Eight years ago, I wrote about a disturbing trend - if one can call self-starvation something so benign as a trend: the rise of the double zero, a US female dress size 00, equivalent to a British size 2 (Australia size 4).

Society registered its disgust. Women were striving to transform themselves not merely into zeros, but double zeros, with all the symbolism of reducing oneself to the less than nothing that this entailed.

Hollywood starlets bonily embraced the guise with full La La Land zeal, becoming ‘‘lollipop ladies‘‘; heads moonily out of proportion to their bodies. A catwalk model, Luisel Ramos, died from malnutrition. In the wake of this grotesque occurrence, designers who had once insisted on such builds cynically deflected responsibility by banning girls with a low body mass index (BMI).

But now Grazia magazine has alerted the world to a new, still more toxic, phenomenon: the cult of the - barely conceivable - size triple zero. This craze is evidenced in Hollywood in the skeletal forms of publicity-seeking actresses/personalities Nicole Ritchie, Kate Bosworth, Julie Bowen and Denise Richards.

And it is no longer, it seems, the preserve of rich, super-skinny celebrities. Abercrombie & Fitch, based in the US, has started using triple zero sizing on its labels.

Chillingly, a US size 000 measures up to a British size 0, five sizes smaller than a British size 10, itself on the smallish side in a culture in which the average British woman is a size 16, and the public’s ideal physique a size 12, according to YouGov. A US size zero measures 25 inches (63.5 cm) around the waist; a triple zero, a meagre 23 inches.

It can be difficult to visualise the bodies behind such unvital statistics. My eight-year-old nephew, so lean that he can fit into his baby pyjamas, has a waist of 23.5 inches; his lithe nine-year-old sister, measures 24 inches. The girths of these adult women are smaller, despite their being significantly taller, in a way that seems hardly possible. To be so narrow-framed at this scale is to be emaciated.

One does not need to be a medic to know that this is unhealthy. A BMI below 18.5 is considered underweight. Drop much beyond this and fertility is affected, low oestrogen having implications for osteoporosis. Circulation problems abound in a way that can lead to limb amputation. At the most atrophied extreme, loss of heart muscle can cause heart attack. As my doctor father, who used to work with anorexics, succinctly puts it: ‘‘Unless they recover, you do not tend to see anorexics beyond a certain age. They die.’’

So what on earth is going on? For a start, there is social media attention-seeking at play, whereby bony selfies equal instant publicity. At the same time, in a grotesque post-modern caricature, technology is having a warping effect on how some women perceive and seek to recreate their bodies. Slimming apps, such as SkinneePix, which reduces selfies by five to 15 pounds, and Plump&Skinny Booth, which whittles waists while plumping breasts, have spawned the desire for real-life supra-real proportions. While ‘‘vanity sizing’’, in which designers artificially lower dress sizes to ‘‘flatter’’ women into purchasing, only confuses matters.

And yet, something still more sinister is taking place. Celebrity fitness guru James Duigan strikes at the heart of the matter when he says of such women: ‘‘Their weight struggle becomes their story.’’ Celebrities’ fat/thin, or thin/dangerously thinner oscillation has become a lucrative genre by which publicity is generated; careers born and made on this ruinous juggernaut. To my mind, there is also the factor that, as society becomes ever fatter, so a self-appointed elite will seek to distinguish itself by going to the opposite extreme - at equal peril.’’

Susie Orbach, the psychotherapist and author of 1978’s pioneering Fat Is a Feminist Issue and Bodies (2009), which discusses the ways in which bodies are becoming sites of display and manufacture rather than places in which to exist, agrees.

Orbach tells me: ‘‘I think it’s the latest iteration of what has been happening over the past 30 years, taken to an extreme of food deprivation porn. We’re talking about the creation of pre-adolescent bodies. You turn yourself into a commodity. Your self becomes this body in the making, because the message is that we’re not supposed to have bodies. So women make themselves all surface, two dimensions, in the manner of an app.’’

She adds: ‘‘It is a class issue - no different to poorer societies putting a value on fat, but in reverse. Being thin is to be part of an elite. It says: 'I belong to the world of the international rich’. And their contribution becomes not having done anything, but the idea: 'Take my body as my work'. It becomes their story, a narrative of falling and redemption.’’

I have spoken to Orbach, whose latest project is called ''Endangered Bodies" (endangeredbodies.org) - about this topic over the years, and, each time, both of us lament not only that this conversation is still going but that matters appear to get worse. Did she imagine, when she wrote Fat is a Feminist Issue, that she would still be campaigning 36 years later?

‘‘I always say I feel deeply optimistic and deeply pessimistic, although maybe not deeply optimistic any more. I’m a psychotherapist and I’ve written more about other things over the years. But I can’t leave this subject. It intensifies so profoundly. And now it’s such a part of boys’ and men’s experience, too. It’s part of the experience of five-year-old girls and old ladies. It’s everywhere. I didn’t expect still to be engaged with it, but how can one not be?’’

Looking at this new rash of sub-size images, one can only agree - and fervently hope that it doesn’t take another three decades for us to come to our senses.

- The Daily Telegraph

