Overeaters Anonymous

Overview
Overeaters Anonymous (OA) is a Twelve Step program for people identifying themselves as "powerless over food" including, but not limited to, compulsive overeaters, those with binge eating disorder, bulimics and anorexics. OA was founded by Rozanne S. and two other women in January, 1960. OA's headquarters (World Service Office) are located in Rio Rancho, New Mexico. OA estimates its membership at 70,000 and is active in over 70 countries. OA has developed its own literature but also uses the Alcoholics Anonymous (AA) books Alcoholics Anonymous and Twelve Steps and Twelve Traditions.

Definitions
OA defines compulsion as any "impulse or feeling of being irresistibly driven toward the performance of some irrational action." OA further defines compulsive eating as a progressive, addictive illness. Much like AA's position on alcoholism, OA believes compulsive overeating is chronic and is done in an effort to alleviate psychological stress.

OA, like all other Twelve Step programs, symbolically understands human structure in three dimensions: physical, mental, and spiritual. The disorders and diseases the groups deal with are understood to manifest themselves in each dimension. Emotionally it is not "eating down" feelings, it is considered to be the "inner hunger."

Clinically, eating disorders are evaluated using instruments like the Questionnaire of Eating and Weight Patterns (QEWP), which has specialized versions for adolescents and parents (QEWP-A, and QEWP-P). In addition to evaluating eating patterns, the tests also measure depression.

Demographics
Recent studies of OA members have found 84% identified as binge eaters, 15% as bulimic, and 1% as anorexic. An earlier study found 44.5% identified as binge eaters, 40.7% as bulimic, and 14.8% as anorexic. Researchers have found the percentage of males in OA has increased from 9% in 1981 to 16% in 2001. This is generally inline with estimates made by the APA that the male to female ratio of those with eating disorders ranges from 1:6 to 1:10. Most OA members are white and highly educated. Some researchers have speculated the racial disparity is related to cultural perceptions of obesity.

The typical OA member surveyed works in a full-time capacity. Homemakers only comprise 6% of the population, in contrast to 30% of those surveyed in 1981. This vividly reflects the trend in our society for increasing numbers of females to be employed outside of the home. Further, 80% of today’s participants have attained a college degree, far surpassing the 59% of those attaining the degree in 1981. Another noteworthy change is reflected in the percentage of those divorced or separated. This number has risen from 10% in 1981 to 21% in 2001. It is apparent that greater gender equality over the last twenty years has significantly contributed to myriad demographic changes, yielding both positive and negative consequences.

Recovery tools and strategies
OA program literature describes eight "Tools of Recovery." These include attendance at OA meetings, reading/writing from the Twelve Step literature, adhering to a food plan, having a sponsor, giving service, taking time for prayer and meditation, sponsorship, and making phone calls to other members. They 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 her job obsolete.

Food plans
In Overeaters Anonymous, abstinence is "the action of refraining from compulsive eating." 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 dietician. 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. Research has found that OA members with excessively rigid plans are not likely to remain abstinent. It is suggested that new members start with a some-what rigid plan that becomes increasingly more flexible approaching the end of a year in the program.

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 liteature, 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 and increased sense of spirituality was correlated with positive gains in eating attitudes, less 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 significant. 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.

Changes in worldview
Changes in worldview are believe to be critical for individuals in the recovery process, as they are generally accompanied by significant behavioral changes. According, several research have identified world view transformation in members of various self-help groups engaged in addiction issues. Such research describes "worldview" has having four domains: (1) experience of self; (2) Universal Order/God; (3) relationships with others; (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 the bulimic with the illusion that she 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 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 has 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
The concept of abstinence in OA has been criticized for its inherent ambiguity. While in AA abstinence means not drinking alcohol, there is no direct analogy for compulsive eaters.

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 comprehensive.