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Saturday, January 12, 2013

Desperate for Overeaters Anonymous?


6 Reasons to Skip This 12-Step


It's January and if you watch TV, read Women's (or Men's) magazines, or overhear locker-room talk you know what that means.  Just last week my husband emerged from the gym, biting his tongue having heard a couple of guys talking about white flour and 'bad' foods to eat and their New Year's resolutions to strike them from their diet.
Yes, one of us bites his tongue. I, on the other hand, feel compelled to discuss the issue further.

Why a post on OA anyway, you ask?


Because I have been hearing tales of OA meetings, about Grey Sheet, about control and powerlessness for years now, from clients who’d been involved with OA and wrestled to break out of it’s grip, and from those struggling to move on. And, because I want to point out--as I did in the Weight Watcher's post—what you need to be cautious of if you are considering taking advantage of this program.

But first, here’s a disclaimer; I have never personally experienced Overeaters Anonymous meetings, nor the sponsor relationship, although I have read through their booklet several times to ensure I am taking their information first hand as well as through the filter of its ex-members. I am writing based on what I frequently hear in my office, from those who have left the group, often with mixed emotions. They left, ultimately because they realized it wasn't working for them, sometimes feeling a longing for the camaraderie of the group, sometimes seeing their departure as their own failure. But often recognizing that the OA approach was ultimately far from healthy.
Overeaters Anonymous is a peer led support group based on the 12-step model of recovery. What's 12-step, you ask? Here's a link for an explanation:

Twelve-step programs are fabulous for helping individuals take control when struggling with a range of addictions—such as alcohol and drugs. But eating should not be so black and white, with columns of drug-like foods and good food. We can compulsively overeat on anything—given the right setting and triggers.

So what's my beef about this 12-step program for compulsive overeating?


1. It's free. But you get the expertise you pay for.


Guidance and support abound, by well-intentioned individuals (called sponsors) struggling with their own compulsive overeating. And their approach to managing food is simply avoidance. Are sweets an issue? Ban them. Bread? Ban it. Anything white, as in white potatoes and white rice—purge them from your diet. Admittedly not all OA members follow this rigid approach (aka Grey Sheet), which has supposedly lost favor with the organization. Yet even in their descriptive program booklet, there’s specific reference to avoidance of these foods.

It appears to me, from my patients’ descriptions, that issues of control around food get transferred to control in the sponsor-member relationship. Instructions and repeated check-ins and accountability come from sponsors, lay people struggling with compulsive overeating themselves. They are not trained professionals, and draw only from their specific issues and experiences. Patients have described feeling shame and the need to be dishonest with their sponsor, and they ultimately complain of difficulty being released from the hold of the sponsor even after deciding to leave OA.

2. You decide what you eat?


With Overeaters Anonymous, you can follow whatever diet you please—it's up to you, not them! “We choose what’s appropriate and nutritionally sound for ourselves”, they say. Sounds perfect, no? Yet this can be dangerous, if you are misinformed as were the gym goers my husband overheard or if your thinking is distorted from years of diet rules. If you believe that limiting your intake to fruits and vegetables is adequate for yourself, I just wouldn’t agree. There is a place for some reality checking with a professional!

3. We must admit we are powerless over food?


That's their ‘step one’ so it’s no surprise that OA and I differ philosophically here! No, I do not believe you are powerless—although you may certainly feel powerless around food. Yes, when you have under eaten throughout the day, you will feel out of control when food finally appears. When you are stressed and have not yet learned alternative means to manage your feelings other than relying on food, you will overeat. And if you feel you are not entitled to eat—because you shouldn't feel hungry, or if you desire something palatable but feel that you are not entitled to eat what you enjoy simply because of your weight—surely you will eat it compulsively and feel powerless. “Our mind/body as compulsive eaters is different than a normal eater…” they say, and I couldn’t disagree more.

4. “Spiritual growth is the basis for stopping and maintaining compulsive free eating.”


That’s what they say in their manual. Sure, a sense of peace and inner calmness will help you move away from compulsive eating. But frankly, if someone leaves a plate of home-baked brownies on your kitchen counter, even if you’ve had a spiritual awakening, you’ll likely still eat more of those delectable baked goods than you intended—and there’s nothing disordered about it! Rather, it’s a pretty normal response, triggered by our senses. And if we’re distracted at the same time, we’ll likely eat more. And if we’re hungry at that time, we may consume them faster and in greater portions. I’m all for spiritual growth, but you don’t need to believe in a higher being to take control of your eating.

5. “Then we need a plan of eating…that includes refraining from particular foods and or specific compulsive behaviors.”


Unfortunately, restricting food intake and creating lists of good vs. bad foods does nothing to change your long-term relationship with food. Short term, this black and white view may seem to serve you well. But after some time, thoughts about the forbidden foods, longing for what you miss eating, and ultimately overeating on that which you’ve eliminated, will result. But you may just blame yourself instead of this outrageous approach that itself contributes to your lack of control around food. I do not endorse their approach of identifying and then eliminating all foods that you struggle to eat in control.
“Think of it not as deprivation but of as a positive act and spiritual discipline…” they urge. Really? Is this the kind of guidance that will help free you from disordered thoughts around food and eating? I don’t think so!

6. Where do we agree?


I support OA’s interest in helping you move away from unhealthy behaviors, including [my additions in parenthesis]:
  • Eating until (uncomfortably) stuffed
  • Rigidly restricting (your food intake and the foods that give you pleasure)
  • Having to clean your plate
  • Hiding, and hoarding food
  • Distracted eating
  • Purging and restrictive dieting


“These behaviors should be stopped.” They say. And with this, I agree. But their recommendation to follow a 3-0-1 plan to include only 3 meals with nothing in between is simply absurd. It will neither stop your behaviors nor your preoccupation with food and eating.

So now where can I turn?


Support groups can be quite valuable, but I’d advise joining one moderated by a professional in the eating disorder community. In Massachusetts, check out medainc.org, or explore your local eating disorder organization. Yes, compulsive overeating is an eating disorder and needs to be address by professionals whose treatment is based not on their personal experience, but on years of clinical expertise and guidance from evidence-based research. Well-intentioned free guidance can cause more harm than good, as you‘ll struggle to let go of the additional set of rules they’ve imposed.

19 comments:

  1. I really like this post, I've never been to an OA meeting although I did go to a few alanon meetings when I was living with an alcoholic. I never really felt they helped me feel much better. As far as OA I dislike the idea of labeling foods as bad. Food is just food. My relationship with it may be dysfunctional but its not the fault of the food. It's something I need to learn or continue to work on my responses.

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    1. You summed it up beautifully--yes, it's NOT the fault of the food, and it's worth continuing to work on! Thanks for commenting.

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  2. I experienced an eating disorder program that follows the 12-step model and the OA model. I was shocked to find out that they did not ALLOW white flour, sugar or caffeine in their program. An eating disorder program that eliminates whole food categories? Ugh. That seems pretty counterproductive to me.

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    1. So sorry to hear that! I certainly do not endorse all eating disorder programs out there!

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  3. A book that I highly recommend for those who are considering becoming members of a 12-step program (and also for those who may be struggling to participate authentically in---or to extricate themselves from---12-step programs) is "Many Roads, One Journey: Moving Beyond the 12 Steps" by Charlotte Davis Kasl, PhD (1992). I personally know people who attend 12-step meetings regularly and who believe that they benefit from participation. However, I've also witnessed harm done (mostly by omission) to people who needed a much different kind of help (and caring) than that which many 12-step groups are able to offer. Of course, there are many exceptions.

    Kasl's book presents a thorough and fair critical analysis of potential benefits and risks related to 12-step membership, in general, with a brief but telling discussion of OA on pg. 226 (it underscores some of the "shaming" and "fundamentalist"-type language used in official OA literature...rhetoric that might be particularly hegemonic and disrespectful towards members of socially oppressed groups, e.g., women of color.)

    A sharp difference of viewpoint within the official membership of Overeaters Anonymous (re: the advisability of using any kind food plan vs. adamantly NOT using a food plan) has contributed to an ongoing, divisive, and many-decades-long source of contention within the organization (e.g., diminishes group solidarity). This divisiveness, however, may actually be a source of organizational strength which prevents a too-narrow focus on any particular approach to eating ("dieting" is seen as a form of futile "white knuckling".)

    When I was a member, for example, my first sponsor believed strongly that my eating choices should be a matter best addressed between myself and the "Higher Power" of my own choice. My second sponsor agreed to work with me as my sponsor provided I agreed to one (non-negotiable) condition: I would adopt a food plan---the details of which (she insisted) should be worked out between me and "any Registered Dietitian" of my choice. In other words, my cooperation with a higher power outside my own mind (to help guide me) was considered most important.

    OA meetings that I attended almost NEVER included discussions about food, food plans, or eating---other than personal admissions (and briefly shared accounts) of "compulsive overeating" and the harmful consequences of compulsive overeating; in fact, during group meetings, virtually all attempts to bring up topics related to caloric or carb contents of food, or quantities of food, or specific types of food (topics sometimes tentatively broached by unschooled new comers)were ignored and dropped instantly or were met with gentle reminders that such food-focused discussions could serve little or no truly helpful purpose in 12-step recovery from compulsive overeating. (So, this represented a group norm which, as you may imagine, created a different kind of social atmosphere in comparison to, say, most Weight Watcher meetings).

    This topic (12-step recovery programs) certainly provides a rich field to mine; it gives folks (both professionals and interested others) additional relevant ways to view and to review social discourses (dominant and subversive) about individual struggles (and socially constructed disorders) related to eating.

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  4. I came across this blog entry while trying to find current information on my local OA's meetings. I almost closed the browser when I read the blog entry title but decided to remain open minded. I was, in fact, "returning" to OA after leaving. I have done no better on my own -- not really worse either. While reading a newly released book titled: Salt Sugar Fat - author: Michael Moss - I have been "enlightened". However, with this book, OA, & this blog entry -- I understand you go in understanding that not everything is gospel & do your homework.
    I find it very odd to write on something you have never "Attended" & have only read through their brochures. Also, writing on hearing people's experiences. I think this is like me blogging about local nutritionist that dismiss OA & other diet/nutritional help in order to better their business & brand. I would blog that I had personally never seen this local nutritionist but read through some of their brochures & had taken accounts from previous clients.
    Am I saying that OA is the answer to everyone's eating problems, disorders, & addictions - nope.
    I am saying that people should do their research. Being a nutritionist is also a JOB... how do they make money? Clients.
    Did you know that Jenny Craig is owned by Nestle? Yep, the same chocolate making processed food corporation that Jenny Craig seems to be "saving" you from.
    OA has many negatives & pitfalls as well, but write about something you have never even experienced - P.s. you can attend open meetings to have more knowledge about what you write - is absurd! I just keep having visions of me telling people that I hate a ford focus - never driven one, but I've read some reviews & a couple of people told me their horror stories.
    To each their own, but me replying to this blog entry is not to fly an OA banner, but in response to not just being unfamiliar with OA meetings (in person) but admitting to it & then expecting a reader to put credibility into your words. When I do my homework I want to know how you came by this info - and your admitted slight knowledge is a reason to skip writing on something you really don't know much about.
    Also, the idea that people somehow have come to believe that a "nutritionist" is on some higher level than your average weight watchers, jenny craig, OA, fad diet, etc., etc. --
    It's a business as well.
    Just like a doctor. How do they make money?
    Does this mean they are bad or worse than any other help you might search out in the quest to eat better & live a more healthy life? All you can do is try - try a nutritionist, try OA, try a book, try a class ...
    I don't think there is 1 golden path that takes us to Healthy Land where everything is rosy & beautiful - good & bad can be found all around. Just saying.

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    1. My assessment of Overeaters Anonymous was synthesized from two things: 26 years of hearing patients' first hand accounts of their experiences and observation of the consequences of their rigidity around food and the control issues that entangled them; and, a thorough reading of materials produced directly by OA. My blog post addresses these very issues--the philosophy and approach and the resulting impact of this approach, based on what I know from my clinical experience and the available research about all or nothing approaches to food, and the experience of patients who attempt to deny their hunger to avoid eating between meals. I present a balanced approach to my evaluation--even highlighting where we are on the same page--which was not challenging to do even not being a member of OA.
      Thanks for taking the time to comment and best of luck in your approach to changing your relationship with food.

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    2. I have not had the experience in OA where someone has told me what I could or could not put in my mouth. I agree with the commenter above; perhaps you should not take information secondhand but, rather, take the time to fully investigate the item about which you write.

      And, yeah, OA is not for everyone. But not everyone is lucky enough to be a "normal" eater with perhaps some overeating issues. Many paths, one goal (health).

      However, being non-controversial never got us page clicks, I suppose.

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  5. OA has helped many people experience freedom from constant attention and need for food. Many have let go of weight that was making them uncomfortable and let go of emotional connections with food. The support given between the people in this program is free and there is nothing like support and hearing others success or struggles to help push you forward. It's a very good program with good results.

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  6. I agree . I have been an OA member for two years in Chicago . Both of my sponsers told me to eat what I want and not restrict any food on my plan. I followed the program and steps with my sponsers that helped me release the weight and obsession with food. So my experience in Chicago and in the OA phone lines has been to seek a nutritionist and not restrict any items.

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  7. This post is now closed for comments.

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  8. I was in O/A for 15years and did not eat suger, or white flour. I lost weight and was extremely healthy. I stopped going and now 13 years later I am back into eating everything feeling sick and gained all my weight back. I feel guilty and remorseful when I overeat and feel I have no control. I know I use food to cover my feelings. I started to go back to OA just to share my feelings and feel listened to and not judged. It is helping, but I cannot seemed to let go of the overeating. I started the steps, but don't truly believe it all. I wish there was something else I could do, but cannot seem to find anything. Diets do not work for me and I refused to go on one. I keep trying to figured out if I should keep going to meetings. Take some things and leave the rest?! I have to do something because I am sick of living this way. I want freedom this obsession!

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  9. If you feel deep in your heart, that you are "allergic" to certain foods (sugar, flour) probably best to stay off of it. Some people can eat it fine, others (like me) watch out. Cant Stop. I find meetings and finding that certain "Higher Power" is really needed, because eating disorders are about Isolation and feeling comfort and unity with food. Someone once said, "Food is the first thing that ever loved me back". So it is a spiritual problem too. It's a symptom of hurting inside, for a myriad of reasons. An adjunct "therapy" if you will, which REALLY helps even out disordered eating is a regular practice of Yoga.

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  10. You have completely ignored the perspective of a compulsive overeater. Everything you say is true in regards to a normal person who has trouble eating appropriate quantities. OA is not geared towards people who simply need to lose weight, or eat when they're stressed, or just can't stay away from the sweets; it is geared towards individuals who suffer from a spiritual malady known as addiction, which manifests itself physically. You seem to think that someone cannot be addicted to food, but the reality is that someone who is addicted to food will demonstrate the exact behaviors of someone addicted to alcohol. The only difference is the drug of choice. I can understand that someone who is not an addict, or who does not know an addict, might miss this, and misunderstand OA. I would just like to suggest that there are people for whom a 12 step program is the only solution to combating an addiction to food, and that it is insensitive of you to underestimate the struggle that other people suffer with food.

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    1. Everyone who presents with this problem believes they are addicted, that they are different and not normal. My experience tells me otherwise, so I do not differentiate

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  11. One thing OA suggests is that you develop your food plan wirh the help of a nutritionist. If a client who was in OA came to you for help wirh a food plan do you seek to understand his or her issues with food or do you discount them because of your opinion of OA?

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  12. I wonder why you say this: "Twelve-step programs are fabulous for helping individuals take control when struggling with a range of addictions—such as alcohol and drugs." I've been in both OA and AA, and the stress on powerlessness and the constant statements that it's a lifelong disease were equally unhelpful with both issues, for me.

    For anyone who binges I would recommend a book called Brain Over Binge by Kathryn Hansen. It says basically that binge eating is caused by a combination of past dieting and habit, and teaches how to get past the cravings that come from the habit but will gradually weaken if you are eating enough.

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  13. I think that you feel this way because you've never encountered someone with a food addiction, or if you have, you haven't understood it in its depth. Yes, you're correct, anyone left with a plate of steaming delicious brownies would be tempted to have more than one. But this is not the situation of the food addict, the person who is in desperate need of OA. The food addict eats some toast for breakfast. Suddenly he is overcome by a need to eat brownies. It doesn't matter that he's supposed to pick up his elderly mother in 10 minutes. He must have those brownies. So he races to the store to buy brownies, and shovels them in his mouth on his way to his mother. He struggles to hold conversation with his mother because he can't stop thinking about food. More. More. Now he must have a bucket of fried chicken. He doesn't know what he'll do without it. He won't be able to get through his morning. He drops his mom off at her knitting club meeting and races to the KFC. This continues until he goes to sleep.

    You're right, OA is not for everyone. Most people are not food addicts. OA is for a small minority of the population. But that small minority needs OA. OA has saved lives. I suggest talking with a food addict to understand the disease of addiction and a drug of choice actually being food/sugar/ flour etc.

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    1. I see people who you've described well--who have left OA--and have had success moving from their sense that they are addicted to food.

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