The size-zero models and waif-like celebrities who grace magazine covers and dominate television screens did not cause Mandy's eating disorder: something rooted far deeper did that.
But these images exacerbated the problems Mandy, 27, and the women who suffer from anorexia nervosa face to overcome the disease. Mandy and four other patients at Cygnet Hospital Ealing's Eating Disorder Unit, ranging in age from 21 to 57, represent the group that the size-zero debate can potentially harm the most. Last week, they told The Independent on Sunday that the fashion industry, Hollywood and the media should take responsibility for the images they portray and the lives they affect.
Kim said: "You look at them and think, 'God, I wish I did look like that. I really want to look like that.'"
Lily Cole, Mischa Barton, Nicole Richie and Victoria Beckham are among the well-known size zeros whom young women are reputedly increasing trying to emulate. Nicole Kidman may be the latest celebrity to start dropping dress sizes after she slimmed down from a size eight to a size six.
The five patients who sat in the unit's group room last Friday would rather see models with higher Body Mass Indices (BMIs) and more average body weights. The underweight model images do affect them and younger girls in the early stages of anorexia.
Mandy doesn't blame the models and celebrities for their low weight. She said these women are publicly scrutinised each time they put on an extra pound. Even so, the women in hospital don't think it's right that they and others are in the wards battling their illness while celebrities and models with the same condition are not.
Cindy, 21, asked: "Why aren't they in hospital getting treated, like we are? Why can they be like that and we can't?"
Mandy, who has battled anorexia since a young age, added: "We're all sectioned and have tubes put down our noses to be able to eat, and we have people out there who have lower BMIs than us."
Those with a BMI below 17.5 are considered in the anorexic range, said Vanessa Ford, clinical manager and nurse at the Eating Disorder Unit, which provides assessment and treatment for patients aged 16 and over with eating disorders. Below 15 is life-threatening, and below 10 is "non-conducive with life". The lowest BMI Ms Ford has seen at her clinic is 9.8.
But anorexia isn't just about food and striving to be skinny - it's about control and deprivation, Ms Ford said. The disease takes over and makes it difficult to be at peace, to relax, to simply enjoy life.
The women who suffer from anorexia find it difficult to hold relationships or even to socialise. Food becomes their main focus, to the point where it's almost all they think about. The images they're bombarded with daily fuel this obsession and give them an unhealthy goal to try to reach.
Mandy said: "I don't think they always cause anorexia, but I think they have a big influence once you're in the grip of anorexia."
Even with the public outcry to ban underweight models and to help girls focus on a healthier body image, companies are coming out with more products that only drive the Western quest to be thin. Coca-Cola plans to launch a drink, Enviga, that, it claims, will burn 60 to 100 calories a day after the third can is finished.
Television shows, particularly reality shows, also fuel the illness. The women mentioned shows such as You Are What You Eat and Fat Camp. These shows make them feel that eating normally is "bad", Mandy said, and the others agreed.
The women in the unit said that even the success they felt when they started losing weight wasn't enough to make them happy. They always wanted more - to drop another size or to lose another few pounds. They'd like to see underweight models, celebrities and the media take responsibility for the harm the images they promote can cause.
Mandy said: "They need to realise they're costing people their lives. They need to think about that. They're playing with people's lives. It's not a game."
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