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OA (Oh No?)

Posted Feb 12 2013 11:24am
12-step programs have guided countless individuals to sobriety and recovery.  I've worked with patients who fully attribute their substance abuse recovery to participation in "the rooms."  While some patients never take to the fellowship, citing a variety of objections (e.g., don't like the idea of a higher power, feel the organization is cultish, etc.), many find these self-help groups to be helpful and supportive.

Do these same benefits translate to the world of overeating? Is Overeaters Anonymous helpful or hurtful?

We know that that there is something inherently addictive about alcohol and other drugs.  With food, I'm not so sure.  Despite plentiful claims in the popular media, we don't have any good research that suggests that "food addiction" exists.  For an interesting summary on this debate, check out this dietitian's blog .  We know that people can demonstrate an addictive relationship around food, but this doesn't mean that the food itself is addictive.  Rather, behaviors like restriction and bingeing can be incredibly habit-forming.

Moreover, most of the foods that people label as addictive (e.g., sugar, carbohydrates, fats, etc.) are foods that they've tried to restrict in some ways. Deprivation can, as we know, lead to overeating.  For instance, almost every patient I see who tells me she's addicted to sugar happens to be restricting her carbs.  Once she  supplements her carbohydrate intake, much of the sugar cravings subside.

The problem with OA is that many groups (not all, but many) conceptualize food or certain foods as addictive.  As a solution, they preach abstinence (similar to other 12-step programs).  OA members will speak of their abstinence from sugar, wheat, etc.  Some OA sponsors will prescribe their sponsees specific meal plans.  Any departure from the meal plan is considered a relapse (i.e., back to Day 1).

The problem with this approach, if you're not guessing this already, is that abstinence equals deprivation!  As a result, many who try out OA, find themselves developing even greater problems with bingeing or overeating, as a result of the diet-binge cycle.  We're able to carve out an existence without alcohol or drug. but abstinence from food is impossible and abstinence from certain foods increases the experience of deprivation.  By defaulting to abstinence, OA does not teach members how to eat in moderation (which, in my opinion, is necessary to be functional around food in this world), contend with emotions that lead to overeating, or heal one's relationship with food.  It only makes it worse.  OA members may practice abstinence from various foods until a time in which they're presented with that food/can't take it any longer/give up. . . leading to one colossal binge.  I've worked with a number of patients who come into treatment, precipitated by an increase in disordered eating, which they attribute to OA.

Now, it may be possible to find OA groups and/or sponsors that are less restrictive and offer the typical benefits associated with 12-step groups.  But unless that's possible, those who struggle with compulsive eating may be better served through Anorexics and Bulimics Anonymous  or emotional eating groups run by private practitioners who espouse a more intuitive approach to eating and food.

Thoughts?

*thanks to Meliss, who begged the question : )
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