The full story of how a 22-year-old model died at the end of a catwalk show after days without eating can be told today.

The death of Luisel Ramos sparked the growing debate over the so-called size zero models and prompted the ban on models with a body mass under 18, which is officially unhealthy, at Madrid's fashion show.

Organisers of London Fashion Week have refused to back a similar move despite mounting calls for action.

Insiders disagree

But many agents, designers and photographers have held out, claiming there is nothing unhealthy about thin models.

Supermodel Erin O'Connor joined the debate, saying: "It's an important issue so all opinions are welcome. I could handle taking some responsibility for this but what about looking deeper and asking designers and others in the industry, not just the models."

The 28-year-old said she has been in a situation where a stylist noted clothes were too tight — to which she replied: "Well, why don't you make them bigger?"

Shocking death

Ramos's death illustrated the health crisis in the fashion industry. She collapsed and died after stepping off the catwalk for a costume change.

The cause of death was given as heart failure. But her father said she had been fasting for days.

A karate and gymnastics aficionado, she had enrolled at 18 in the model academy run by Maria Ines Rodriguez, an important figure in the world of Uruguayan fashion.

Under Rodriguez's tutelage, Ramos immersed herself in the administrative as well as the showy side of the business, taking to the catwalk three times a year.

Ramos had co-ordinated the Uruguay fashion week's closing show as Rodriguez's "right hand".

It was a Wednesday in early August and she had spent most of the day before her rare runway foray organising chairs and tickets and checking on the backstage costume racks and make-up kits.

She had many reasons to be proud that night. Her mother Else and father Luis Ramos, a member of Paraguay's 1966 football World Cup squad, were in the 1,000-strong audience.
So was her 23-year-old fiancé Jairo Berrondo, whom she'd met 10 years before, got engaged to in 2004, and planned to marry later this year. Ramos would be sharing the catwalk for the first time with her 18-year-old sister Eliana.

Last bow

But rushing backstage for a final costume change, she faltered.

An onlooker said: "She suddenly went pale and said she had heart pains." Ramos collapsed before she made it to the changing room. Micaela Rodriguez, another model and a medical student, went to her.

"It was clear it wasn't a common faint," she said. "She wasn't breathing and there was no pulse."

Her family and fiance presumed the show had stalled because of a hitch, until one of the organisers appeared and asked if there was a doctor present.

Dr Maria Laura Jaumandreu went backstage. "There were three girls trying to revive a fourth girl who was on the floor," she said.

"The moment I took her hand I felt there wasn't a pulse and realised the gravity of the situation."

Dr Jaumandreu attempted heart massage until an emergency medical team arrived six minutes later, by which time Luisel's family had fought their way backstage.

Despite every effort to resuscitate her, Ramos was declared dead at 9.15pm.

Fasting

It was the following day that rumours started to circulate. Stories sprang up that Ramos had been told by a modelling agency that she could "make it big" if she lost a "significant" amount of weight.

There was talk that she had been living off nothing but green leaves and Diet Coke for three months.

A news website printed quotes attributed to Mr Ramos, suggesting that his daughter had lost weight, drastically and deliberately, once Rodriguez told her she could model for fashion week.

"From that day on, when she got that promise, she hardly ate," he allegedly said. "Her whole life she liked pizza and mozzarella. Now she only took Diet Coke, no other food."

She had always been slim. At 5ft 9in and less than 60kg, she had a body mass index of less than 18. But in the weeks leading up to the show, it was claimed, Ramos's weight dropped to 50kg.

German news reports claimed her last meal was a breakfast of a glass of milk and a slice of bread.

Wild claims

There were claims that drugs were involved. Doctors speculated in print that she must have been starving herself, drinking very little fluid, possibly taking laxatives and forcing herself to vomit to lose so much weight so quickly.

Her father appointed a lawyer, Edison Lust, as the family's spokesman, who insisted in a statement to Montevideo's Carve Radio that Luisel had not been starving herself, or using drugs, but that she might have been "under much pressure and stress" because of organising the fashion show.

Berrondo told the Uruguayan magazine For You that he and Ramos had shared a pizza the night before she died.

Eliana added that she and her sister ate hamburgers and mayonnaise together at the Spanish Embassy at noon on the day of the show. "It is madness to say she was anorexic," she added.

Luisel was buried in Montevideo two days after her death. Many members of Uruguay's fashion and footballing communities attended the funeral.

Heart failure

A post-mortem examination showed only that she had died of a sudden heart attack.

There were no signs that either drugs or malnutrition were to blame and there was no history of cardiac problems in the family.

A chemical analysis has been carried out on post-mortem samples.

Eliana retracted an earlier statement that her sister might have been stressed and said she had enjoyed working for Rodriguez.

She added: "We do not want to give out any other statements. My sister died and I want her to rest in peace."

The results of the chemical analysis are due to be made public next week but the press in Uruguay is pressuring the authorities to release them early.

Whether those tests reveal that her death was caused by malnutrition or not, it seems that poor, thin, unknown Luisel Ramos is destined to be the martyr who blew open the big, dirty open secret of the fashion world: that it values thinness more than life.

World views

London

In the UK for his Emporio Armani runway show and to host a celebratory party, Armani weighed in on the debate, blaming the media for building up the image of the skinny model, and not the fashion industry.

"I have never wanted to use girls that are too skinny," he said.

"I prefer girls that show off my clothes in the best way. Unfortunately though, the stylists and also the media have interfered and they now want models that are incredibly thin."

Italy

Milan's mayor, Letizia Moratti, has threatened to follow Madrid and ban underweight models below a body mass index of 18 from the city's fashion week.

Australia

Kathy Ward, director of Sydney's Chic modelling agency, believes a ban on too-skinny models is a positive step for the industry.

The editor of the feminist Wo! Magazine, Anna Greer, said that the "impossible body ideal imposed by the fashion industry and media and pop culture is obviously a huge contributor" to teenage eating disorders.

United States

Stan Herman, a designer and president of the Council of Fashion Designers of America, said a ban on skinny models in New York would be classed as discrimination and could lead to legal action.

France

Didier Grumbach, head of the French couture federation and chamber of haute couture in Paris, condemned any attempt at regulation and said "everyone would laugh".