Dr Vera Ingrid Tarman,
MD. MSc. CFCP, ABAM
Beating the odds to loose and keep the weight off is pretty challenging. Commercial and professional diet programs are helpful in the short-term, but long-term results are dismal. The reason? The addictive nature of food that can sabotage an otherwise powerful food plan has not been addressed.
In my last post, I introduced the community twelve step programs. Some of these programs have demonstrated prolonged success and thus have shown that the focus on addiction is the better prescription for many people. Fortunately there are many food-related Twelve Step fellowships available. Last month, I introduced two of the earliest programs: Overeaters Anonymous and Grey-Sheeters Anonymous. There are at least nine other food-related fellowships.
While Overeaters Anonymous (OA) was the first of the Twelve Step food-related programs and is still the largest, one of its earlier offshoots was Overeaters Anonymous 90-Day. Recall that in the early days, Grey Sheeters split from OA because they wanted members to adhere to a particular food plan that omitted sugar and flour —OA’s policy is not to endorse any plan of eating. 90-Day members alternatively held to the OA principle of not pushing a meal plan but their format dictates another deviance – which “only those with three or more months of continuous 90-day format abstinence” are allowed to speak at meetings. Its mother group, OA, does not have such a stipulation on speakers. People can speak even if they are “still in the food”, that is, are still eating compulsively. 90-Day members claimed that anything said by people who are still eating addictively is not helpful or hopeful for those members who want to abstain from trigger foods. This expectation of having 90 days before speaking gets picked up by many 12-step food groups going forward.
At least three other Twelve Step fellowships that evolved from OA have formally recognized the addictive nature of food. They each tend to highlight the physical or biochemical aspects of the disease. While their names—Food Addicts Anonymous (FAA), Food Addicts in Recovery Anonymous (FA), and Recovery From Food Addiction, Inc. (RFA)—are only subtly different, their structures are all based on the same Twelve Steps.
Like Grey Sheet, FAA and RFA both promote adherence to a specific food plan. FAA eliminates sugar, flour and wheat, but FA does not. Grey Sheet eliminates these, along with grains. RFA promotes a food plan based on the writings of Kay Sheppard, author of Food Addiction: The Body Knows Moreover, FAA, FA and RFA, Grey Sheet all recommend abstinence that is “weighed and measured”.
While FAA provides a copy of its food plan on its website, FA and Grey Sheet will not provide the actual plan without membership in its community. The belief behind this reluctance to offer a meal plan without membership to the community is that the meal plan alone is insufficient to maintain long-term sobriety; why set person up to loose weight, without the necessary support and guidance to maintain this loss over the long haul? Essentially, it is the group support that is the main ingredient for success between commercial programs such as Weight Watchers and 12 step programs. Admittedly, Weight Watcher does offer group support but they are less frequent (i.e. weekly to monthly) and voluntary. In 12 step programs, meetings are daily and mandatory. Food addiction is a tough addiction to beat. “You have to take the tiger out of the cage three times a day” is a common adage heard in the 12 step food-based circles, and so people (especially if new to the program) need help handling that tiger of over-eating on a daily basis.
Moreover, most of these food-related Twelve Step groups all view addiction as more than biochemical. Addiction is a “physical, emotional and spiritual” phenomenon. Thus, the groups promote a more expansive approach towards food sobriety, beyond just eliminating trigger foods. For example, most programs expect members to “commit their foods”, in other words, the member must tell someone else in the program, prior to the day of eating, what they will eat and then stick to whatever they have promised. Some give additional requirements: members are asked to make three calls a day to other members, have daily contact with their sponsor, and read the 12 step literature daily. They are required to go to seven meetings a week. If there are no groups in the community they live in, there may be on-line groups. Failing that, the recommendation is to go to AA and just switch the word alcohol to food.
To the uninitiated, these requirements can seem mammoth, but to those who are “working the program” successfully, it is this intensity that has given them the necessary support to remain food abstinent over the long haul. It is my impression that the more intense the program, the more likely the success of its members. It seems success comes at a cost: People have summarized that OA achieves “fat serenity” while other groups claim to have achieved “food serenity”, along with the desired weight loss / maintenance.
A less demanding program makes the person vulnerable to relapse. “Going back out” – the food addict’s term to describe “falling off the wagon” is a temptation for many, especially once they have lost their weight. This is almost always bad news for the food addict, as most people regain their weight and more. Food addiction is a chronic and progressive disease. The eating gets worse, the triggers multiply, the despair can become immobilizing. Not everyone comes back to get help and seem destined to further weight gain, illness and eventually, death.
Just to muddy the waters even more, yet another two additional food recovery fellowships exist –- which are both based on even more further requirements. Compulsive Eaters Anonymous-HOW (CEA-HOW) and Overeaters Anonymous-HOW (OA-HOW) demand that members complete dozens of writing exercise. In both cases, the HOW stands for “honesty, open-mindedness and willingness,” perceived as the keys to long-term recovery. Questions to be answered are assigned by sponsors and are based on AA’s foundational literature, Alcoholics Anonymous (also called the “Big Book”) and Twelve Steps and Twelve Traditions.
CEA-HOW differs from OA-HOW because, like its cousins FAA, FA and RFA, its groups are “sugar and flour abstinent and committed to weighing and measuring” food while OA-HOW does not require adherence to any particular food plan. OA-HOW calls itself a “movement” within OA, whose broad definition of abstinence reads: “… the action of refraining from compulsive eating and compulsive food behaviors while working towards or maintaining a healthy body weight.”
If none of these programs offers the right mixes of flexibility and structure, there are still lesser -known options. These include Food Compulsions Anonymous (FCA), which is for people who have a problem with “compulsive overeating, anorexia, bulimia, obsession with food or other food addictions”; Anorexics and Bulimics Anonymous (ABA) is for those who have unhealthy “eating practices”; Overcomers Outreach (OO) is a Christian-based program that blends the Twelve Steps with Biblical references. Finally, there is a relatively new, “back to basics” OA offshoot, OA Big Book Step Study that is following in the footsteps of some AA groups by concentrating on teaching and practicing the Twelve Steps as originally completed by the early members of Alcoholics Anonymous.
It is truly difficult to ferret out the differences between all of these groups. Clinicians get baffled – which meal plan captures the best food-addiction menu? People looking for help get overwhelmed: What is the difference between all these programs? Which is the best for me? It is truly a buffet of choices amongst all the 12 step food based programs.
What a person eventually decides is often depends on what is available in their community. Some programs like Grey Sheet and FAA have a strong on-line community, while others, like OA and FA, have many face-to-face meetings in the major cities. Some groups have fewer rules: OA has the fewest demands, where as the others which are tougher appeal only to those who are highly motivated. Wading through this dizzying area of choices requires patience and a willingness to experiment with a few of these groups. It is worth shopping around until the best fit – with the meal plan and the particular requirements of the group – is found.