It’s no secret that navigating the ins and outs of eating disorder recovery can be rife with obstacles, challenges, and setbacks. But traversing that road while also staying faithful to your culture’s religious or spiritual practices that include food restriction can be particularly tough.
Just as those who observe the Jewish high holidays may experience, those who participate in Ramadan, the Muslim period of spiritual reflection, worship, and self-improvement may have to make some difficult decisions about how they or their families choose to worship — specifically because the holy month involves abstaining from food and beverages for most of the day.
“Fasting Ramadan is one of the essential worships,” says Hala Abu Taha, senior dietitian and volunteer at the Middle East Eating Disorder Association (MEEDA). “Muslims stop having any food or drinks or smoking from sunrise until sunset. As a Muslim who fasts for Ramadan, I can say fasting is challenging and has many spiritual benefits if individuals have no medical conditions. However, fasting during the journey of eating disorder recovery or treatment can be harmful.”
According to experts like psychologist Omara Naseem who penned a guide for patients and loved ones about the intersection of Ramadan and eating disorders, the purpose of the fast is to “allow the individual to understand the pain and suffering of those less fortunate in the world who live their lives in poverty and famine, leaving the participant feeling more grounded and grateful for all that they have.” Naseem makes it clear that intention matters and that “an eating disorder may skew your mindset away from faith and more towards fasting for the eating disorder (e.g. to lose weight)” instead of focusing on purposeful mindfulness.
While fasting may be a central part of Ramadan, Taha says it is not the only way to express or explore one’s faith during the holy month. “The bigger picture it's not only about restricting food and drinks,” she says. “Patients in recovery can engage themselves in more spiritual worships like donating money and food or reciting more Quran, forgiving others, and praying more.”
Taha explains that while she has observed prejudice in the Muslim community toward individuals who are unable to fast, Islam itself does not endorse or condone stigmatizing those who do not traditionally observe the holy month. “In Islam, Allah [God] has given permission to people who can't fast not to — all they have to do is ask imam [a person that is well knowledgeable and trustworthy] to confirm they do not need to fast.” Taha says this principle is often applied in the case of pregnant women and those living with a chronic disease that would be negatively impacted by the fast.
“As a Muslim member of MEEDA, it was crucial for me to ask and investigate thoroughly if people with active eating disorders can fast,” Taha says. “The answers I got from high-ranked individuals in Islam were that each patient should be evaluated by their medical doctor and if their doctor confirms that fasting will be harmful, they shouldn't. If fasting will affect a patient's physical or mental health, there is no ‘best way’ to fast.”
If you or your loved one are considering fasting during Ramadan, consulting a medical professional may serve as an important first step in making the decision. In a 2014 clinical case report in the International Journal of Eating Disorders, researchers found that the “drastic change in one's diet such as that which occurs during Ramadan” may play a role in triggering or exacerbating eating pathology in teens predisposed to eating disorders. They concluded that it is crucial to have a physician evaluate the situation when warning signs are present.
In her own practice, Taha has seen how fasting can be a slippery slope for disordered behavior and the importance of considering potential triggers. “Many of my patients with anorexia recall preoccupation with food which can cause high anxiety and lead to more fatigue,” she explains. “One of my patients recently stated that fasting Ramadan triggered her to restrict more. Another patient who suffers from binge eating disorder recalled how fasting triggered more binge episodes.”
For those who do decide to fast, reflecting on where you are in your recovery journey can help with coping ahead of these potential pitfalls. By anticipating the mental and emotional toll of abstaining from food, your family can determine what additional resources and support you may need.
Taha suggests starting with making a meal plan and scheduling ahead of time. “Break [your] fast as soon as [the sunset prayer] to nourish the body with all the food groups needed and not eliminate any group or reduce portions. After iftar [the meal eaten after sunset], frequent meals should be followed by a maximum three-hour gap. Delaying the suhur [the meal consumed early in the morning before fasting] is essential for people to have stable blood sugar and energy levels throughout long fasting hours.”
While there are many factors to consider when deciding how to safely and appropriately observe Ramadan, Taha emphasizes that the support of family members can be critical for those who are not able to fast and that shifting traditional attitudes and beliefs can go a long way in helping individuals in recovery.
“It's very important for family members to understand that an eating disorder is not a choice and patients can be triggered by any behavior,” she says. “Family members can show support by making sure that food is always available in fasting hours for the patient to have. They can also encourage and join the patient in other spiritual worships and try to avoid talking about ‘healthy food’,dieting or even weight changes during Ramadan.”