose work is "tied" to appearance and camera. Ekaterina Sakhnova pays special attention to girls who combine strict diets with grueling workouts. From the outside, she says, it looks like a healthy lifestyle, but from the outside, it's the same energy deficit.
Why winter peak models age quickly
The disappearance of the fat layer on the face leads to a sharp visual aging — loss of collagen, elasticity, and wrinkles, since a young face is based on "volume," explains Ekaterina Sakhnova.
— There are separate fat bags under the skin of the cheeks, temples, and under the eyes. They create smooth convex contours and support the skin from the inside. With a sharp weight loss, these bags quickly deflate, and the skin does not have time to shrink. This causes sunken cheeks, holes under the eyes and on the temples, sharpened cheekbones, and unsightly wrinkles. This type has been dubbed the "ozempik face" on social media, although this is what any rapid weight loss looks like, with or without medication, the doctor explains.
The appearance is also affected by the fact that a drop in estrogen levels is added to the loss of volume with extreme thinness, and it supports the production of collagen and elastin fibers, ensures hydration of the skin and its blood supply. According to the endocrinologist, when the ovaries almost stop producing estrogen due to a lack of energy, the skin changes in the same way as during menopause: it becomes thinner, loses elasticity, becomes dry, wrinkles appear on it faster. For renewal, it needs protein, fats and trace elements.
— When exhausted, hair thinns and falls out, nails break, hands and feet look unsightly — cold and bluish. Sometimes a thin down appears on the back and arms — this is how the body tries to keep warm. For a doctor, this is one of the characteristic external signs of severe weight deficiency," the expert emphasizes.
For those who use drugs of the so-called GLP-1 agonist group for weight loss, which include semaglutide (contained, in particular, in the acclaimed "Ozempik"), the interlocutor of Izvestia advises to abandon this rash step. Such medications are prescribed only by a doctor. The indication is obesity (that is, a body mass index of 30 or 27 if there are already weight—related diseases, such as prediabetes or hypertension). Before starting treatment, specialists examine the patient and exclude contraindications. In addition, medications are taken under supervision: tests, nutrition with enough protein, and monitoring to ensure that as little muscle as possible goes with the fat.
— If a person with normal weight uses such a drug for the sake of an angular figure, then he risks only side effects. Most often it is nausea, vomiting, constipation, and dehydration. Less common are complications such as inflammation of the pancreas and gallstones. The drug slows down gastric emptying, and at high doses, even cases of intestinal obstruction have been described without control. These drugs have not been developed for people without obesity and diabetes, and their safety in this group has not been well studied," says Ekaterina Sakhnova.
Where is fashion moving and is it necessary to lose weight for it
One way or another, the proportions in clothes are changing in favor of slim beauties. International fashion stylist Alexandra Levitina notes that, according to Vogue Business, small sizes accounted for 97.6% of catwalk looks during the autumn-winter 2026 season (while 94.9% in the spring-summer 2025 season), and the share in the plus-size category was only 0.3%. Fashion experts consider this dynamic in the context of the proliferation of weight loss drugs and an interest in working on appearance.
According to the interlocutor of the editorial board, public perceptions of appearance influence the choice of brands, and the types that are shown on the podium become landmarks for the audience through the media — both factors are interrelated.
Fashion bloggers, who are sometimes far from model standards, also have an impact on fragile minds. They competently create the effect of extreme thinness in rils due to the successful angle, light, special cut of clothing and installation.
— There are many techniques that create visual illusions. For example, contrasting side inserts can visually narrow the silhouette, and the volume in the shoulders or hips enhances the contrast with the waist. Body rotation, muscle tension, foreshortening, and light change the perception of proportions. Retouching allows you to additionally change the contour of the body. Therefore, it is difficult to reliably determine the real parameters of the figure or the difference "in two sizes" from the video, the stylist explains, adding that the curved background lines next to the figure may indicate processing, and the absence of visible signs does not exclude the filter even in the video.
Therefore, it makes no sense to compare yourself with virtual beauties and put your health at risk. Moreover, according to the expert, modern fashion focuses not only on very slim people. In response to unhealthy trends, there is inevitably a demand for "conscious harmony."
— The increased demand for taking care of oneself and one's appearance is already noticeable: in the report of organizations that publish research on the state of the fashion industry and trends next year (Business of Fashion and McKinsey), "well—being" is highlighted as an important consumer priority, and in 2027 a desire to reduce stress and take more care of oneself is predicted. This is Alexandra Levitina.
In her opinion, you can choose a suitable version of a trendy silhouette for any figure, focusing on the degree of fit, length, fabric and combining things depending on individual proportions. To create an elegant look, the stylist recommends matte fabrics of medium density that gently fit the figure, such as crepe or smooth knitwear. The thing should allow you to move freely and not gather into folds due to the tight fit.
— It is important to select the scale of the drawing taking into account height and proportions. The printed dress is well complemented with a plain unbuttoned jacket. Midi skirts are more harmoniously combined with boots that go under the hem, and it is important to adjust the length of trousers to shoes. It should be borne in mind that thin, tight—fitting knitwear can emphasize the contours of the body, and rigid fabrics that stick out can add volume to the silhouette, the specialist warns.
You can choose models with tucks or raised seams that help the fabric repeat the shape of the body. The degree of openness depends on the length of the items and their combination.
The expert adds that in the next three to five years, interest in an athletic type with noticeable muscular relief may increase. Vogue Business has already noted women's craving for strength training and the appearance of such images in fashion and beauty ads.
— The return of glamour and volume is reflected in Pinterest Predictions 2026: the forecast highlights the aesthetics of the 1980s with wide shoulders and large jewelry. These directions can combine in an image that emphasizes physical strength. At the same time, different audiences have their own ideas about attractiveness. Therefore, my forecast assumes the coexistence of several landmarks: athletic, slender and more voluminous types may retain influence in different segments of fashion," says Alexandra Levitina.
According to her, the trend analysis of Tagwalk (a platform for finding fashionable images) for the autumn-winter 2026 season highlights a fitted cut, trousers with straps and masculine aesthetics. Such models indicate a pronounced contrast in volume: designers emphasize the waist in jackets and dresses, expand the shoulder line and combine narrow trousers with a loose top.
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