Ramadan can be a difficult time for those with mental health difficulties, but for those who have an eating disorder, it can trigger difficult thoughts and feelings. The period of fasting and feelings of fullness at Iftar or Suhoor, the increase in number of social gatherings centered around food and feelings of hunger can be difficult triggers and may cause significant deterioration in physical health or disrupt recovery in those with an eating disorder.
That is why it’s important to get advice from professionals, family or friends about whether fasting is right for you. For those in acute stages of illness,who have lost a significant amount of weight, are underweight or 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, however 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 according to Allah’s teachings, fasting is prohibited in these situations. The very act of fasting, particularly if it triggers thoughts of starvation and losing weight, can take you away from the true meaning of Ramadan. Instead, there are many other ways you can experience and get the best from the Holy Month.
What can I do during Ramadan if I am not fasting?
- Ramadan is not just about abstinence from food. It includes abstinence from other behaviors that may be considered harmful, such as smoking. Pick a few behaviours you want to work on during Ramadan and make these your goals for the month. Try to focus on what you can do rather than what you can’t do.
- 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 can help you to feel good during this month and increase your blessings from Allah. Providing food to others who may be less fortunate is highly recommended.
- Continue to engage in social activities as much as possible. These 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.
- Not fasting may bring up feelings of anger, guilt or shame. Talk to someone you trust 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 able to fast?
If you have sought professional advice and are able to fast, determining that doing so will not impede on your physical health or your risk of relapse, there are a number of ways you can look after yourself.
- Make sure you do not skip on Suhoor or iftar, as you should be leading with the intention to practice fasting, not starvation. Including snacks between Iftar and Suhoor rather than having one large meal can be helpful to prevent binge eating, so consider adding a snack before bedtime.
- If you have a regular eating plan, discuss with the professionals supporting you how to make adjustments for Ramadan and plan well in advance. Periods of hunger or restriction can increase the risk of binging or purging, so making sure you’re having sufficient food between Iftar and Suhoor. Eating slowly and planning in advance is key. It is normal to feel full and bloated after Iftar and 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 to make sure you’re getting enough energy through the fast. Include slow energy release foods such as bread, rice, oats, yoghurt, dates, eggs and nuts. Often 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 binging and ensure that you replenish sufficient energy after the fast.
- Managing social eating during Ramadan can be difficult particularly 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 about losing weight 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, consider and 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 to best support someone with an eating disorder during Ramadan:
- Remind 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 the goals and motivations that are present, which will allow them to hopefully fast in the following year.
- You may help support your loved one by suggesting and supporting them in 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 can 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 thinking of and 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.
It is very easy to compare ourselves with what others are eating and this may 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.
Dr Teizeem Dhanji
Dr Teizeem Dhanji is a consultant child and adolescent psychiatrist from the UK and join lead on Lighthouse Arabia's ED service.