Ramadan can ‘feed into eating disorders’, warn UAE health experts

Mental health experts warn that Ramadan can mask or even exacerbate eating disorders among sufferers or those prone to the conditions.

Dr Sabine Skaf, a clinical psychologist, advises those with an eating disorder to avoid fasting. Duncan Chard for The National
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DUBAI // People who suffer eating disorders are urged to be mindful of their health during Ramadan.

Mental health experts were concerned that observing the fast can mask or make disorders such as anorexia and bulimia worse among sufferers or those prone to similar conditions.

Dr Thoraiya Kanafani, a clinical psychologist, said sufferers should be careful not to “trigger a relapse” and urged family members to pay special attention to relatives struggling with food issues.

“During Ramadan, anorexia sufferers are fasting so this is something that they prefer; not eating. When it comes to iftar they’ll eat very small amounts. Because it’s very social, their family won’t be as focused on their eating patterns as much.

“For sufferers Ramadan can feed into their eating disorder so when it comes to iftar it’ll be like their normal way of eating – small quantities, low calories. They’ll say they plan to eat something bigger later and usually don’t.”

The opposite can be true of bulimia sufferers, said Dr Kanafani. “For them, they’ll eat so much when they break fast and they will feel bloating, feel guilty, and will throw up after.”

She advised those who with eating disorders to avoid fasting for the sake of their health, something that is supported by verses in the Quran that excuse the sick or elderly from fasting.

“When it comes to Ramadan, we talk about not fasting a lot [with patients]. Most people with an eating disorder feel guilty about that, choosing between health and religion.

“We reassure them and discuss other ways they can make up for not fasting; giving back to the community, paying for poor families to have iftars, there are many other ways. When it’s within scripture they feel a lot more at ease.”

Clinical psychologist Sabine Skaf, co-owner of the Human Relations Institute and Clinic, said for those in recovery from an eating disorder fasting could trigger a relapse but it is not 100 per cent deterministic.

She, too, advised sufferers to avoid fasting.

“People who are sick are excused from fasting [and] mental health is as important as physical health,” she said.

Dr Saima Khan, a family medicine specialist at City Centre Clinic, said Ramadan can affect those with every kind of eating disorder.

“People struggling with anorexia can get away with starving themselves because not only is fasting enabled but it is rewarded. While Ramadan is not a month to go on a super diet or binge, many people approach Ramadan planning to go on a diet which exacerbates the needs of an eating disorder.”

For example, those with bulimia or binging addictions can fall into a destructive cycle of binging and purging from the fasting followed by an excessive iftar feast.”

She said destructive triggers vary from person to person, from emotional stress or family pressures to overwhelming social gatherings.

Given that meal times during Ramadan are often large social gatherings, it is vital that a sufferer’s support network is aware of the issues and alert to changes in behaviour.

“During Ramadan, or any other fasting period, the support network should suggest the individual seeks professional help as this is the only way to address the disorder in a healthy way. The option to not fast is there too,” said Dr Tosatto. Dr Kanafani said families need to be “even more alert than usual” during Ramadan. “The supportive environment is essential. If it’s best for a person not to fast, the family must understand and support that.”

It is also vital that fasting does not disrupt a person’s medication, added Dr Kanafani.

Dr Khan urged sufferers to seek help and support. “If you are recovering from an eating disorder it is best to consult a doctor before planning to fast as they will help you come up with an individualised plan. A doctor, dietician, therapist, can help you make Ramadan into a spiritual experience rather than knowingly inflicting harm on yourself which is not permissible in Islam

“You may or may not be well enough to fast and your doctor can help you decide that.”