Not So Fast: Is There a Connection Between Religious Fasting and Eating Disorders?

I’ve always wondered about how being encouraged to fast for religious reasons might impact those who are vulnerable to eating disorders and those who already have eating disorders. I can’t imagine it would be easy to be around others who were fasting in the name of religion while struggling with an eating disorder. Equally, I can certainly see the dangers of participating in fasting for those who are predisposed to eating disorders.

Despite not being religious myself, however, I understand that fasting is important to some people who subscribe to religions that encourage the practice. So, how might we balance the potential dangers of fasting with the freedom of religious observance? And, what is the impact of religious fasting on individuals with eating disorders, or those developing eating disorders?

In this post, I’ll highlight some of the main findings from 2 studies about religious fasting and eating disorders: one quantitative study exploring the experiences of women in Bulgaria and one case series about eating disorders and Ramadan.

Fasting: Uniformly Negative?

It would be easy for me to say that no one should fast, ever. Fasting is usually not a good idea for a number of reasons, not least of which is the “hanger” (hunger + anger) it can provoke amongst those fasting. More seriously, fasting can do strange things to one’s body, and as we’ve known for quite some time (thinking back to the Minnesota starvation study by Keys), severe restriction of calories can lead to the development of obsessions around food and many other symptoms we relate to eating disorders.

However, there are other reasons for fasting than those related to eating disorders. Many religions (including Islam, Judaism, and various sects of Christianity) have fasting as a core tenet and encourage regular fasting, particularly at certain times of the year. I will not pretend to be an expert on any of these religions; indeed, I hardly think that my third year undergraduate course in world religions makes me qualified to go into depth about the reasons behind fasting rituals. In broad sweeps, however, fasting may not always be motivated by a desire to lose weight; and, as religious belonging has been shown to be a protective factor against eating disorders in some samples (e.g. Homan & Boyatiz, 2010), it gets a bit complicated to encourage people to not follow their faith.

But how can you tell what someone’s motivations for fasting are? How do you know if someone is using religion as an excuse not to eat? Angelova & Utermohlen (2013) conducted a study in which they explored how women in Bulgaria used traditional and religious fasting. Their results tell us a little more about women’s motivations for fasting in a context where fasting is fairly common, and how this may differ depending on the individual’s assessed eating disorder symptomatology.

The authors administered a number of self-report measures to a sample of 205 women, all Caucasian, with a fairly broad age range (18-81, average 32.1) from the capital of Bulgaria. They grouped these women according to faith and dietary restrain categories to see how the two related. Faith categories included: non-believers, passive believers, and active believers. Along the lines of dietary restraint, they were grouped into non-restrictors, dieters or fasters, or dieter-fasters.

You might be wondering about the differentiation between dieting and fasting (I was). Interestingly, the authors position dieting as a less likely correlate of disordered eating, partially because of the way it has been studied: in the literature, there is a fascination with drawing ties between religious asceticism and anorexia (see Bell’s work on “holy anorexia,” for example).

I’m still a bit unclear about the choices the authors made in distinguishing the difference between dieting and fasting. I suspect, from their description, that the difference lies in culture (i.e., they describe “conventional dieting,” which I suspect means dieting in a Western sense, vs. “traditional fasting,” which could account for traditional practices in the Bulgarian context). In their results section they also note that it is the underlying motivation that differentiates the two; in other words, dieting would be done with a goal of attaining a thin body. This seems somewhat at odds with their prior note that dieting may be less likely to result in disordered eating. In either case, I also think there is a risk here that eating disorders might be perceived as simply dieting (or fasting) “gone too far,” which we know they are not.

In their sample, women who adhered to thin ideals, were passive or non-believers, who had more exposure to media, and who had higher levels of eating disorder symptomatology were more likely to diet, rather than fasting. Those who fasted, on the other hand, tended to be more religious, did not tend to have high levels of eating distress and were less dissatisfied with their bodies.

Perhaps the most interesting result from this study is that the level of eating distress (according to their score on a measure of eating disorder pathology- the EAT-40) interacted with level of religious belief so that:

• For women who scored high in eating distress, stronger faith meant more dietary restraint and body image issues
• For women who scored low in eating distress, stronger faith was less commonly associated with dietary restraint; instead, it could help to bolster the women against body image concerns and dieting

It is a complicated relationship, to be sure, but an interesting one. I’d have been curious to hear whether the women themselves identified with the authors’ conclusions; essentially, that fasting can exacerbate or disguise eating disorder behaviours, but that fasting is also tied to faith, which can help to guard against feelings of body dissatisfaction.

Ramadan & Eating Disorders

While Angelova & Utermohlen’s sample had mixed orientations toward religion, this isn’t likely the group of people we tend to think of when we think of religious fasting. Perhaps the best-known example of widespread religious fasting today is the fasting that takes place during Ramadan, a Muslim holy period during which time people refrain from eating during daylight hours.

After noticing that eating disorder referrals to their adolescent medicine clinic had increased in the period during and after Ramadan, Akgul, Derman & Kanbur (2014) explored the links between fasting at Ramadan and eating disorders.

Akgul et al. conducted their work in Turkey, a country that, while secular, has a large Muslim population. As they note, fasting at Ramadan is widespread in Turkey, with about 60% of the population reporting that they would likely fast during the holy period. The authors provide several case studies from their work, and report that Ramadan may act as an eating disorder trigger for some adolescents.

Case reports are evidently not the best way to make a strong argument for a phenomenon like Ramadan as trigger for disordered eating, because they describe the experiences of very few people. However, the case studies described here do offer some insight into the complex relationship between religious fasting and eating disorders.

While some of the patients had begun restricting or bingeing and purging before Ramadan, several lost the majority of their weight during the holy period. For some, fasting during Ramadan proved to them that they were able to fast, leading to their continuing use of fasting after the month was over. For others, the breaking of the fast during Ramadan contributed to a feeling of loss of control around food, leading to purging the food taken in during this time.

Overall, the authors suggest that fasting during Ramadan is not itself a cause of eating disorders, but rather that the period of fasting can be a trigger for those who are at risk for or who are in the process of developing an eating disorder. One of the more intriguing findings, in my opinion, is the authors’ suggestion that the movement of Ramadan to the summer months (Ramadan shifts in position during the year relative to the 12-month calendar because it is in accordance with the lunar calendar) may have contributed to the relative increase in disordered eating behaviours following the fasting month. During Ramadan, no food is consumed during daylight hours, so during the summer months, fasts are longer: up to 17-18 hours.

This study at least acts a springboard for more conversations about how religious fasting might impact those who are predisposed to eating disorders. Are there safeguards that might be put in place to help minimize the potential dangers of religious fasting while also allowing people to practice their faith in a way that is meaningful to them?

So what does it all mean?

Together, these studies begin to unearth the complex socio-religious factors that might impact the development of eating disorders. Considering how religion, and various aspects thereof, might either help to protect against or contribute to the development of eating disorders is certainly an area that warrants more research.

I like that these studies help us to move beyond a simplistic equation of asceticism and eating disorders. Just like not everyone who goes on a diet will develop an eating disorder, nor will each person who fasts. The motivations for fasting, whether religious or otherwise cultural, seem to be quite important. So too does being aware of, and screening for, a predisposition to eating disorders amongst those who may fast. Still more reason to take into account the complex interrelationship of genetic and sociocultural factors in eating disorders!

In the future, I think it would be interesting to explore something that I alluded to in the beginning of the post: what is it like to be around others who are fasting when one has recovered from an eating disorder? I would imagine that this has the potential to be fairly challenging, so I’d be intrigued to hear people’s stories.

References

Akgül, S., Derman, O., & Kanbur, N. (2014). Fasting during ramadan: A religious factor as a possible trigger or exacerbator for eating disorders in adolescents International Journal of Eating Disorders, 47 (8), 905-910 DOI: 10.1002/eat.22255

Angelova, R., & Utermohlen, V. (2013). Culture-specific influences on body image and eating distress in a sample of urban Bulgarian women: The roles of faith and traditional fasting Eating Behaviors, 14 (3), 386-389 DOI: 10.1016/j.eatbeh.2013.05.005