How to manage your eating disorder during Ramadan

The practice of fasting and feasting is present in many religions. In Islam, Ramadan is a time for prayer, self-reflection, self-discipline and heightened devotion and worship. Followers fast from dawn to sunset. Fasting serves to cleanse the soul and redirect oneself away from worldly activities. It is the most sacred month in the Muslim calendar. However, those with an eating disorder may feel understandably anxious regarding the impact of fasting upon their difficulties. If possible, talk to someone close about your concerns and let them know how they can support you.

This year Ramadan may be further complicated by the COVID-19 pandemic and the need for social distancing. Instead of celebrating with their families, some people may be undertaking Ramadan by themselves.

Is it safe for me to fast?

For those in an acute phase of an eating disorder, it may not be safe to fast. For example, if you have recently lost a lot of weight quickly, are significantly underweight or have disturbed electrolytes, you may be increasing your risk. If you have previously lost 3kg or more during Ramadan, consider if you are ready to fast this year. You may also recognise that fasting would jeopardise your recovery and increase the risk of relapse. Discuss your health with your doctor. Muslims may be excused from fasting if it will complicate a health condition and you may wish to discuss your decision with your Imam or spiritual leader. Consider if there are other ways you can work towards the goals of Ramadan.

Why am I fasting?

The purpose of fasting is to promote self-reflection and devotion to Allah. However, it is possible that some people can experience unhelpful thoughts about losing weight during Ramadan, which in turn can lead to increased and excessive fasting practices. Therefore, it is important to remind yourself of the meaning behind Ramadan.

What if I am not fasting this year?

You or your medical practitioner may have decided it is not safe for you to fast this year, which may give rise to a number of feelings including anger, guilt and shame. Try to talk about these feelings with someone you trust. As above, try to connect with the meaning of Ramadan and demonstrate your devotion to Allah through reciting and reflecting on the Qur’an, praying and charitable acts. Make a plan to ensure you have the food you require during the day and do not begin to skip meals. Explain to those close to you why you are not fasting to reduce awkward questions. If others in your household are also not fasting, try to share meals together. Do join in Iftar.

I can’t follow my regular eating plan – what should I do?

If you are in treatment, it is likely that you and your therapist have worked hard to implement a regular eating pattern of 3 meals and 2-3 snacks per day, spread at regular intervals. It may be scary to move from this to fasting. Make sure you have a plan in place before Ramadan starts. Do not skip Suhur and ensure that you include complex carbohydrates and other energy providing foods such as cereal/oats, labneh, bread, dates, honey and yoghurt.

Iftars often comprise of huge buffets with many rich and delicious savoury and sweet dishes. Eating dates after a long days fasting can help bring the blood sugar level up to normal, therefore it is a good idea to break your fast by having dates first.  After dates, start with salad and soup to reduce the risk of bingeing or overeating later. Eat slowly for better and healthier digestion. Make sure you take sufficient food (a family member or friend may support you – or copy someone you know has a sensible approach to eating). Remember this will be more than you normally eat for a main meal because you need to make up the energy. Make sure you include complex carbohydrates (e.g. rice, bread, potatoes) and protein (e.g. meat, chicken) to replenish your energy supplies. If possible, find somewhere to sit down and eat your meal at a sensible pace. We recommend you have dessert for three reasons, firstly to ensure you have sufficient energy to last you through the next day’s fasting and secondly, because this is part of Iftar and breaking the fast. For those with an eating disorder, eating for social reasons can often be challenging. Thirdly, having dessert in a planned way will reduce the risk of bingeing.

Drink plenty of water from Iftar till Suhur, in order to stay hydrated. It is better to drink small amounts of water over this whole period than drinking large amount of water in one go.

How can I manage a buffet?

Buffets can often be overwhelming. If you have an opportunity, practice before Ramadan starts. You may also feel anxious about eating in front of large numbers of people. If possible, share your concerns with someone you trust. Speaking to family members beforehand may reduce accidental unhelpful comments. You may find it helpful to write out a plan of how to manage your eating disorder during Ramadan and follow it. As Ramadan progresses, you can keep adapting your plan until you feel more confident.

I’m scared I’m going to lose control and binge and purge!

If you are someone who binges or purges (now or in the past), you will know that these behaviours are often triggered by hunger and long periods of low intake so it is understandable you may be very apprehensive during Ramadan. Make sure you do not miss Suhur or Iftar as this will increase the risk of losing control the next time you eat. As above, make sure you take a sufficient amount of food and eat slowly, allowing time for your stomach and brain to receive the message that you have eaten. Do not restrict on food at Iftar because you are worried you may binge on dessert later.

Following Iftar you may feel very full. This is normal and not a sign that you need to vomit or use laxatives. Try to distract yourself through talking to others, reciting and reflecting on the Qur’an, meditating, watching TV, or undertaking charitable acts. Remind yourself of the purpose of Ramadan and the meaning of breaking the fast. Instead of helping, purging is likely to leave you hungrier and more at risk of further bingeing and purging.

If you do binge or purge, do not give up. Learn from the experience – what can you do differently the following day? You may need to eat more at Suhur, ask someone for help or increase your planned strategies. Look back at what has worked before when you have had the urge to binge.

Everyone is talking about eating, fasting, or food preparation!

It is understandably difficult with the emphasis on food and fasting during this month. Think about how you manage this talk at other times in the year. Be ready with conversation topics that can act as alternatives.

What should I do after Ramadan?

Some people may be tempted to follow a restricted diet after Ramadan is over. This is likely to maintain or intensify your eating disorder and increase your preoccupation with eating, shape and weight. When Ramadan is over, start your regular eating plan as soon as possible.

I am celebrating Ramadan by myself this year – help!

Due to social distancing, some people may be celebrating Ramadan by themselves this year. This may be particularly difficult given the limited structure and time away from the house at present. Please look at our Meal Planning and Coronavirus page for more tips. Try to arrange videoconferencing at times when you can share meals with others. If you are worried about bingeing, portion food out and buy limited amounts of highly preferred foods.

One more point… it is very easy to compare ourselves and what we eat to others. Please remember that other people will have different food tastes and energy requirements to you. As someone with an eating disorder, you may have different vulnerabilities or challenges related to fasting. Make a plan based on YOU and keep to it.

To read first person accounts of Ramadan by those with eating disorders see:

https://www.beateatingdisorders.org.uk/your-stories/ramadan-grips-of-anorexia

https://www.beateatingdisorders.org.uk/your-stories/eating-disorder-ramadan

And finally, we would like to say ‘Ramadan Kareem’.

Dr Vicki Mountford

Consultant Clinical Psychologist

Maudsley Health Abu Dhabi