Balancing Spirituality and Recovery: Coping with Eating Disorders During Ramadan

Ramadan is a time for reflection, prayer and unity for Muslims around the world. It is the holiest month in the Muslim calendar which serves to cleanse the soul and direct Muslims away from worldly activities. The act of charity, engaging in good deeds and remembering those less fortunate increases our empathy and compassion towards others and gives us a sense of fulfilment.

Ramadan can be a difficult time for those with mental health difficulties, particularly those who have an eating disorder. Prolonged fasting, feelings of fullness or hunger and social gatherings centred around food, can be difficult triggers which may cause significant deterioration in physical health or disrupt recovery in those with an eating disorder. It is therefore important to get advice from professionals, family or friends about whether fasting is right for you. For those in acute stages of illness, those who have lost a significant amount of weight, are underweight or those who would be medically compromised with periods of fasting, it is not recommended to fast during Ramadan. You may also be at a stage of recovery or at a healthier weight, where periods of fasting could increase your risk of relapse, and so again it would not be advised to fast during this month.

If you are exempt on medical grounds, it is important to remember that fasting is prohibited in these situations. If fasting triggers thoughts of starvation or losing weight, it can take you away from the true meaning of Ramadan. Instead, think of the many other ways you can get the best from the holy month, some of which are mentioned below.

What can I do during Ramadan if I am not fasting?

• Focus on what you CAN do rather than what you CAN’T do. Ramadan is not just about abstinence from food but abstinence from other behaviors which may be considered harmful such as smoking. Pick a few behaviors you want to work on during Ramadan and make these your goals for the month.
• Increased worship and prayers are also an important part of the holy month. Consider praying the Quran, making dua or remembering Allah in a way that suits you.
• Giving charity or engaging in acts of kindness towards others. This can help you to feel good and increase your blessings from Allah. Providing food to others who may be less fortunate is highly recommended.
• Engage in social activities as much as possible. This may be during the day, particularly if attending Iftars is difficult due to the large amounts of food that may be presented. You may decide to have dinner and join friends or family later at night. For some, it is helpful to sit with family at Iftar, so you feel involved. Do what works best for you.
• Talk to someone you trust. Not fasting may bring up feelings of anger, guilt or shame. Talk about these feelings and try to connect to the true meaning of Ramadan and Allah’s intentions for you.

How to look after myself if I am fasting?

 If you have sought professional advice and are able to fast below are a number of ways you can look after yourself whilst fasting:

• If you have a regular eating plan, discuss with the professionals supporting you how to make adjustments for Ramadan. Periods of hunger or restriction can increase the risk of bingeing or purging, so make sure you’re having sufficient food between iftar and suhoor and not skipping meals. You should be leading with the intention of fasting not starvation, so snacks are important. It is normal to feel full and bloated after Iftar. This is not a sign that you need to vomit or use laxatives. Planning distractions and connecting with Allah can help you to manage these feelings.
• It is helpful to pace your drinking between iftar and suhoor rather than drinking large amounts of water at once.
• Planning meals in advance can be helpful as it ensures you get enough energy through the fast. Include slow energy release foods such as bread, rice, oats, yoghurt, dates, eggs and nuts. People crave sugary foods after a period of fasting so have dates when breaking your fast and plan to have a dessert after your meal. Planning for this will help reduce the risk of bingeing and ensure that you replenish sufficient energy after the fast.
• Managing social eating during Ramadan can be difficult if you are anxious about eating in large groups. Iftars can often include large buffets with lots of different options and so making choices can be difficult. Where possible plan ahead by looking at the iftar menu and share any concerns you may have with a trusted friend or family member.
• Ramadan can disrupt sleep so ensure you’re getting enough rest as lack of sleep can affect your mood.
• Keep a check on how your thoughts or feelings are affected by the fasting. If you notice unhelpful thoughts coming back it would be helpful to talk to someone and perhaps take a break from fasting. Also keep a check on your behaviours and notice early any behaviours or rules that might creep up again.
• After Iftar, plan how you might keep yourself distracted. This could be through meeting friends or family, worship or engaging in hobbies.
• Remember that if things do not go as planned it is ok. You can adjust how you might do things differently the next day and always seek support if you need it.

How can a parent/carer/family member/friend support someone with an eating disorder, during Ramadan?

 Reminding your loved one that they are exempt from fasting and that Allah rewards those who look after themselves is important. It could be helpful to look at goals and motivations that are present which will allow them to fast in the following year.

• You may support your loved one in finding alternate ways to use their time during the holy month. This could include projects, charity/volunteer work or personal reflection and worship.
• Try not to have conversations solely about weight or food during Ramadan. Often people become preoccupied by the meals they will prepare during iftar, so be mindful of this and try to remain neutral in your conversations.
• Your loved one may be following a regular eating plan and so it is important to support them to stick to this, despite others fasting around them. It may also be helpful for them to continue to sit with the family during Iftar so they have a sense of togetherness during the month. If this is outside a meal time, perhaps they can pre-plan a snack or make adjustments that will support them to feel involved.
• Support by engaging in distractions post iftar or through the day. Find activities that the family can enjoy together, that are not related to food or eating.

A final note…

It is easy to compare ourselves to what others are eating and this can be heightened during Ramadan. Remember that everyone has different energy requirements and your challenges related to fasting will be different. Make a plan based on your needs and hold on to the true meaning of Ramadan. Always discuss your concerns with someone you trust and get support when you need it as you are not alone.

Written by: Dr Teizeem Dhanji
Child and Adolescent Psychiatrist at Sage Clinics