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Culturally-based fasting as a trigger for eating disorders

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With Lent just around the corner, it is an apt time to think about cultural and religious fasting, which is just what new research released yesterday, Jan. 28, has done. This new article, appearing in the International Journal of Eating Disorders, considers the context of fasting in a different light - as a potential trigger for eating disorders among adolescents.

Based on an observation at a hospital in Turkey that there was a spike in adolescent patients with disordered eating presenting consequent to Ramadan (a Muslim religious holiday requiring fasting from dawn to dusk for a month), researchers were curious about a potential causal association. This interest led researchers to conduct an in-depth case report on a few of their patients presenting in this way who attributed Ramadan as a specific trigger.

In some cases, this time of fasting was used as an excuse to eat little, even during the allowed pre-dawn and after sunset meals. In others, the food restriction and potential weight loss due to Ramadan became a practice that extended past the holidays due to the patient's feeling of success in having controlled their eating and weight.

The authors are clear, however, that they do not suggest the religious fasting caused an eating disorder, but rather that it served as a way to speed up the onset in adolescents already predisposed to one. Specifically, the patients interviewed reported feeling that Ramadan served as both a way to serve their religious duty and to diet without having to justify the dieting.

There is plenty of research about perceptions of beauty and body image cross-culturally, but specific cultural pressures or triggers for eating disorders or relapse have been less explored. In Western culture, Lent is most comparable to Ramadan, but usually involves giving up specific things (usually foods) rather than fasting completely. However, any cultural or religious holiday that restricts food or allows an individual to selectively limit certain foods poses a potential trigger to individuals already predisposed to disordered eating.

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. With so many potential triggers that exist in our environment already, we must not exclude those that may be specific to culture or faith, or we are missing a vital piece of the complicated picture.

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