Sarah Ramadan has always been a perfectionist. Whether it was pleasing her parents, teachers, or coaches, her motivation was to make others proud. “It’s hard to say if I ever did things for myself,” she says. By her early teens, her drive for perfectionism began to permeate her body image. “I associated weight loss with personal development. I thought I would be a better person if I lost weight, since that meant I cared for my body.”

Ramadan gradually started to make small changes in her diet and to adjust her behavior, slowly cutting calories like opting for skim milk in her cereal and drinking extra water to feel fuller. She came up with excuses about why she had to skip meals. “Things began to spiral,” says Ramadan, and by age 14, the Canadian had started to develop the eating disorder anorexia nervosa. “Week after week, I was having greater food fears and triggers. I associated food with weight gain, which was associated with shame. I avoided eating for fear that it would inflict worthlessness on my being,” she says.

To hide her weight loss, Ramadan would wear extra layers of clothes that helped fill out her frame. At the peak of her disorder, her daily food intake amounted to just 60 to 70 calories a day, about the amount in a small fat-free yogurt and some broth. The 5’3″ teen dwindled to 78 pounds. The extreme weight loss took a serious toll on her body. She was always freezing, had dry skin and thinning hair, and developed an irregular heartbeat and low blood sugar. She would black out when she got up or walked too quickly, and she became anemic while her body’s calcium and estrogen levels also drastically decreased. Her body was so frail she developed bruises from the protrusion of her bones.

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When Ramadan was 15, her mother walked in her room while she was wearing only a tank top and began to cry. Realizing their daughter was in trouble, her parents stepped in, placing her in a four-month inpatient treatment center. Ramadan’s weight was restored, and she looked recovered, but mentally, she says, she was still battling the disorder. Not long after, she relapsed and spent a week in a hospital cardiac unit with an irregular heartbeat, placing her at risk for a heart attack. A second round of inpatient treatment was moderately successful, and she was discharged in time to start her senior year of high school.

While a year went by without any relapses, Ramadan says the same issues were still there. She started to slip back into old habits, and in her first semester in college, the disorder again gained traction. This time, without her parents to mandate care, she spiraled downward. By early 2014, she weighed just 68 pounds. She was in critical condition, and the school advised her to leave campus until she recovered. It was the wake-up call she needed. “I realized everything I looked forward to in life just dissipated, all at the hands of this eating disorder.”

A childhood memory helped sharpen her desire to make a change. “I remembered on my fourth birthday I was eating cake without a care in the world,” Ramadan says. “I hadn’t remembered feeling that happy in the longest time. It woke up a part of me that wanted to fight for that little girl.”

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While she had the desire to change, she needed a plan. She called on her brother, Aladdin, a personal trainer. He helped set up a meal plan that gradually increased her calorie intake. “I knew I needed to eat to gain weight, but eating is actually physically exhausting when you’re not used to it. I had lost all my cravings and hunger cues. I had to learn how to enjoy food again,” says Ramadan. She started to feel a difference and was motivated to continue.

A few months later, Ramadan decided to start working out. “I was an athlete prior to anorexia and was constantly playing soccer. I wanted to get back to that part of me that I’d lost,” she explains. She started doing some low-intensity yoga, but her brother’s passion for the gym also drew her to resistance training. “I never saw the gym as an empowering place until it transformed my idea of what my body could do.”

Today, the 22-year-old works out about five days a week, mostly doing resistance and powerlifting. “Fitness showed me my body was more than I ever gave it credit for,” Ramadan says. “It reminded me that I’m a strong person and I deserve to feel strong.”

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At the end of 2015, Ramadan decided to enter a bikini competition. She trained for a year and a half, but during this time, her brother was murdered. Undeterred, Ramadan dedicated her training to him. “The show allowed me to prove to myself I can diet again without it triggering a relapse. It was a big symbol to me that I was fully recovered.” She placed second out of 22 women in her bikini division.

Today, Ramadan maintains a healthy weight of 120 pounds and continues to train regularly while following a balanced, plant-based diet, eating about five to six meals a day. Although she is hoping to compete again, she wants to give her body ample time to recover. Ramadan says she hasn’t forgotten the trauma that she put her body through with the disorder and wants others to make sure they are exercising for the right reasons. “You need to have a goal that is going to keep you moving and inspired,” she says. “Fitness shouldn’t just be another mechanism to control your life or your self-worth. It should only empower the worth that is already within you.”

Ramadan’s Favorite Leg Day Routine

  • Barbell squat (3×8)
  • Hip thrust (3×12)
  • Romanian deadlift (3×10)
  • Single-leg hip thrust (3×10)
  • Leg curl (3×10)
  • Glute kickback (3×12)
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