By Valerie Martin, LMSW

Over the past several years, a number of controversial articles and research studies have explored the relationship between eating disorders and religious traditions. Several years ago, there was a significant focus on the Jewish tradition, in particular the Orthodox community. Some studies and health experts concluded that the rate of eating disorders (EDs) in this community was substantially higher than in the general population, while other studies and articles challenged these findings. In 2008, the Orthodox Union produced a 40-minute documentary exploring the topic, Hungry to Be Heard (click to view it for free.) More recently, there is an increased focus on the Muslim community and how the Islamic tradition of Ramadan may correlate with eating disorders.

My goal is not to contend whether or not a particular religious culture has a higher rate of eating disorders, but rather, to explore how religious rituals and traditions that involve fasting may contribute to or exacerbate eating disorders.

In the book Treatment of Eating Disorders: Bridging the Research-Practice Gap (2010, Maine et al), the authors define fasting as an inappropriate compensatory behavior (ICB) that involves “not eating food for extended periods of time due to body shape or weight concerns.” They explain further, “Eight consecutive waking hours is probably the lower boundary for considering a period of time without eating as a fast (Fairburn, 2008). During this time, individuals may drink fluids without breaking the fast, but if they have eaten very small amounts of food, their behavior is better considered to be restriction.”

It is important not to pathologize religious fasting outright; cultural insensitivity would certainly harm therapeutic rapport from a treatment standpoint. Exploring motivation for fasting is key. That said, some might state religious tradition/ritual as their motivation for fasting, and also have eating disorder-based motivations. Maine and her colleagues write, “If individuals indicate that part of the reason they fasted was to affect their weight or shape…the fast may be considered an ICB… if manipulating weight and shape underlies religious-based fasting, it may be considered inappropriate.” Thus, when the motivation for fasting is solely based on religious beliefs, it is not considered an ICB (according to these authors).

A study published in the January 2014 issue of the International Journal for Eating Disorders explores the implications of religious fasting for Muslim adolescents. During Ramadan, the Islamic month of fasting, participating Muslims refrain from eating, drinking, and smoking from dawn until sunset. The study’s authors state, “for the past 2 years, we have noticed an increase in patients with disordered eating patterns that have applied to Hacettepe University, Division of Adolescent Medicine during or shortly after Ramadan. We document [sic] six of these patients… We argue that the possible effects of a drastic change in ones diet such as that which occurs during Ramadan, play an important role in triggering ED’s [sic] in adolescents with a predisposition or may exacerbate an eating pathology.”

In a July 2014 editorial on Vice’s “Munchies” website, contributor Safy-Hallan Farah shares her own experience:

“For young Muslim women struggling with eating disorders, Ramadan can be the worst time ever. I know this firsthand. As a teen girl, I would intermittently starve myself and vigorously work out… In between being normal and being the version of myself that had what medical professionals call Eating Disorder Not Otherwise Specified (EDNOS)*, I’d spend a ridiculous amount of time on pro-anorexia and -bulimia sites. This intensified during the summers and during Ramadan, so I know what young Muslim girls with eating disorders are going through right now. Many don’t know if they’re fasting for Allah or for anorexia.”

Though Christianity lacks a specific tradition of fasting, the ritual of Lent does encourage restriction (often of certain foods), which could certainly pose a trigger for people with eating disorders. I work at a residential treatment center (for eating disorders, addiction, trauma, and co-occurring disorders), and recently one of my clients with anorexia (also a devout Christian) said that she restricted at breakfast that morning but was proud that “it was not because of my eating disorder. It was because I was reading scripture and God was sustaining me, so I didn’t need food.” If that’s not an eating disorder manipulating someone in the name of religion, I don’t know what is.

We’ve had several Orthodox Jewish clients over the past few years, and my experience has been that when a woman’s Rabbi knows she is in treatment for an eating disorder, the Rabbi fully supports the treatment team in making adjustments to rituals or traditions to prioritize her health and recovery. In researching for this post, I found a lovely article at Ritualwell by Rabbi Debbie Young-Somers in which she shares an alternative ritual for those who are in eating disorder recovery to participate in Yom Kippur:

“For individuals who suffer, or are in recovery, from an eating disorder, eating on Yom Kippur is a holy act. Rather than finding ‘purity’ or ‘spiritual growth’ through denying themselves food, the act of eating itself is an act of teshuvah. This was not something I had considered until I was approached this year by a friend seeking a liturgy that helps her acknowledge the holiness of the act of eating on Yom Kippur, having found little that helped online or in our traditional liturgy. This was developed together with her, in the hope it might also help others.” (Click through for the full text of the ritual.)

Additional resources that may be helpful are the book The Religion of Thinness: Satisfying the Spiritual Hungers Behind Women’s Obsession with Food and Weight by Michelle Lelwica, and her corresponding blog at Psychology Today. For anyone struggling to determine whether certain behaviors are motivated by religious devotion or eating disorder, an important question to ask is, “Has my eating disorder/the need to be thin become my higher power?” Michelle also writes about how spirituality can support recovery once a person is ready to “relinquish the holy grail of thinness.”

Numerous cultural factors can contribute to the risk of eating disorders, and while religion is only one of those factors, it should not be overlooked. It is possible to be both respectful of a religious culture and cautious about how certain rituals or traditions could be risk factors for those with eating disorders or predisposition for them. As Elizabeth Claydon writes at Examiner.com,

“just as healthy eating can act as a slippery slope into orthorexia for certain people, fasting for religious or cultural reasons could transform into longer-term disordered eating or an eating disorder. It is important that clinicians are aware of this risk so warning signs aren’t conflated with religious practice.”

The important takeaway on this topic is that we (especially clinicians and religious clergy) need to be aware of the possibility for religious fasting to impact an existing eating disorder or someone who is predisposed to an eating disorder. However, making a generalization that “religious fasting is bad” is a harmful blanket judgment that could alienate many people and make them less likely to reach out and get the help they need.

*In 2013, the DSM-V replaced EDNOS by OSFED (Other Specified Feeding or Eating Disorder).

Photo by Kelsey Weaver via Flickr.com shared under a Creative Commons license.