Written by: Fatema Jivanjee-Shakir, LMSW
Primary Therapist at The Renfrew Center of New York City
Ramadan can be a trigger for those suffering from an eating disorder. In this post, we look at where the intersection occurs, and what can be done to manage it.
What is Ramadan?
Ramadan is a holy month for Muslims, followers of the Islamic faith. Ramadan falls on the 9th month of the Islamic lunar calendar. In 2022, Ramadan occurs primarily during April of the Gregorian calendar. It is believed that during Ramadan, Allah revealed the Qur’ān to Prophet Muhammad. This scripture serves as a guidance for Muslims around the world.
One of the pillars of Islam is sawm, which means to refrain or abstain. During the month of Ramadan, many Muslims around the world practice fasting from food, drinks (including water), and sexual activity from sunrise to sunset as a way of observing sawm. The length of the fast can vary from 9 hours to 20 hours depending on the person’s geographical location. During Ramadan, Muslims typically eat an early morning meal before sunrise, called suhoor, and an evening meal after the sun sets, called iftar.
Ramadan is often viewed as a time of self-restraint, cleansing, and reflection. The endurance of discomfort cause by the deprivation of food is believed to cultivate patience, discipline, and appreciation for the privileges and bounties one has access to. Ramadan is also a time of increased social connection, as many Muslims come together not only for prayers, but for meals like suhoor and iftar. It’s common to see families and friends getting together and preparing large feasts to enjoy together during these meals.
How do Ramadan and eating disorders intersect?
Ramadan can be a triggering time for those suffering from an eating disorder in a number of ways. The practice of fasting can contribute to bingeing. One may restrict food all day and then engage in binge eating upon breaking the fast due to feeling extreme amounts of hunger or feeling as though they have permission to binge because they were “good all day” by fasting. While it’s important to nourish oneself upon breaking the fast, the underlying disordered eating thoughts that accompany bingeing upon iftar can be unhelpful for many folks, as it reiterates the idea that food has to be earned.
Furthermore, eating after breaking the fast can cause physical and emotional discomfort. When your body has gone all day without nutrition, introducing food into the system can lead to physical symptoms such as stomach pain, diarrhea, nausea, and bloating. This discomfort can bring on guilt for some people, who may feel bad for the amount they ate or may feel guilty for feeling sick after having the opportunity to eat following a fast. Some folks may purge as a way to cope with the physical and emotional distress caused by eating.
Additionally, for those who are struggling with restriction and dieting, fasting can perpetuate the restrictive mindset and its associated behaviors. Some people may continue to restrict past sunset. This can place the individual at increased medical risk, as lack of nutritional intake can lead to a host of medical complications. It can also impact functioning. Fasting can make it difficult to concentrate and partake in activities like school and work. It can also impact mood and anxiety levels. While fasting can impact these facets of one’s life, the impact can be even greater if fasting is continued beyond the typical hours.
Fasting can also come with praise that perpetuates diet culture. It’s common to hear people commend the willpower and control they believe someone is exerting by fasting. People may also be praised for weight loss during Ramadan. This can place a lot of pressure on the individual who is fasting to continue the restrictive behaviors beyond the fasting hours and beyond Ramadan in an effort to continue receiving the praise, feeling a sense of control, and losing weight. For folks in larger bodies, there can be an increased pressure from the self, family, or friends to use Ramadan as a way to kick off a diet and lose weight. This mentality can trigger disordered eating.
A Note on How Biological Development Intersects with Ramadan and Eating Disorders
The month of Ramadan can bring up a lot for folks related to sex, gender, and pubertal development. In some Islamic sects, fasting becomes required when an individual reaches puberty. In other Islamic sects, fasting is practiced from a younger age.
For those who begin fasting at the time of puberty, the practice can come with a heightened awareness of the body and bodily changes that occur during this time. For some there may be a sense of control that occurs if they notice that fasting allows for a pausing of pubertal development, namely in the form of weight loss or weight gain prevention, which can subsequently slow the progression of breast development or pause menstruation. If an individual notices that fasting is accompanied by these side effects (regardless of whether they begin fasting at the time of puberty or before), they may continue engaging in restriction beyond the fasting month in an effort to control the body’s development.
Fasting is discouraged during menstruation. If an individual is eating at a time where other family members and friends are fasting, it can bring attention to this pubertal shift. This can be uncomfortable for many as the biological bodily changes are often accompanied by a change in social expectations and responsibilities associated with both religious and cultural norms. For example, in some Islamic sects, the pubertal shift comes with a change in the type of clothing that is worn. The new clothing typically covers more aspects of the body than what might have been covered prior to the pubertal shift. This can again lead to a heightened awareness of the body and its changes. Transition and change, such as those that occur during puberty, can serve as a risk factor for the development and maintenance of eating disorders.
I’m Muslim. Do I have to fast if I have an eating disorder?
People who are elderly, pregnant, or ill are exempt from fasting according to Islamic doctrine. Eating disorders are classified as an illness, and therefore those who are struggling with an eating disorder are not required to fast. However, many people find it difficult to view the eating disorder as an illness, in part due to cultural stigma, and this can lead to feelings of shame and feelings of failure related to practicing one’s religion. Furthermore, for those who are in recovery, there might be internal or external pressures to fast once the eating disorder behaviors have stabilized or when someone whose weight was below their body’s set point has weight restored. What we know about eating disorders, however, is that recovery doesn’t end when the behaviors do. The disordered eating thoughts and underlying emotional difficulties often require ongoing treatment before an individual is in a place to safely resume fasting.
How do I decide if fasting is right for me?
Deciding whether to fast during Ramadan when you are struggling with an eating disorder can be a difficult one. The first thing to remember is that this question is important for all folks who struggle with an eating disorder or disordered eating. It’s commonly thought that this question only applies to folks who struggle with restriction and/or are in smaller bodies, but this is not the case.
Next, explore what your intention is with fasting. Is it to honor your religious practice, or to honor your eating disorder? Eating disorder thoughts can be strong and convincing. Being honest with yourself and your supports about the answer to this question is a key place to start.
Consult your doctor to determine if it’s medically safe for you to fast. Talk with your treatment team to explore if you are in a stage of your recovery where you can engage in fasting in a safe way. How can you continue to nourish your body while honoring your religion? What support systems can you engage to help you manage triggers that may arise?
Regardless of whether you fast during Ramadan, it can be helpful to explore what relapse prevention strategies and coping mechanisms can be engaged during this month. Often times, there is increased food and body talk during Ramadan, which can be triggering for folks in recovery. Plan for triggers that may arise and talk with your supports about how they can help you navigate these situations and create environments that feel safe for your recovery during this time.
Finally, explore other ways you can engage in the underlying spirit of Ramadan in a way that does not involve food. Some folks choose to fast from social media, TV, movies, or music. For others, rather than decreasing certain activities, they choose to increase activities like salat (prayer) and sadaqah (helping others) that connect them to the foundational principles of Islam. The decision to fast is an individual one, and it can often be helpful to talk with one’s religious leaders and treatment team to explore what observance of Ramadan can look like for the individual person.
Note: In this article, the Saudi Arabian terminologies of Islamic words are used. Different regions have different cultural influences that impact the language utilized. For example, South Asian Muslims refer to Ramadan and Ramzan, suhoor as sehori, iftar as iftari, salat as namaaz, and sadaqah as sadaqo.