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.

The Importance of Professional Supervision for Dietitians

Professional supervision has long been recognised as an integral part of practice for psychologists and other mental health clinicians. Outside of student placements and perhaps some within workplace arrangements, supervision is likely to be less familiar to Dietitians (where a culture of mentoring is more common). This is however changing, thanks to the work of Dietitians Supervision Resources Australia, and the mandatory supervision requirements for maintaining Credentialed Eating Disorder Clinician (CEDC) status with the Australia and New Zealand Academy for Eating Disorders. This blog post will help to clarify what professional supervision is, how it differs from mentoring, and explain why it’s important for Dietitians to include supervision in their professional development plan.

Supervision vs mentoring – what’s the difference? 

Dietitians undertake mandatory mentoring (for 1 year) as part of the provisional Accredited Practicing Dietitian (APD) program. The goal of the mentoring program is to build the mentees knowledge and help brainstorm ideas and find solutions to career challenges. This may provide some crossover with aspects of supervision (e.g. facilitating reflective practice) but Dietitians Australia makes a clear distinction between the two. Once the mentoring program is complete there’s no ongoing requirement for mentoring to maintain APD status, but Dietitians are encouraged to seek out mentoring needed. Mentoring in this capacity may be ad hoc or a longer-term relationship, and there are no requirements for becoming a mentor.  

What is supervision? 

Hawkins & Shohet provide the following definition of supervision in ‘Supervision and the helping professionals’ (2012): 

“Supervision is a joint endeavour in which the practitioner with the help of a supervisor, attends to their clients, themselves as part of their client practitioner relationships, and the wider systemic context, and by doing so improves the quality of their work, transforms their client relationships, continuously develops themselves, their practice and the wider profession”.

Effective supervision is: 

• a structured and formal process with a clear purpose of developing the learning and growth of the supervisee  

• outlined by clear boundaries agreed upon by the supervisor and supervisee 

• dedicated to facilitating reflective practice of the supervisee rather than just providing answers to questions (although there is space for teaching too when needed) 

• built around providing learning, support, and accountability for the supervisee 

• a relationship that helps to improve Dietitians competence & wellbeing, improve career longevity, ensure that patients/clients of the supervisee receive high quality and safe care, and that dietetic practice aligns with the professional code of conduct      

• a skill that requires the supervisor to undertake training and an ongoing commitment to their own growth and development as a supervisor e.g. supervision of their supervision practice  

Dietetic supervision at Mind Body Well

Mind Body Well Dietitian Team Leader Tom Scully provides professional supervision (via Telehealth), which is particularly suitable for Dietitians who:

• have an interest in, or are already working with people with body image and weight concerns or a history of dieting 

• are interested in improving their confidence and competence in working with eating disorders or other areas of mental health including mood disorders and substance use disorder  

• are a Dietitian working within a minoritised community/group that you are a member of and would like a place to discuss the rewards and challenges that this can pose 

• work with LGBTIQA+ clients and would like to increase your confidence in providing culturally appropriate and affirming care 

You can read more about supervision at Mind Body Well and make an enquiry via the link below.

'Wellness' Program or Diet in Disguise?

Intuitive eating and non-diet approaches to weight and nutrition have been gaining popularity as many people elect to step off the dieting treadmill and change their relationship with their body, and their eating attitudes and behaviours. As these approaches have gained momentum however, many diet programs, companies and influencers have begun to co-opt the language of ‘non-dieting’ to mislead people back into the diet cycle. A number of established weight loss companies have re-branded, and new ‘wellness’ programs have emerged, with strong marketing messages about supporting people to make ‘sustainable lifestyle changes’ rather than focusing on weight loss.

However, when you really look at many of these programs it’s clear that they have not really changed their focus, but have instead become traditional diets in disguise – the new breed of diet industry companies. These so called ‘wellness’ programs continue to promote restrictive eating behaviours, encourage people to monitor their weight, and hold at their core the false idea that thinness equates to health - only now with an added side-serve of ‘wellbeing’.

So how can you tell the difference between an actual non-diet approach and a wolf in sheep’s clothing? One of the main differences between dieting and intuitive eating is the focus on weight loss and changes to body shape which are integral to dieting programs. Intuitive eating however is weight neutral, and focused on healing your relationship with food and your body. Intuitive eating is not about weight loss, it won’t ask you to eliminate any foods from your diet, or to label foods as ‘good’ or ‘bad’. Intuitive eating is a not a hunger-and-fullness diet but rather is about unconditional permission to eat all foods, building body trust and eating foods which feel satisfying and enjoyable. Another main difference between intuitive eating and dieting is that intuitive eating has a strong evidence base supporting its effectiveness, compared to traditional diets which are shown to be ineffective for 95% of people (especially in the medium to long term).

This re-branding of weight loss dieting to ‘wellness’ is dangerous and confusing for so many people. This new generation of diets aims to differentiate themselves from traditional diets by claiming that they are not ‘fad diets,’ that they value ‘wellness over weight loss,’ and some even use the language of eating disorder recovery as part of their marketing campaigns. Yet most of these programs continue to focus on food restriction, monitoring or logging what you eat, and weight monitoring. These programs now commonly offer self-care activities ‘on the side’, and may market themselves with health buzzwords or topics such as gut heath or inflammation. They offer a simplistic view of health and wellness, and a narrow assumption that weight loss equals health.

Studies show that weight loss dieting is one of the biggest risk factors for the development of eating disorders and disordered eating. Yo-yo dieting which is characterised by the cyclic nature of losing and re-gaining weight has been shown to have negative effects on physical health and how you feel about your body. Dieting also promotes the development of maladaptive eating behaviours. When our food intake is restricted, food often becomes our focus, which can cause obsessive thinking about food, and can result in either further food restriction, or episodes of reactive binge eating – where the body tries to gain back some of the energy which has become depleted from restrictive eating.

So how can you tell the difference – how can you differentiate a diet in disguise from an approach which is truly focused on enhancing health and wellbeing?

An approach may be a ‘diet in disguise’ if it:

• Encourages you to disconnect from your body by ignoring body signals (including hunger and fullness)

• Is focused on changing your body - weight loss or body shape/size

• Asks you to count points, macros, or uses approaches like a traffic light system

• Uses negative language around ‘good’ and ‘bad’ foods, classifying certain foods as inflammatory, detoxifying, guilt-free, or clean

• Recommends that you restrict or eliminate certain foods or food groups

• Acknowledges that diets don’t work followed by a BUT… (insert dieting behaviour here)

• Causes you to feel preoccupied with food and weight loss

• Recommends you buy expensive supplements or unusual foods

As an alternative to diet industry programs we recommend an individualised and therapeutic approach to understanding your nutritional needs, and changing your relationship with your body. If you’re ready to make this change, the team of Psychologists and Dietitians at Mind Body Well can assist.

Other relevant Blog posts:

• What is Intuitive Eating?

• Let’s set some perspective on ‘Food Addiction’

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

• Breaking up with weight loss

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’?