Rahma El Sayed always looked forward to Ramadan as a child.
It's the most-holy time on the Islamic calendar, where Muslims fast between sunrise and sunset for 30 days to strengthen their spiritual connection with Allah and their community.
However, for Rahma, now 27, the excitement around the event transformed into a source of anxiety because her restrictive eating disorder took advantage of Ramadan for its own twisted ends.
"Unfortunately, Ramadan just almost became like a catalyst to prompt those behaviours and, almost, help cover up a lot of those behaviours that I was engaging with at that time," she said.
"Slowly, I started to actually lose the meaning behind Ramadan because, rather than fasting for my religion, or fasting for my faith … I was becoming too preoccupied with the eating and drinking side of things."
Rahma was formally diagnosed with anorexia in her early 20s, coupled with overexercising, and described her eating disorder as having a mind of its own.
"An eating disorder is something that is really difficult. It does consume so much of your mind," she said.
Sheik Alaa Elzokm, Imam at the Heidelberg mosque, said those with physical and mental illnesses, including eating disorders, were not obligated to fast.
"There are always exemptions for those who cannot fast, and God is not going to put a burden on them. We make it easy for them and we accept them the way they are," he said.
He said it was important for Muslims with eating disorders to consult medical specialists about whether it was safe for them to fast, and for religious leaders to be guided by that expert advice.
With the help of her treatment team, Rahma developed a plan and was able to safely fast this year for Ramadan, for the first time in a few years.
"The biggest thing I can definitely recommend is talking and accountability, expressing your concerns to your friends and your family," she said.
"Work with a treatment team and build yourself a plan and then communicate that plan.
"But, also, don't be too hard on yourself — treat every single day as best as you can."
Eating disorders still misunderstood
Ayesha — a Muslim counsellor at the Butterfly Foundation — said eating disorders do not discriminate and can impact people of any age, ethnicity, gender or body shape.
"We know that the eating disorder can, and will, latch on to any messaging that is, in a way, validating the thought process around maintaining and preserving its existence," she said.
While Ramadan and Eid festivities bring people together, she added that the focus on food could be triggering and that social interactions might increase the possibility of unwanted comments about a person's eating or appearance.
"Coming from an ignorant place, these comments can often feel quite hurtful and be unsupportive of a person's recovery," she said.
Eating Disorders Victoria dietitian Aneela Panhwar, who is also a Muslim, said eating disorders were still misunderstood in the broader population, and often not seen as the severe mental health conditions that they are.
"As far as eating disorders are concerned, we've still got a really long way to go," she said.
"There is definitely some cultural stigma that still exists.
"There might still be people who continue to believe that having an eating disorder or a mental health condition is actually indicative of a deficiency in their faith, unfortunately — even though that's completely unrelated — or they might choose to believe that it's a matter of choice."
Ayesha added that, in the realm of mental health issues, eating disorders are among the most serious.
"They have the highest mortality rate," she said.
"There is the added component to the physical well-being of a person being at risk. And, in that case, it makes it far more dangerous for person to engage in fasting."
She said it was difficult to determine the rate of eating disorders in the Muslim community in Australia, due to a lack of research as well as barriers to people coming forward and seeking help.
Ayesha said some research indicated it was once assumed rates of eating disorders "would be low in the Muslim community, due to the alleged absence of the 'thin ideal'".
"However, due to sociocultural and technological developments resulting in increased social media use, along with increased Western influence, different ideals of beauty have begun to infiltrate different cultural communities," she said.
"Internalising the thin ideal may lead to increased levels of dieting, body dissatisfaction, and eating disorders."
What are some solutions?
If you, or someone you know, is struggling with an eating disorder, there is support available — including the Butterfly Foundation (1800 334 673) and Eating Disorders Victoria (1300 550 236).
"The aim of Ramadan is not to starve yourself. But it is to humble yourself, practise gratitude, practise generosity [and] mercy," Ayesha said.
Ms Panhwar said that, while Ramadan might involve sacrifice, it wasn't meant to make a person suffer.
"It's a really important belief that we have in Islam that no-one's ever put through a test that they can't endure," she said.
Sheik Elzokm pointed to a passage in the Qur'an – "Allah does not charge a soul except [with that within] its capacity" – meaning God would not ask someone to do something that would cause them to suffer, and he would consider an individual's intentions.
"It's really important that the individual who's involved tries their best to stay in touch with the intention behind Ramadan – just to remind themselves that they're not fasting for purposes of weight loss, and restriction, and dieting ... [and] that religious fasting is actually really different to that," Ms Panhwar said.
Sheik Elzokm pointed out there were many other ways to observe Ramadan, including prayer, reading the Qur'an, attending mosque, giving to charity and coming together as a community.
"It is not only about fasting … you have many other ways to enjoy the month of Ramadan, and have this spiritual connection with God," he said.
For those who found themselves fasting for the wrong reasons, Ms Panhwar recommended coming up with a plan to prepare for Ramadan and Eid festivities and beyond.
That plan should be developed with a GP, psychologist and dietitian, at a minimum, to ensure the individual has their nutritional needs met, and they should also engage with their family, friends and religious leaders for support, she added.
Ms Panhwar said other options might include fasting on a modified schedule that works for the individual, or immersing themselves in the other aspects of Ramadan, or even fasting from time-wasting activities, such as scrolling on social media or watching TV.
She added that it was important not to skip the morning meal before dawn — called suhoor — because it helped the body's metabolism avoid going into starvation mode, and consuming complex carbohydrates, protein and plenty of fluids could help maintain energy levels throughout the day.
For those with friends or family members living with an eating disorder, Ms Panhwar said it was important to show them love and support.
"Remember that you're not alone, in that lots of people may be struggling exactly the same way."
While Rahma is in active recovery, she said the progress was not linear.
"Don't feel guilty if you are struggling with Ramadan and, if you don't feel as connected to … religion during this month," she said.
"God is always going to be there. And, even when things are super tough, [I] just remind myself that I can absolutely make it through this."
For eating disorder or body image support, contact Butterfly's National Helpline on 1800 ED HOPE (1800 33 4673), chat online or email butterfly.org.au. Confidential and free support is available seven days a week, 8am-midnight AEST.
