Ramadan and Eating Disorders

What is Ramadan?

Ramadan is a holy month of significance for Muslims. It is a period of 29-30 days where Muslims are challenged to increase in all forms of worship, revive their awareness of God and in turn, achieve a deeper connection. An integral expression of this is demonstrated through spiritual fasting (sawm).

Spiritual fasting involves abstaining from eating or drinking from dawn until sunset. The intention behind spiritual fasting distinguishes the act from other forms of fasting which may be intended for weight control or influencing metabolism.

For Muslims, fasting in Ramadan is a shared experience and therefore increases community connection. It is obligatory on all those who are capable (physically, financially, mentally etc) and of mature age (passed age of puberty). There are many conditions and circumstances, however, that exempt followers from needing to fast, especially if it poses a significant threat to a person’s health and well-being.

Every year, there will be millions of Muslims around the world who are unable to or struggle to fast due to their situation (including an active eating disorder). There are concessions that exist and can be verified by local religious leaders (e.g. an Imam). Nevertheless, the nature of an eating disorder is inherently encouraging of fasting and restriction and an eating disorder gaining control can be seamlessly disguised as religious practice. This can make seeking help extremely difficult and lead to feelings of shame, dismay and isolation.

Things to consider around Ramadan and eating disorder recovery

Eating disorders exist in all community groups and Ramadan can be a challenging time for Muslims who have an active eating disorder, or a lived experience of one.

A daily cycle exists of waking up early to eat, fasting during daylight, followed by breaking the fast at sunset. For a person who is unwell with an eating disorder, this cycle can trigger eating disorder thoughts and can even be contrary to their prescribed treatment. If this is the experience for you or someone you know, it is important to consider the following:

• You are not alone

• Speak to your GP about accessing professional support if you’ve not yet done so

• It is recommended to discuss your concerns with your treatment team and religious leader (e.g. an Imam) ahead of time in order to plan for Ramadan

• You may be able to decide on an adapted fasting schedule according to your needs and progress in recovery (e.g. fasting alternate days or fasting on shorter days of the year)

• Reflect on your intention behind fasting – are you fasting to express your religious beliefs or are you intending weight loss? Are you finding it impossible to eat sufficiently before dawn? Are you feeling this urge to delay breaking fast at sunset?

• If there is a supportive person in your family or community that you can talk to, it can be helpful to do so. There can be a lot of focus and conversation around food during Ramadan which is anxiety-provoking and having someone to turn may help you navigate that.

• It may be that you are not medically safe to participate in fasting at your current stage of recovery and that’s OK. Focusing on recovery today can mean that you can observe Ramadan more fully in the future.

Even if you are currently unable to fast, you can choose to explore the many other ways of practicing your faith that are also encouraged in Ramadan.

Other ways to participate in Ramadan

• Prayer and practicing mindfulness

• Donating time/clothes/food/money to people in need

• Preparing meals for others

• Attending Friday or night prayers at the local Mosque

• Appreciating that seeking treatment, taking steps towards recovery is honourable and an act of worship itself

Eid celebrations

As with Ramadan, Eid can be wonderful celebration with family and friends for millions of people worldwide. However, for people with an eating disorder, it can be a challenging time. They may even dread the day.

Festivities like Eid, will almost always involve special food in abundance and cultural traditions which can be triggering. In the lead up to Eid, it’s important that you express any fears you have with your support network (e.g. your treatment team, partner or family member). This can help you feel prepared and provide a sense of safety.

Journaling is a great way to put words to some of the emotions we feel and a useful release in addition to voicing our concerns with others. We can also use a journal to plan ahead for the festive day which could involve setting reminders to eat regular meals and snacks, scheduling time to check-in with ourselves and rest.

If there are some aspects of Eid that are more confronting for you (e.g. menu planning/cooking), then you might like to involve yourself with other aspects instead (e.g. decorating your home or organising gifts).

We can accept that some level of anxiety is to be expected and that it’s okay to have these feelings. Remind yourself that, like any other day, the day will pass. Try your best to be kind to yourself.

Blog post written by Aneela Panhwar, Accredited Practising Dietitian at Mind Body Well.

Challenging Stereotypes: Masculinity and Eating Disorders

For far too long, eating disorders have been stereotypically associated with women, most commonly young women. However, the truth is that eating disorders do not discriminate based on gender, size, sexual orientation, cultural background, age, or ability. Men, too, grapple with these complex mental health conditions, and it's time to break the stigma surrounding men and eating disorders. In this article, we shed light on the prevalence of eating disorders among men, the unique challenges they face, and how we can challenge societal norms to support those in need.

Eating Disorders in Men: The Numbers Speak

Recent statistics from Australia's Butterfly Foundation revealed a significant presence of eating disorders among men. It is estimated that over one-third of eating disorder presentations are seen among men, with 360,131 Australian men living with an eating disorder (Butterfly, 2019).

According to the National Eating Disorders Collaboration, it is estimated that men account for:

• 20% of people in Australia who experience Anorexia Nervosa

• 30% of people in Australia who experience Bulimia Nervosa

• 43% of people in Australia who experience Binge Eating Disorder

• 55-77% of people in Australia who experience Other Specified Feeding or Eating Disorder (OSFED)

• 67% of people in Australia who experience Avoidant Restrictive Food Intake Disorder (ARFID)

Heightened Risk Among Certain Groups

Certain groups of men face a higher risk of developing eating disorders. This includes queer men, transmen, gender diverse groups, and men involved in fields that promote specific body ideals or physiques, such as athletes, bodybuilders, and actors.

Unique Presentations in Men

Eating disorder presentations among men may differ from those commonly associated with women, or they may also be very similar. Men may focus on low body fat and high muscularity as well as weight. They might also be more concerned with high protein foods and counting macros, as well as engaging in excessive or compulsive exercise with an emphasis on muscle appearance. Concepts like ‘bulking’ and ‘shredding’ and the use of supplements and performance-enhancing drugs can also be prevalent.

The Impact of Stigma

Unfortunately, eating disorders among men are often underreported due to the stigma surrounding these conditions. The stigma can lead to a lack of awareness of symptoms, misdiagnosis, delayed diagnosis, difficulty accessing appropriate treatments, and a feeling of exclusion from available treatments.

Cultural Expectations and Norms

Cultural expectations and ideals surrounding body size and appearance can play a significant role in the development of eating disorders among all genders, including men. Society's narrow definition of masculinity, characterised by being muscular, strong, stoic, and independent, contributes to the pressure men face to conform to unrealistic body ideals. ‘Diet culture’ preys on this by promoting fasting, high protein products, and ‘biohacking’ – all of which contribute to the normalisation of disordered eating behaviours and a focus on gaining muscle.

Challenging Stereotypes: Redefining Masculinity

To address the stigma and promote a healthier understanding of masculinity, it’s important that we challenge existing stereotypes and societal norms. Here are some prompts to think differently:

1. Question the origins of the narrow definition of masculinity, and how this impacts the lives of men and masc folk

2. Develop media literacy skills to recognise how masculinity is portrayed

3. Notice how diet culture products are marketed toward men and women

4. Learn about the gendered and socialised nature of emotions

5. Explore and redefine masculinities, encouraging a broader and more inclusive sense of identity

Seeking Help: An Act of Courage

Remember that all people are worthy of support, and seeking treatment is a brave and essential step for anyone struggling with an eating disorder, regardless of gender. At Mind Body Well, our team of Psychologists and Dietitians is here to support you on your journey to a healthier relationship with food, exercise, your body, and identity. We welcome people of all genders, ages, sexual orientations, and cultural backgrounds.

Getting Away for the Holidays?

Many people have mixed feelings about the holiday season - while it can be a time of joy there can also be significant challenges for people with eating disorders or body image concerns.

These challenges can be even more intense when you’re planning to go away for holidays, or to visit family. Time away from home can bring changes to routine and daily activities; spending time with different or more people than usual; different food availability or access; increased social eating; and reduced access to usual coping strategies or activities. We’ve put together some suggestions to help prepare for the holiday season.

Food and eating suggestions

• Discuss your holiday with your treatment team, and problem solve to make a plan together

• Where possible, plan at least some of your meals, and think about when you might eat out or do your food shopping

• Have some easy options available while travelling, pack snacks or foods you’re more comfortable and familiar with and use these as a back-up when needed

• Work with your Dietitian to consider what a balance of safe and challenging foods might be like for you during the trip

• Pack clothing you feel most comfortable in

Support suggestions

• Have a trusted person you can debrief with - a friend or family member. It’s ok if the person isn’t with you on the trip, plan some phone check-ins with them if needed

• If you know you need plenty of alone or quiet time, let the people around you know and plan it in advance

• Think about different types of supports outside your immediate network, e.g. helpful social media accounts, helplines or online chats (see below)

• When you’re in social eating situations, trying to focus your attention on being present with the people around you and use this as a distraction to help you avoid over-thinking about food

Coping suggestions

• Think about distractions or activities you find helpful at home which you could take with you, e.g. journalling, knitting, reading, puzzles

• Write yourself a list of helpful coping strategies which you can use as a reminder when things get difficult, e.g. distraction, urge surfing, challenging thoughts, mindfulness or self-compassion practices

• Prepare some resources to keep you motivated while you’re away, e.g. podcasts, books, social media accounts. Check out our inspiring links

• Where possible, try to pay attention to things you enjoy or feel grateful for while you’re away, e.g. being able to travel, basking in the sunshine, spending time with people you care about

• Remember this is a temporary situation and you will soon be back in your familiar comfort zone

Useful Services

• Eating Disorders Victoria Hub

• Butterfly Foundation Helpline

A Non-Diet Understanding of PCOS

September is Polycystic Ovary Syndrome (PCOS) awareness month. PCOS is a very common condition which affects between 12-21% of cisgender women and transgender/gender diverse people with ovaries during their reproductive years, with around 21% of First Nations people in this group being impacted. For many people diagnosed with PCOS the automatic recommendation from their medical team is to lose weight, or to prevent weight gain. This recommendation can however be highly problematic, so let’s explore the rationale behind weight loss advice for PCOS, and whether this is helpful management strategy (spoiler alert: it’s not!).

Summary of PCOS

• Symptoms of PCOS may include irregular or absent menstrual periods, fatigue, excess hair growth on the face and body, hair loss on the scalp and difficulties with fertility. Contrary to popular belief, you do not need to have cysts on your ovaries to have PCOS, however this is a common symptom

• Hormones play a big role when it comes to PCOS symptoms. People with PCOS often have higher levels of androgens including testosterone, as well as insulin resistance which means that our bodies are not able to use insulin to get glucose from our blood into our cells as effectively

• PCOS can cause chronic inflammation which can further disturb our hormones and increase risk of chronic health conditions including cardiovascular disease. Other factors that are common in PCOS and can increase inflammation include poor sleep and stress

• PCOS is also linked with a range of mental health conditions including depression, anxiety and eating disorders

• There is currently no cure for PCOS, however there are a range of options for managing PCOS symptoms and for enhancing quality of life

PCOS and weight

A significant proportion of people with PCOS live in larger bodies or report struggling to ‘manage’ their weight. Folks with PCOS often report that they find it hard to lose weight but very easy to gain it. One of the contributing factors to this is high levels of insulin and insulin resistance. Insulin is a growth hormone, so high levels tend to cause increases in weight.

One of the most common recommendations for PCOS management is to lose weight, often without taking peoples previous weight history into account. PCOS treatment guidelines often recommend reducing weight to improve PCOS symptoms and related biomarkers (i.e. blood test results such as testosterone or blood glucose), however sustained weight loss is very challenging and in many cases not possible, including for those with PCOS.

The good news? Other management strategies that don’t require weight change can be very effective in improving symptoms and biomarkers. And let’s not forget that people in bodies of all sizes can have PCOS, so it’s very important that weight loss not be focused on as a ‘one size fits all’ treatment.

Do weight loss diets work for PCOS?

Diets are unhelpful for the majority of people with PCOS for a number of reasons:

1. Diets don’t work for the absolute majority of people. 95-97% of people who engage in dieting to lose weight regain most or all of the weight within 2-5 years. 2/3 of those people gain more weight, and end up with a higher weight than where they started. For the majority of people of diet, this results in weight cycling with weight trending upwards over time. Weight cycling can increase the risk of chronic conditions such as cardiovascular disease.

2. Dieting increases the risk of developing an eating disorder. Eating disorders and disordered eating are common in PCOS, and dieting behaviour can add further fuel to the fire by creating an environment of restriction and preoccupation with food, weight and shape. Restrictive eating patterns or cutting out certain foods can actually increase the risk for binge eating – due to the all or nothing cycle which is stimulated by food restriction. This is often followed by an ongoing restrict-binge cycle, which creates an unhelpful eating pattern and relationship with food which can evolve into an eating disorder.

3. Some PCOS diet plans recommend cutting out entire food groups to manage PCOS. This can increase the risk of nutritional deficiencies, and as with any other restrictive diet can increase fixation on food and either further restrictive eating, or responsive binge eating episodes.

4. Insulin resistance is a common symptom of PCOS. With insulin resistance comes high insulin levels in the blood, which can impact our hunger and fullness signals because it stimulates our appetite. People with insulin resistance often report experiencing intense food cravings, particularly for foods rich in carbohydrates. This is because your body is not able to use the insulin in your body effectively to transport glucose from your blood into the cells, so it can literally feel like you are starving. The extreme hunger and food cravings often lead to binge eating episodes, which can then further increase insulin levels – and so the cycle continues.

5. What about carbs? You wouldn’t be alone in thinking that reducing your carbohydrate intake will prevent high insulin levels or insulin resistance. On the contrary - the stress experienced when following a restrictive diet can increase inflammation, which is actually linked with insulin resistance. Most people who have tried low carb diets find them to be too restrictive and ultimately unsustainable long term. Our bodies need carbohydrates from our food because carbs provide every cell and organ in our body with the energy they need to function. You know that pounding headache you get when you’ve eaten a low carb meal or haven’t eaten for a long time? That’s your brain screaming out for glucose. Low carb diets can lead to low energy, brain fog and mood changes, and also create a high risk of binge eating episodes.

So, if not dieting for PCOS what can I do instead?

• Discuss treatment options with your GP. There are a range of different medications, supplements and treatments that may help with managing your PCOS symptoms. It could also be helpful to see a reproductive specialist as part of your PCOS treatment team for more specialised advice and treatment options.

• Eating regular meals and snacks can assist to improve insulin sensitivity, regulate blood glucose levels and help to support energy levels. Giving your body adequate and consistent fuel can also help to regulate appetite and reduce binge eating.

• See a Dietitian who specialises in PCOS nutrition using a non-diet and weight inclusive approach. The Dietitian will be able to tailor recommendations to manage your PCOS symptoms and to support you to improve your relationship with food.

• Find a way to move your body that’s comfrotable, accessible and enjoyable for you. Movement is linked with improve insulin sensitivity, mood and sleep quality, as well as reducing long term risk related to chronic health conditions.

• Managing your stress levels can assist with reducing inflammation and improving overall mental health and wellbeing. You could also consider seeing a Psychologist to assit with developing healthy emotional coping and stress management strategies.

• Get enough sleep! Inadequate or poor quality sleep can increase inflammation, and feeling tired can contrinute to binge eating, so don’t underestimate the power of getting a good night’s sleep.

See also:

• Let’s get some perspective on food addiction

• What does it mean to be a ‘Non-Diet Dietitian’?