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Luisel Ramos, who suffered a heart attack recently

The dress, leggings and A-line mod styles may have made headlines at this year’s international fashion weeks, but the real debate that raged off the runways was the size of the models.

The issue jumped into the limelight after organisers of Madrid Fashion Week banned models with a body mass index - a ratio of height to weight - of less than 18. That meant a model measuring 170 centimetres tall had to weigh at least 52 kilograms. Under such a ruling British supermodel Kate Moss would not be able to take part.

A factor driving the controversy was the death of 22-year-old South American model Luisel Ramos, who suffered a heart attack after stepping off a runway in August. She had been on a three-month diet of green leaves and diet Coke after being told she could be an international sensation - if she lost weight, a report in the Sydney Morning Herald said.

There was also a strong reaction to the models at New York Fashion Week, said Tim Gunn, who stars on pay TV’s Project Runway and is chairman of the fashion design department at Parsons The New School for Design in New York. “Some of the girls caused you to gasp,” he says. “When the knee joint is wider than the thigh, it can be scary.”

The debate is intensifying amid concern that the use of spindly models sets unrealistic standards of beauty that encourage young people to crash-diet at the expense of their health.

Milan mayor Letizia Moratti urged organisers behind Milan Fashion Week to follow Madrid’s example.

The storm only abated after organisers confirmed plans to introduce a new skinny model policy next year. All models will need to present a doctor’s certificate of good health before they will be allowed to walk at the autumn season shows in March, while under-age talent will have to be chaperoned.

The British Fashion Council, which organised London Fashion Week, cancelled its photo call after a barrage of criticism for refusing to follow the lead taken by Madrid and ban models under a certain size.

A consortium of retailers said they would prohibit extremely thin models from participating in The Clothes Show Live in December, a major UK fashion event that has kicked off the careers of many famous models.

The debate gained high-profile support. Peaches Geldof, the 17-year-old daughter of Sir Bob Geldof and the late Paula Yates, told the British tabloids the issue was “disgusting”.

“I think the whole fashion industry needs to wake up. It disgusts me,” said Peaches, speaking after the Ben de Lisi show at London Fashion Week.