How the pressure to look perfect on the big day is leading some women to extremes.

Adapted from Newsweek article by Pat Wingert and Sarah Elkins

Since 24-year-old Noelle Nicolai got engaged in early January, she's been surprised that no one has asked about her plans for "happily ever after" or the details of the engagement. Instead, all the questions have revolved around one topic: what she's going to look like on her wedding day.

"I've fielded a barrage of 'What are you going to do with your short hair?' 'Do you have a dress?' 'What will your makeup be like?'," says the Utah native. Although Nicolai has long prided herself on her ability to resist what she calls society's "aesthetic obsession," she says that less than a day after becoming engaged she found herself writing a to-do list of "shallow" goals that included teeth whitening, monthly facials, waxings, hair shine treatments and tanning. She went to a dermatologist for a regime of antibiotics, creams and cleaners to guarantee a blemish-free face by her wedding day at the end of June. She even pulled out her retainers from her high-school years to get her teeth back in "post-braces alignment." At the top of her list: knocking 12 pounds off her already thin frame. (She's got a Body Mass Index of 20—the lower end of the normal weight range.)

All this fuss seems a little crazy to her fiancé, who's constantly reminding Nicolai that he's happy with her as she is. But Nicolai is hardly alone in her desire to look perfect on her wedding day. Consider the stacks of wedding books on store shelves.  The standard for brides today, says Nicolai, "is red carpet-worthy good looks." Not only can that lead to unrealistic expectations and unnecessary stress for brides-to-be but, sometimes, to unhealthy behavior as well.

According to one bridal salon owner that was interviewed, today's bride-to-be naturally wants everything to be perfect.  They want their hair, nails and makeup all professionally done. They want a beautiful dress. Many brides will order their dress a size or two smaller than what they currently wear because they're determined to be thinner by the big day. Some go much further than that. Some brides who ordered a size 12 to get alternations to make their dress a size 20.  The denial seems absolutely ridiculous.  Ironically, it's often the women with the least to lose who lose the most. A lot of thin girls get obsessed with being even thinner end up coming in for their fittings looking like a rack of bones.

Researcher Lori Neighbors, an assistant professor of nutrition at the University of Wisconsin-Milwaukee, recently took a more scientific look at the relationship between looming nuptials and weight loss. In a study recently published in the journal Appetite, Neighbors followed the dieting patterns of 272 engaged women who were, on average, six months away from their wedding day. She and her co-author, Jeffrey Sobal, professor of nutrition at Cornell, found that 70 percent of them were trying to lose more than 20 pounds and another 20 percent were closely tracking their weight to ensure that they didn't gain anything. "People take their bodies on as projects, and one of the times you want that project to be the most successful is on your wedding day," says Sobal. The study found that most engaged women choose healthy ways to achieve their goals: they cut the junk from their diet and increase their exercise levels. But the researchers were distressed that more than 20 percent of the women they studied used methods they characterized as "extreme," including skipping meals, going on liquid diets, fasting, or taking laxatives or unprescribed diet pills and supplements. A small percentage even started smoking as a weight-loss strategy, while others began vomiting after meals. "With the current high prevalence of anorexia nervosa and bulimia, the pressure of a wedding is one thing that may trigger this kind of unhealthy behavior," says Sobal. (The National Eating Disorders Association estimates that as many as 10 million women and girls in the United States suffer from a serious eating disorder.)

Neighbors says the rising expectations of bridal beauty have in recent years spawned a wedding weight-loss industry. "Up until fairly recently, there was little overlap between the bridal and fitness industries," she says. "Today there are a ton of wedding weight-loss books and wedding fitness programs out there."

Such programs can help women develop healthy lifelong habits, says one personal trainer. A lot of women come in wanting to tone their shoulders and arms because they're going to wear a sleeveless or strapless dress. But sometimes clients go to extremes, overexercising to the point where they could be endangering their health. Desperate women regularly phoned wanting to lose 20 or more pounds in a month - that's just unrealistic. The general rule of thumb is 1 to 1.5 pounds a week, and even that requires commitment. It's easy to pay someone to make your hair look nice. It's easy to pay someone to do your makeup and it's easy to pay for a dress. But losing weight, that takes actual physical work. People who come in looking for quick fixes, who are not really that focused on fitness to begin with, normally only last two sessions.

Women may not be able to buy a lean body, but they can purchase a tanned one to offset all those yards of white fabric. Despite all the warnings about skin cancer, doctors say many young women are turning to tanning salons to achieve that bronzed look, and putting their health at risk in the process. What they typically say is that they are just going to go a few times for a "base tan", says one dermatologist.  They don't realize that tanning bed energy goes six times deeper than natural sunlight. Fifteen to 30 minutes in a tanning bed can be the equivalent of three or four hours on the beach. You're getting concentrated damage. Even a couple of visits, especially if they result in a burn, can dramatically increase the risk of developing skin cancer.  The tanning industry says it's a safe way to get a tan, but if you ask people who use them, a lot of people get burned.

Brides are also wanting a shot of Botox, a little filler to eliminate a wrinkle, or a shot of cortisone to deal with an outbreak of acne. Chemical peels, once the hot thing, are now giving way to laser treatments that eliminate little broken blood vessels, sun spots and other bothersome blemishes. These treatments are safe if done correctly, but there are a lot of people (including general practitioners and nondoctors) offering these services who have had very little training. Some have even used research-grade botulinum toxin in lieu of Botox, because it's cheaper—but misuse has landed a few people in the hospital for months, hooked up to ventilators, after developing full-blown cases of botulism. Dosage and placement are critical for these treatments.  A lot of people are looking for low-cost alternatives, but you get what you pay for.

Nicolai says she's trying to be smart about her choices. She decided that her acne wasn't bad enough to take a chance on a prescription, which has a long list of possible side effects. She has plotted out a healthy weight loss plan and hopes to lose three pounds a month by cutting back on carbs, increasing lean protein, reducing portion size and scheduling four to six 90-minute gym sessions a week. She's also put off her trip to the tanning parlor but says she may still go just before the wedding.

There's a much-YouTubed "Bridezilla" video of a shrieking bride literally chopping off her hair, and while the clip is clearly staged, Nicolai says a lot of brides-to-be can relate. "Bridezilla exists within every bride-to-be, and it takes effort to rein in that inner demon," she says. She's trying to maintain some perspective and balance. She's made an effort to seek out research on how to make a marriage successful. She's setting aside time for religion and service projects, and she's making sure that every conversation with her fiancé doesn't revolve around the wedding. But that doesn't mean she doesn't still feel the pressure to look her best when she walks down the aisle. "At the end of my wedding day, it won't matter if my hair was perfect, my teeth were blindingly white or my body was as hard as the rock on my finger," she says. "But that doesn't mean I won't try!"