Starving from sunset to sunrise is a stretch for the average Muslim during Ramadan—but for some women, they're not complaining. For those with eating disorders, it's the month they most look forward to all year.
Maha Khan first developed anorexia when she was 15. "Every year, I used to wait for Ramadan thinking, 'Now I can lose weight'," says Khan, who is now 32 years old and the founder of the Islam and Eating Disorders blog. For Humaira Mayet, 21, a part-time science tutor who struggled with anorexia for six years, Ramadan "was anorexia's way of justifying my starvation—the more I restricted, the more spiritually strong I was for being able to resist the temptation of food."
During Ramadan, most Muslims abstain from food and drink, sometimes up to 17 to 19 hours at a time. The holy month is widely considered the most important date in the Islamic calendar, and fasting is seen as an opportunity for Muslims to enhance their spiritual connection to God and to exercise self-restraint. Over the 30 day period, weight loss is seen as the norm—urban myth has it you can lose up to 12 kilograms while fasting.
I would break [my fast] with a date and an energy drink.
But for those with eating disorders, Ramadan offers a way for them to cut out food while avoiding detection "My mother was very observant of my diet. [But] Ramadan was the only month of the year I could restrict [food] without arousing suspicion," Mayet says.
According to leading ED charity Beat, 725,000 people in the UK are affected by eating disorders. But there are no official figures for how many are Muslim. One of the few studies on the prevalence of eating disorders in Muslim communities was back in 1988, and it showed that British Asian girls were at higher risk of developing anorexia and bulimia than their non-Muslim counterparts. According to Pew Research, Muslims account for 23 percent of the world's population. It stands to reason that they must make up some of the estimated 70 million people struggling with eating disorders.
While Ramadan might seem like "an amazing opportunity to lose weight," as one pro-ana forum wryly dubs it, that's not to say it isn't without its challenges. Food is central to Ramadan and becomes the focal point of the religious holiday, whether it's planning what to eat at iftar, the evening meal where Muslims end their fast, or preparing dishes in its run-up.
"For a Muslim suffering from an eating disorder, Ramadan can turn what is already a difficult time into an almost impossible dilemma," says Beat spokesperson Mary George. "The drastic changes in diet and food intake during this period can accelerate eating disorder symptoms."
The tension of communal eating when breaking the fast—typically with large quantities of food—presents the biggest challenge of all. "Mealtimes, whether at home or outside, were the most difficult times," Khan says. "I really started to panic around people and would have anxiety attacks when food was presented to me. I would spend my whole day in bed, fretting over what I had eaten [the night before]. I dreamt of food and I studied one cookbook after another."
Khan even took to staying at home, the only member of her family to break the fast by herself instead of at the customary family gathering. "I would break it with a date and an energy drink. Then I would spend hours in the kitchen arguing with myself whether I should cut out protein and starch even further."
Ramadan is seen as the most crucial month for Muslims worldwide to demonstrate their devotion to God. The women I spoke to were plagued by an inner conflict: Were they fasting for God or fasting for their eating disorder?
"When I ate, I felt guilty and inadequate and a part of me knew that using Ramadan as an excuse was perverse," Mayet says. Khan echoes her sentiments: "While under therapy for anorexia, I wanted to observe the full month of Ramadan. My treatment team and family said no. My BMI was very low and medically, I was unfit to fast. I cannot tell you the sheer panic that overcame me. We had so many arguments at the hospital and at home. 'I'm going to fast,' I kept telling my mother."
When she did manage to fast it was only so Khan could get closer to achieve her goal weight of 121 pounds. "I would pray but my mind was not engaged with what I was praying... It was all limited to losing weight. How can one engage fully in the month of Ramadan [thinking] like this?" Her weight plummeted. Not long after the religious period, doctors gave her just five weeks to live.
Eating disorders have become known as something that affects those who are affluent and white.
The common misconception that eating disorders aren't a 'Muslim problem' can compound feelings of shame, guilt, and isolation. According to Khan, "there is so much misunderstanding in Muslim [communities] about this illness that hundreds and thousands of women are suffering in silence."
Countless Islamic forums are rife with the notion that conditions like anorexia and bulimia are so-called "Western" diseases that have crept into the Muslim world. One site warns: "Eating disorders are a growing phenomenon in the Muslim community. What was once a condition mainly for non-Muslims has slowly crept into the ummah (the international Muslim community)."
This is clearly flawed. While the prevalence of eating disorders in the Western world is higher than that of non-Western countries, research has shown that Muslim women are just as susceptible to bulimia and anorexia, regardless of their cultural background or where they grew up. In a study published in the International Journal of Eating Disorders, researchers found that female university students in Tehran were just as likely to develop eating disorders as their Iranian-American counterparts.
"Eating disorders have become known as something that affects those who are affluent and white," says Priya Tew, an award-winning dietician and eating disorder specialist. "The bulk of scientific research has also been carried out on this population, making it the group most talked about."
In turn, Muslim women with eating disorders are discouraged from seeking treatment—or worse, they may believe that they don't need it. "This will make it harder for Muslim women to speak up about their problems with food and there may be less places they feel they can receive help from," Tew says.
When the Qur'an exempts Muslims who are ill from fasting, it doesn't make it any easier for eating disorder sufferers who are in recovery. Those who choose not to observe Ramadan often come under scrutiny from others in their community.
Leanne Scorzoni, 34, is a Muslim convert and medical assistant who says she is in "active recovery" from EDNOS (Eating Disorders Not Specified), an eating disorder where sufferers may not meet the diagnostic criteria for anorexia or bulimia. "I consciously decided that [fasting] wasn't healthy for me. I didn't feel like I was doing [it] for God," she said.
She says that her condition meant it was impossible for her to enjoy the spiritual benefits of observing her fast. "My mind was completely removed from prayer and reflection. It was better for me to be eating healthier than it was to completely take away food.
Read more: How Islamophobia Hurts Muslim Women the Most
"There have been times I've been eating in public and Muslims have come up [to me] and demanded to know why I wasn't fasting. There have even been Muslims who fully accepted I had an eating disorder but still asked me: 'Can't you just fast anyway?' I refuse to be guilt tripped for getting well. I don't feel guilty that maintaining self-care has to mean I allow myself to eat when my body is hungry."
When members of the Muslim community don't believe that eating disorders qualify as a "legitimate' medical issue to miss fasts, it can prove just as isolating as suffering in silence. "Some fetishize food and religious ritual to the point people around them cannot be open and honest regarding medical needs," Scorzoni says. "That somehow needing a doctor's care is considered sinful or weak."
Khan, however, remains optimistic that Muslim attitudes towards eating disorder sufferers are slowly changing for the better. As everything, it starts with speaking out. "Now we are breaking the silence around eating disorders," she says, "[Hopefully] more and more Muslims [will] talk about it."