Overeaters Anonymous

“Abstinence in Overeaters Anonymous is the action of refraining from compulsive eating and compulsive food behaviors while working towards or maintaining a healthy body weight.” [10] This concept of abstinence has been criticized for its lack of specificity. While in AA abstinence means not drinking alcohol, some argue that it is not possible to set out specific foods, because OA's experience is that different people have different food triggers (i.e. foods and food behaviors that cause them to eat compulsively). While it is often said that alcoholics don't have to drink, but compulsive eaters still have to eat, Overeaters Anonymous responds by pointing out that alcoholics do have to drink, but cannot drink alcohol, just as compulsive eaters do have to eat, but cannot eat foods which cause compulsive eating.[11]

OA literature specifically defines "compulsion" as follows: "By definition, 'compulsion' means 'an impulse or feeling of being irresistibly driven toward the performance of some irrational action.'"[12] Therefore, "compulsive eating" and "compulsive food behaviors" (as those terms are used in OA's definition of abstinence) means irrational eating, or irrational food behaviors, taken as a result of an impulse or feeling that feels irresistible. So, according to Overeaters Anonymous, "abstinence" is the act of refraining from "compulsive eating" and "compulsive food behaviors," while working towards or maintaining a healthy body weight. While this definition can fairly be described as nuanced and subject to personal interpretation (e.g., the definition of a "healthy body weight"), or requiring self-searching analysis (e.g., to determine the drivers of certain behaviors), it is not unspecific.

The objective of OA's definition of abstinence is that the compulsive eater refrain not from eating, but rather, from compulsive eating and compulsive food behaviors, and work towards or maintain a healthy body weight. Thus, OA calls for the compulsive eater to define his or her own plan of eating which enables the compulsive eater to abstain from compulsive eating and compulsive food behaviors, while working towards or maintaining a healthy body weight.

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 needs and understanding of their compulsions change, without that change constituting a breach of 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.[11]

In Overeaters Anonymous, abstinence is "the action of refraining from compulsive eating while working towards or maintaining a healthy body weight." According to OA, "by 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.[13][15] OA recommends that each member consult a qualified health care professional, such as a physician or dietitian.[13] 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.[11]

Individual OA meetings and sponsors may make more detailed suggestions. Some of these caution against foods containing excessive sugar, caffeine and white flour.[14] A qualitative analysis of bulimics recovering in OA found bulimic OA members with excessively rigid plans are less likely to remain abstinent. The researchers conducting the analysis suggested that new members begin with a somewhat rigid plan which becomes increasingly flexible by the end of a year in the program.[14]

An individual's plan of eating may call for the exclusion of certain triggering behaviors. For example, a person who knows that eating after a certain time in the evening triggers compulsive food behavior might include in their plan of eating a commitment to abstain from eating after that time of night; a person who knows that snacking between meals triggers compulsive food behavior would probably include in their plan of eating a commitment to abstain from chewing (or sucking) between meals.[11]

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.[3]

Some researchers have found that in spite of its perceived high importance to the program spirituality does not correlate with measures of weight loss; others have found somewhat contradictory conclusions. In particular, an increased sense of spirituality was correlated with improvement in eating attitudes, fewer body shape concerns, and better psychological and social functioning. However, measures of religiosity and particular religious affiliations have never been found to correlate with treatment outcomes.[3][14][16]

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.[3][17]

Changes in worldview are considered critical for individuals in the recovery process, as they are generally accompanied by significant behavioral changes. Accordingly, several researchers have identified worldview transformation in members of various self-help groups dealing with addiction issues. Such research describes "worldview" as four domains: experience of self, universal order (God), relationships with others and perception of the problem. In OA, members changed their beliefs that "it is bad to eat" to "one must eat to stay alive and should not feel guilty about it"; "one is simply overweight and needs to lose pounds" to "one has underlying psychological and interpersonal problems"; "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"; "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."[19]

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; it permits the user to experience comfort, and to feel punished afterwards.[3]

In relationships, many OA members attested to trying to control their own lives and those of others. Paradoxically, an 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 relationships with others.[19]

Members describe their sense of relaxation and liberation, and the increasing 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 begin 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. With these old attitudes, egocentricity and exaggerated, false self-confidence perpetuate the problem which led them to join OA. While their eating disorder was active, many OA members claimed that their experience of self was composed of an obsessive aspiration for perfection which concealed their sense of worthlessness.[19]

OA has been an object of feminist criticism for encouraging bulimic and binge-eating women to accept powerlessness over food. Feminists assert that the perception of powerlessness adversely affects women's struggle for empowerment; teaching people they are powerless encourages passivity and prevents binge eaters and bulimics from developing coping skills. These effects would be most devastating for women who have experienced oppression, distress and self-hatred. Twelve-step programs are described as predominantly male organizations which force female members to accept self-abasement, powerlessness and external focus, and reject responsibility. Surrender is described as women passively submitting their lives to male doctors, teachers and ministers; the feminist view suggests that women focus on pride instead of humility.[3][19]

OA contends that the context of powerlessness within the program isn't referring to an individual's flaws, but simply with the acceptance that they have a problem with food that they cannot seem to defeat with their unaided will. The slogan "We are powerless, not helpless," is an example of this distinction. By accepting that they are powerless over certain things and thereby surrender the illusion of control, they are then able to make an honest appraisal and make clearer decisions about what they truly do control.[3][19]

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.[3]