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Decker was born in Kettering, Ohio, the daughter of Tessa, a nurse, and Stephen Decker, a pacemaker seller. She and her family moved to Middletown, Ohio, then to Matthews, North Carolina, a suburb of Charlotte. She was discovered in a Charlotte shopping mall as a teenager. Decker began her modeling career as the face of Mauri Simone, a popular prom dress maker. She won the 2003 Model of the Year award at the Connections Model and Talent Convention. In a January 2011 interview with Self magazine, Decker stated that she suffered from an eating disorder and states, "My father did an intervention and got me to stop obsessing about everyone else and wrecking my body."