Overeaters Anonymous

Overeaters Anonymous (OA) is a twelve-step program for people with problems related to food including, but not limited to, compulsive overeaters, those with binge eating disorder, bulimics and anorexics. Anyone with a problematic relationship with food is welcomed, as OA's Third Tradition states that the only requirement for memberships is a desire to stop eating compulsively.

OA was founded by Rozanne S. and two other women in January, 1960. The organization's headquarters, or World Service Office, is located in Rio Rancho, New Mexico. Overeaters Anonymous estimates its membership at 54,000 people in 6,500 groups meeting in over 75 countries. OA has developed its own literature specifically for those who eat compulsively but also uses the Alcoholics Anonymous books Alcoholics Anonymous and Twelve Steps and Twelve Traditions. The First Step of OA begins with the admission of powerlessness over food, the next eleven steps are intended to bring members "physical, emotional, and spiritual healing."

Definitions
OA defines compulsions as any "impulse or feeling of being irresistibly driven toward the performance of some irrational action." OA further defines compulsive overeating as a progressive, addictive illness. OA views compulsive overeating as a chronic condition and part of an attempt to alleviate psychological stress.

Like other twelve-step programs, OA sees compulsive eating as a threefold illness, symbolically understanding human structure as having three dimensions: physical, mental and spiritual. Compulsive eating manifests itself in each dimension. A book describing itself as based on OA methods, states that in the mental dimension a compulsive eater is not "eating down" feelings, but rather expressing an "inner hunger."

To help potential members decide whether or not they need the program, OA provides a questionnaire, asking questions such as, "Do you give too much time and thought to food?" Answering "yes" to three or more of these questions is considered a good indication of problems with which OA may be able to assist.

Recovery tools and strategies
The OA program is based on the twelve steps and twelve traditions of Alcoholics Anonymous. Small changes have been made to make these applicable to eating disorders, but such adaptation has been minimal. To take the twelve steps and practice the twelve traditions, OA program literature recommends using eight "Tools of Recovery." These include A Plan of Eating, Sponsorship, Meetings, Telephone, Writing, Literature, Anonymity, and Service. These tools are considered critical to obtaining and maintaining abstinence.

Meetings offer a consensual validation and serve to diminish feelings of guilt and shame. A sponsor provides guidance through the OA program and support where necessary, but gradually encourages autonomy in the sponsee. A sponsor strives to make his or her job obsolete.

Food plans
In Overeaters Anonymous, abstinence is "the action of refraining from compulsive eating." According to OA, "[b]y definition, 'compulsion' means 'an impulse or feeling of being irresistibly driven toward the performance of some irrational action.'" OA has a long and complex history with "food plans" and does not endorse or recommend any specific plan of eating, nor does it exclude the personal use of one. At present, OA recommends that each member consult a qualified health care professional, such as a physician or dietitian. OA publishes a pamphlet Dignity of Choice which assists in the design of an individual food plan and also provides six sample plans of eating (reviewed and approved by a licensed dietitian) with which some OA members have had success.

Individual OA meetings and sponsors may make more detailed suggestions. Some of these caution against foods containing excessive sugar, alcohol, and wheat. A qualitative analysis of OA found OA members with excessively rigid plans are less likely to remain abstinent. The researchers conducting the analysis suggested new members start with a somewhat rigid plan that becomes increasingly more flexible approaching the end of a year in the program.

Demographics
In 2002 a dissertation compared the results of a survey of 231 OA members in the Washington area of North America undertaken in 2001 with the findings from surveys of OA members taken in 1981, twenty years previously. The 2001 survey showed that 84% of OA members identified as binge eaters, 15% as bulimic, and 1% as anorexic. The 1981 survey had found that 44.5% of OA members identified as binge eaters, 40.7% as bulimic, and 14.8% as anorexic. The survey also found an increase in the percentage of males in OA from 9% in 1981 to 16% in 2001. Both figures are generally inline with estimates made by the American Psychological Association that the male to female ratio of those with eating disorders ranges from 1:6 to 1:10. The researcher stated that the typical OA member in Washington was white and highly educated. The typical OA member surveyed in 2001 worked in a full-time capacity and homemakers only comprised 6% of the 2001 OA population, in contrast to 30% of those surveyed in 1981. This reflects the trend for increasing numbers of females to be employed outside of the home. Further, 80% of the 2001 participants had attained a college degree, compared to 59% of those surveyed in 1981. The percentage of OA members who were divorced or separated had risen from 10% in 1981 to 21% in 2001, also reflecting trends amongst the general population.

Correlations with maintaining abstinence
Research has identified a number of OA practices significantly correlating with maintaining abstinence in OA: adherence to a food plan (including weighing and measuring food), communication with other members (specifically sponsors), spending time in prayer and meditation, performing service work, completing the fourth step, completing the ninth step, writing down thoughts and feelings, attending meetings, reading OA/AA literature, and the educational status of the participant. Researchers have therefore concluded that application of OA practices might directly help promote abstinence and reduce the frequency of relapse in those with binge eating disorder and bulimia nervosa.

Honesty
Though not found in research to be significant, a number of OA members responded that honesty was a very important OA practice. Researchers have noted the high level of honesty at OA meetings and pointed out that working the Twelve Steps reinforces this quality.

Spirituality
Some researchers have found that in spite of its perceived high importance to the program that spirituality does not correlate with measures of weight loss, while others have found somewhat contradictory conclusions. In particular an increased sense of spirituality was correlated with positive gains in eating attitudes, fewer body shape concerns, and positive psychological and social functioning. However, measures of religiosity and particular religious affiliations have never been found to correlate with treatment outcomes.

Demographic abstinence differences
Some research has found the average length of abstinence for bulimics in OA was significantly higher than the average length for binge eaters. Paradoxically, bulimics were also found to attend fewer meetings, and had less of a commitment to write their thoughts and feelings down daily. However, the frequency of relapse for bulimics and binge eaters was not significantly different. The differences may be explained by the predictable nature of the bulimic cycle. Other research has found binge eaters in OA had better success than bulimics. Most OA members who have reported negative experiences in the program are anorexic. This could be caused by OA's focus on problems of eating too much rather than too little. Some OA practices, such as refraining from eating certain kinds of foods, are antithetical in the case of anorexics. Though, most anorexics have a previous history of bulimia.

Results
The average weight loss of participants in OA has been found to be 21.8 pounds. Survey results show that 90% of OA has responded that their lives have improved either "somewhat, much, or very much" in their emotional, spiritual, career, and social lives. OA's emphasis on group commitment and psychological and spiritual development provided a framework for developing positive, adaptive, and self-nurturing treatment opportunities.

Since excessive weight gain or loss is viewed as a symptom of underlying issues, OA focuses on these issues. No one reports on weight gain or losses but on their personal spiritual and emotional progress. A statement read at the beginning of each meeting states that ..."we are not a diet and calories club."

Changes in worldview
Changes in worldview are believed to be critical for individuals in the recovery process, as they are generally accompanied by significant behavioral changes. Accordingly, several researchers have identified world view transformation in members of various self-help groups engaged in addiction issues. Such research describes "worldview" as having four domains: (1) experience of self; (2) Universal Order/God; (3) relationships with others; and (4) perception of the problem. In OA, members changed their beliefs that (1) "it is bad to eat" to "one must eat to stay alive and should not feel guilty about it"; (2) "one is simply overweight and needs to lose pounds" to "one has underlying psychological and interpersonal problems"; (3) "one must deprecate oneself, deprive oneself, please other people" to "it is okay to express positive feelings about oneself and take care of one's needs"; (4) "food is the answer to all problems, the source of solace" to "psychological and emotional needs should be fulfilled in relationships with people"; "I am a person who eats uncontrollably" to "I am someone who has limitations and does not eat what is harmful for me."

Understanding of control
The act of binging and purging provides bulimics with the illusion that they can regain a sense of control. Binge eating has been described as a "futile attempt to restock depleted emotional stores, when attempts at doing everything perfectly have failed." The self-destructive behavior of injecting intoxicating drugs parallels overeating in that it permits the user not only to experience comfort, but to feel deservedly punished when through.

In relationships, many OA members attested to trying to obtain absolute control of their own lives and those of others. Paradoxically, OA member's experience of themselves was also characterized by strong feelings of personal failure, dependence, despair, stress, nervousness, low self-esteem, powerlessness, lack of control, self-pity, frustration and loneliness. As part of these feelings, the self was perceived as being both a victim of circumstances and a victim of the attitude of others. Many members viewed this lack of self-esteem as deriving from their external appearance. Harsh self-criticism is a typical characteristic, accompanied by feelings of "I don't deserve it," and "I'm worth less than others." Such feelings were found to have a dominant influence on the structure of relationships with others.

The members describe their sense of relaxation and liberation and the concomitant growing value of restraint and modesty in their lives. Their testimonies show that, paradoxically, it is by becoming aware of their powerlessness and accepting the self's basic limitations that they start to feel the recovering self's growing power. At the same time, personal responsibility replaces self-pity and the expectation that others will act for the good of the individual. In this attitude, egocentricity and exaggerated, false self-confidence perpetuate the problem that led them to join OA. While eating disorder was active many OA members claimed that their experience of self was composed of an obsessive aspiration for perfection that concealed their sense of worthlessness.

Comparisons
The main difference between Twelve Step work and cognitive-behavioral therapy is the acceptance of a Higher Power and providing peer support. A large study, known as Project Match, compared the two approaches as well as motivational enhancement therapy in treating alcoholics. The Twelve Step programs were found to be more effective in promoting abstinence. However, some researchers have found that cognitive-behavioral therapy is the most effective treatment for bulimics. The two approaches are not mutually exclusive.

OA is most appropriate for patients who need intensive emotional support in losing weight. Each OA group has its own character and prospective members should be encouraged to sample several groups.

Criticism
OA is different from group therapy in that it does not allow its participants to express their feelings about and directly to each other during meetings. OA meetings are intended to provide a forum for the expression of experience, strength and hope in an environment of safety and simplicity.

Feminist
OA has been the target of feminist criticism for encouraging bulimic and binge eating women to accept powerlessness over food. Feminists criticize that the perception of powerlessness adversely affects women's ongoing struggle for empowerment. Similarly, teaching people they are powerless is liable to encourage passivity and prevent binge eaters and bulimics from developing coping skills. These effects would be most devastating for women who have suffered oppression, distress, and self-hatred. In these criticisms Twelve Step programs are described as inherently male organizations that force female members to accept self-abasement, powerlessness, external focus, and rejection of responsibility inherent — qualities attributed to male religion and politics. Surrender is described as invoking images of women passively submitting their lives to male doctors, teachers, and ministers. Alternatively, they suggest that women would do better to focus on pride rather than on humility.

Fanaticism
Opponents of Twelve Step programs argue that members become cult-like in their adherence to the program, which can have a destructive influence, isolating those in the programs. Moreover this kind of fanaticism may lead to perception that other treatment modalities are unnecessary. Surveys of OA members have found that they exercise regularly, attend religious services, engage in individual psychotherapy and are being prescribed antidepressants. This is evidence that participants do not avoid other useful therapeutic interventions outside of Twelve Step programs.

Vagueness of abstinence in OA
Abstinence in OA is refraining from eating compulsively. This concept of abstinence has been criticized for its inherent ambiguity. While in AA abstinence means not drinking alcohol, there is no direct analogy for compulsive eaters. It has been difficult to define abstinence more precisely, as it is impossible to refrain from eating, and also different people have different food triggers (i.e. foods that cause them to binge).

OA's guidelines attempt to address this ambiguity. The objective of OA's definition of abstinence is that the compulsive eater refrain not from eating, but rather, from compulsive eating. OA's precepts call for the compulsive eater to define his or her own plan of eating, that is, the food plan that will constitute his or her abstinence. This enables the compulsive eater to establish a realistic, healthy eating regiment encompassing personal triggers and medical needs. Eating only according to that plan, then, constitutes abstinence. Deviating from the plan is considered an act of compulsion, since it breaches a predetermined commitment.

The program suggests that members identify the foods that "trigger" overeating. Since individuals are responsible to define their own plan of eating, they are able to change their plan of eating if their triggers or medical needs change without the change being considered a violation their abstinence. Members are encouraged to seek counsel with other individuals before making such changes, generally including a member or members of the OA fellowship, to validate that the reasons are sound and not unwittingly a decision based on underlying compulsion.

In some cases, an individual's plan of eating will call for the exclusion of certain triggering behaviors. For example, a person who knows that eating after a certain time in the evening might include in his or her definition of abstinence a commitment to abstain from eating after that time of night.

Literature
OA also publishes the book Overeaters Anonymous (referred to as the "Brown Book"), The Twelve Steps and Twelve Traditions of Overeaters Anonymous, For Today (a book of daily meditations), the OA Journal for Recovery, a monthly periodical known as Lifeline, and several other books. The following list is not comprehensive.