Eating Disorders And Ramadan: Debunking The Myths, Mechanisms To Cope

Authors: Rania Awaad, Neshwa Rajeh, Hamza Jalal, Aminah McBryde-Redzovic

For many, Ramadan is one of the most spiritual and highly anticipated times of the year, but it can also be a very challenging time for Muslims grappling with an eating disorder. Ramadan can be used as both a way to enable and discourage further negative mental health-related behavior by people who struggle with these disorders.

Despite the rich Islamic heritage of mental health contributions, discussions on mental illnesses today continue to be considered taboo for many Muslims. As such, when people decide not to fast due to an illness, they can become further stigmatized¹Ciftci, A., Jones, N., Corrigan, W. (2012). Mental health stigma in the Muslim community. Journal of Muslim mental health. Volume 7, Issue 1. Available on: https://quod.lib.umich.edu/j/jmmh/10381607.0007.102/–mental-health-stigma-in-the-muslim-community?rgn=main;view=fulltext . For individuals with more acute eating disorders, fasting can trigger a relapse. The challenge for many is that they may try to hide their eating disorder behind the veil of fasting, which can leave a person feeling lonely and even further displaced from their faith.

According to the National Eating Disorders Association, about 30 million Americans are affected by this disorder. Eating disorders are a large category of behavioral and physical illnesses regarding persistent and severely disordered eating habits as well as the thoughts and feelings related to one’s daily eating²NEDA. (2018). Statistics & Research on Eating Disorders. National Eating Disorders Association. https://www.nationaleatingdisorders.org/statistics-research-eating-disorders. The most common eating disorders include anorexia nervosa (obsessing about one’s weight and what one consumes), binge eating disorder (frequently consuming unusually large amounts of food in one sitting), and bulimia nervosa (binge eating followed by purging). Anyone, regardless of gender, age, sexual orientation, religion, body weight, health, or ethnicity, can be equally affected by one or a combination of eating disorders. As researchers and clinicians at the Stanford Muslim Mental Health and Islamic Psychology (MMHIP) Lab, we have gathered the most common myths about eating disorders and offer corrected responses that are aligned with both scientific and deen perspectives:

Myth #1: I can’t ever fast if I have a diagnosed eating disorder. 

Fact: Fasting with an eating disorder can be safe for some, but it can also be detrimental to the health and mental well-being of others. A trusted, upright medical professional who understands fasting, its purpose, and the ramifications of both fasting and its exemptions should be consulted before attempting to fast. This professional’s answer as to whether or not someone can fast will likely differ for a person who has had a long-standing eating disorder with few medical complications and has been able to fast safely under the careful supervision of a medical provider; as compared to a person with an acute eating disorder and multiple medical complications or sequelae. Ultimately, the decision to fast should be made after consultation with a medical provider who can provide a case-by-case assessment for each individual. 

For an individual that is given the recommendation to not fast, it is important to keep in mind the following: first, the Quranic injunction is clear pertaining to an individual’s abstaining from fasting as a result of sickness:

“Ramadan is the month in which the Quran was revealed as a guide for mankind with clear proofs of guidance and the standard [to distinguish between right and wrong]. So whoever witnesses this month, let them fast. But whoever is ill or traveling, then [they may fast] an equal number of days [after Ramadan]. Allah intends ease for you, not hardship, so that you may complete the prescribed period and proclaim the greatness of Allah for guiding you, and perhaps you will be grateful.”  [Surah Al-Baqarah 2:185]

An individual who is unable to fast as a result of either an acute or chronic illness should not feel guilt or as if they are deprived of reward. The famous narration of Umar states that the Prophet Muhammad said, “Certainly, actions are based on their intentions.”³https://40hadithnawawi.com/hadith/1-actions-are-by-intentions/ Scholars have commented that one who has the intent to fast but is unable to do so will receive the reward of fasting due to their pure intention. The verse also makes clear that the purpose of fasting is not for a person to undergo undue hardship or pain. Thus, risking one’s health would not be seen as meritorious nor commendable in Islam.

It is also essential that family and community members be cognizant of the risk factors associated with eating disorders and refrain from perpetuating tropes surrounding them. Judgemental comments about eating habits or body image can cause severe emotional and physical harm to an individual with an eating disorder, and avoiding such speech would fall in line with the prophetic teaching, “The one who believes in Allah and the Last day should speak good or remain silent.” [Bukhari, 6136]

Myth #2: I do not have control over my nafs [inner self] and will be sinning if I don’t fast because of my eating disorder. 

Fact: Struggling with an eating disorder, much like any condition, can be difficult and ultimately is a test from Allah, Subhanahu Wa Ta’ala. However, it is imperative to not shun oneself for not being able to fast during the month of Ramadan. It is neither a sign of weakness nor is it indicative of a lack of righteousness. One who is unable to fast due to illness should not ruminate on their inability to fast during Ramadan. Allah , in His Divine wisdom opens and closes the doors of worship in a manner that He deems appropriate for each of His servants. Allah , says,

“And when My servants ask you, [O Muhammad], concerning Me – indeed I am near. I respond to the invocation of the supplicant when he calls upon Me. So let them respond to Me [by obedience] and believe in Me that they may be [rightly] guided.” [Surah Al-Baqarah 2:186]

Nearness in this verse is not accompanied by any precondition other than being a believer, so irrespective of age, gender, or health, one may find nearness to God in this blessed month through sincere intentions, steadfast actions, and a true longing. 

According to all four schools of Islamic jurisprudence, there are exemptions from fasting due to illness and travel. For example:

الفطر لمن خاف زيادة المرض أو بطء البرء

“It is permissible for one who is: ill, fears worsening of his illness, or a delay in recovery to not fast [in the month of Ramadan].” [Shurunbulali, 2010, p. 374] Likewise, a person who believes fasting will cause serious illness or risk death is required not to fast [Jazīrī, 2009, p. 766].

An alternative to fasting in these cases would be to pay the fidyah (expiation) which is given by one who is unable to fast due to illness and, in the case of a chronic illness, will unlikely be able to make up for their missed fasts at a later date. 

The Prophet Muhammad told his Companions, “Allah loves His concessions to be accepted just as He hates for acts of disobedience to be committed.” [Ahmad, 5832] It is out of Allah’s love and generosity that he provides an expiation to remove undue hardship and grants such a person the equivalent reward as if he or she engaged in the original act of worship. Individuals should consult their local imam or resident scholar to determine the best course of action to fit their circumstances. 

Myth #3: I can’t benefit from or have the same spiritual experience as other Muslims during Ramadan because I struggle with an eating disorder. 

Fact: Ramadan is a time during which Muslims seek to gain nearness to Allah , through acts of worship, community service, internal rectification, and supplication for mercy, forgiveness, and Providence. Fasting, though an imperative act of submission for one who is physically and psychologically capable, is not merely about deprivation of food, water, and relations with one’s spouse during the day – rather, it is an exoteric act of worship that is meant to bring about a spiritual change inside a person as denoted by the verse in Surah Baqarah:

“Oh believers! Fasting is prescribed for you, as it was for those that came before you, so that you may attain cognizance [of Allah].” [Surah Al-Baqarah 2:183]

From this verse, scholars have extrapolated the outcome of a successful believer’s Ramadan to be the ascension in nearness to Allah as a result of their increased God-consciousness. For one who is unable to fast during the month of Ramadan due to an eating disorder that could pose a risk to their health, fasting should not be seen as the only means to work towards increasing taqwa. The month of Ramadan is also an important time to reconnect with the Quran, as it is also referred to as the month of revelation [Surah Al-Bawarah 2:185]. The following is a short list of commendable acts of worship that one can partake in during the month that does not relate to matters of fasting or food: 

• Committing to reading a passage of the Quran every day (preferably with translation  for one who does not know Arabic) 

• Performing taraweeh [congregational night prayers]  

• Attending circles of learning, halaqaat, and seminars to increase one’s knowledge

• Listening to lectures/podcasts/digital content pertaining to Islam or the month of Ramadan (see Yaqeen Institute, Ramadan 2023 series)

• Performing sunnah or nafl I’tikaf during the last 10 nights of Ramadan

• Giving charity to support the needy, both locally and globally 

• Spending time serving and drawing closer to one’s family 
• Volunteering to support one’s community  

In addition, one can maximize time for worship and impart some restraint over the nafs by cutting down on screen time, minimizing futile conversations, and avoiding any major or minor sins throughout the month. Ramadan is a gift, thus every opportunity should be taken to maximize ibādah and neutralize distractions (Also see: How to Maximize Ramadan when not fasting.)  

Myth #4: If I know someone is struggling with an eating disorder, I shouldn’t invite them to iftars. 

Fact: This is not supported by research⁴Levine, M. P. (2012). Loneliness and Eating Disorders. The Journal of Psychology, 146(1–2), 243–257. https://doi.org/10.1080/00223980.2011.606435 or lived experience⁵Chapin, A. (2016, June 6). For Muslims With Eating Disorders, Ramadan Can Pose a Dangerous Choice. The Cut. https://www.thecut.com/2016/06/muslims-eating-disorders-ramadan.html and can actually be quite harmful to individuals struggling with eating disorders. It is important to remember that eating disorders are complex mental health conditions that are not simply a matter of willpower or self-control. For individuals with eating disorders, the pressure and anxiety around food and eating can be heightened during gatherings such as iftars⁶Levinson, C. A., & Rodebaugh, T. L. (2012). Social anxiety and eating disorder comorbidity: The role of negative social evaluation fears. Eating Behaviors, 13(1), 27–35. https://doi.org/10.1016/j.eatbeh.2011.11.006. However, this does not mean that individuals with eating disorders should be excluded from iftars or other social events. In fact, social support and connection to the community can be an important aspect of recovery for individuals with eating disorders⁷Mitchison, D., Dawson, L., Hand, L., Mond, J., & Hay, P. (2016). Quality of life as a vulnerability and recovery factor in eating disorders: A community-based study. BMC Psychiatry, 16(1), 328. https://doi.org/10.1186/s12888-016-1033-0.

So, what can you do to be supportive and inclusive?

• Be sensitive and understanding: Recognize that eating disorders are serious mental health conditions and be mindful of the struggles that individuals may be facing. If you are unsure as to what is best for a particular individual, ask them. 
• Don’t focus on food: Instead of focusing on the food aspect of the iftar or suhoor, try to emphasize the social or religious aspects of the gathering. Try to make sure there are other activities to focus on besides eating, such as short reminders or halaqah, a communal dua’, or other similar activities. 
• Don’t force or take offense: Food and feeding people is a very big part of many Muslim cultures. Often, not eating when offered is seen as offensive. However, this practice, while well-intentioned, can be quite distressing and harmful to people struggling with eating disorders. Recognize that not everyone will want to or be able to eat the food you have served, and that is okay. Also, some people struggling with eating disorders may find it too challenging to accept an invitation for iftar or other similar events and may decline. That is also okay. Remember, it is the intention to feed and serve your invited guests that counts in the eyes of Allah , not the action itself.
• Offer alternative options: Consider offering a variety of food options or providing information about the types of food that will be served in advance so that individuals can plan accordingly. Some research shows that pre-planned meals can help reduce stress and anxiety around eating for individuals struggling with eating disorders⁸McMaster, C. M., Wade, T., Basten, C., Franklin, J., Ross, J., & Hart, S. (2021). Rationale and development of a manualised dietetic intervention for adults undergoing psychological treatment for an eating disorder. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 26(5), 1467–1481. https://doi.org/10.1007/s40519-020-00955-y. 
• Avoid making comments about weight or appearance: Comments about weight or appearance should not be made to anyone, especially because, as we will discuss in the next myth – eating disorders do not always appear as the often stereotypical extremely slender young woman. You never know who is struggling with an eating disorder or other body image/mental health-related challenges. For those who do struggle with an eating disorder, these types of comments can be extremely triggering and harmful. With the right support and resources, individuals struggling with eating disorders can recover and enjoy the social and cultural traditions of this blessed time. 

Myth #5: Eating disorders only affect young women. 

Fact: While eating disorders are most common in young adults and women, eating disorders are not exclusive to young adults or women. 

Eating disorders affect people of all ages: Although eating disorders often develop in adolescence and young adulthood, they can occur at any age. According to the National Eating Disorders Association⁹NEDA. (2018). Statistics & Research on Eating Disorders. National Eating Disorders Association. https://www.nationaleatingdisorders.org/statistics-research-eating-disorders, eating disorders affect an estimated 20 million women and 10 million men in the United States, and 13% of women over the age of 50 engage in eating disorder behaviors¹⁰NEDA. (2018). Statistics & Research on Eating Disorders. National Eating Disorders Association. https://www.nationaleatingdisorders.org/statistics-research-eating-disorders. 

Eating disorders can affect men too: While eating disorders are more commonly associated with women, they can affect everyone. In fact, research suggests that up to 25% of individuals diagnosed with anorexia globally are male¹¹Center for Discovery. (2020). Eating Disorder Statistics: Get the Facts Here. Center For Discovery. https://centerfordiscovery.com/blog/get-the-facts-eating-disorder-statistics/ and in the US alone, over 10 million men struggle with an eating disorder at some point in their life¹²NEDA. (2017). Eating Disorders in Men & Boys. National Eating Disorders Association. https://www.nationaleatingdisorders.org/learn/general-information/research-on-males. Men and women struggle at equal rates with what is called subclinical disordered eating or a lesser (but still harmful) form of disordered eating which includes laxative abuse, unsafe and extended fasting, binge eating, and purging¹³Center for Discovery. (2020). Eating Disorder Statistics: Get the Facts Here. Center For Discovery. https://centerfordiscovery.com/blog/get-the-facts-eating-disorder-statistics/. 

Eating disorders affect people of all races and ethnicities: Although eating disorders are often portrayed as affecting only white, young, middle-class women, research suggests that eating disorders affect people of all races and ethnicities¹⁴ANAD. (2016). Eating Disorder Statistics | General & Diversity Stats | ANAD. https://anad.org/eating-disorders-statistics/. Minority people with eating disorders are half as likely to be diagnosed or to receive treatment and some data showed that Asian American college students engaged in purging and other forms of disordered eating more than white or non-Asian, BIPOC college students¹⁵ANAD. (2016). Eating Disorder Statistics | General & Diversity Stats | ANAD. https://anad.org/eating-disorders-statistics/. 

Eating disorders affect Muslims too: An ISPU report showed that over 15% of Muslim youth in their study shared that they knew a fellow Muslim youth struggling with an eating disorder¹⁶Herzig, B. (2014). Young Adult American-Born Muslims and Mental Health: An Exploration of Attitudes, Challenges, and Needs | ISPU. https://www.ispu.org/young-adult-american-born-muslims-and-mental-health/. A study in Egypt found that over 75% of female college students reported struggling with disordered eating¹⁷Azzeh, M., Peachey, G., & Loney, T. (2022). Prevalence of High-Risk Disordered Eating Amongst Adolescents and Young Adults in the Middle East: A Scoping Review. International Journal of Environmental Research and Public Health, 19(9), 5234. https://doi.org/10.3390/ijerph19095234. Research in Iran found that nearly 20% of high school students, both male and female, struggled with disordered eating¹⁸Azzeh, M., Peachey, G., & Loney, T. (2022). Prevalence of High-Risk Disordered Eating Amongst Adolescents and Young Adults in the Middle East: A Scoping Review. International Journal of Environmental Research and Public Health, 19(9), 5234. https://doi.org/10.3390/ijerph19095234. Additionally, 35% of university students in Saudi Arabia, 10% of university students in Turkey, and 23% of middle and high school students in the UAE struggle with eating disorders¹⁹Azzeh, M., Peachey, G., & Loney, T. (2022). Prevalence of High-Risk Disordered Eating Amongst Adolescents and Young Adults in the Middle East: A Scoping Review. International Journal of Environmental Research and Public Health, 19(9), 5234. https://doi.org/10.3390/ijerph19095234. 

Conclusion

Ramadan is not just about fasting, but it is also a time for self-reflection. This can be used as an opportunity to think of ways to become a better person overall. Most importantly, for those who are struggling with eating disorders, it is important to reach out for help and remember this is an illness, not a sign of weakness. To summarize the facts and recommendations above for those struggling with an eating disorder or have a loved one who is: 

• Muslims who suffer from an eating disorder should consult their physician before fasting. Fasting can create challenges and potential health risks if not approached correctly.

• Remember that mental illness does not make one a religious failure and there are other ways to connect with one’s faith during the month of Ramadan. 

• Help people understand that their eating disorder is a bona fide illness, and that they should not feel ashamed or guilty about it.

• Encourage your local imam to dedicate a lecture or Friday khutbah about this topic and other mental health concerns as they relate to Ramadan and fasting.

• Remind individuals that there are exemptions to fasting and that they should consult with a local scholar about giving out a fidyah if they cannot fast due to chronic illness, or how to make up fasts missed if one recovers from illness at a later time.

• Offer your professional medical care providers resources published by the Stanford MMHIP Lab about mental and physical health concerns while fasting.

Always remember that the purpose of gathering during Ramadan is to connect with and enjoy the companionship and fellowship of our brothers and sisters in Islam, not the food in and of itself. The recommendations shared above should be applied throughout the year, including during the two Eids and during other holidays or social events. Supporting individuals with eating disorders goes beyond Ramadan and should be year-round.

The most important step is recognizing the disordered eating habits and thoughts within yourself, and then informing a trusted family member, friend, adult, or mental health professional. If you are in a crisis and need help immediately, contact NEDA (National Eating Disorder Association) Helpline: (800) 931-2237 or text “NEDA” to 741741. 

Related reading:

– How To Maximize Ramadan When Not Fasting

– Chronic Illness and Ramadan: Coping Tips and Strategies