Thursday, September 10, 2009

Overeaters Anonymous

Obesity is at epidemic proportions in western "civilized" countries where there is now greater likelihood of dying from the consequences of overabundance than from starvation. In a recent clinical talk I attended on Obesity the medical specialist presentor, Dr. Randall Adair stated that while the MRI and PET scan data suggested that Anorexia was a brain disorder the overwhelming evidence to date was that obesity was a garden variety addiction disorder.
The treatment of choice for addiction has been group therapy, AA being the most successful and now NA, SMART and other groups having increasing evidence of similiar success. Fundamental to the problems of addiction is the idea that 'we're as sick as our secrets'. Those with addiction are found to have serious issues with anxiety and anger. The 12 step programs have addressed the 'self centeredness" of addiction and recognised that resentments are the principle reason for relapse. Obesity research shows similiar dynamics of "stuffing feelings" with food.
Historically, it was said, men drink and women eat to deal with their emotions. However today increasingly the groups are no longer gender specific in the western world. Much of the what was attributed to gender has turned out to be context dependent. Children have long provided protection for adults from addiction serving as monitors , social police and often bringing out the best in parents who alone might be more likely to self abuse.
Women in the work force, single longer, with more disposable income and increasingly now targetted for addiction purveyors, in terms the incidence (new cases) of alcoholism are surpassing men. Meanwhile obese men are being more routinely identified by their doctors as obese because of the heart and diabetes risks imposed.
Physically time lapse photography comparing obese and thin show that obese people become increasingly 'energy efficient' with increased mass, moving a whole lot less, even including less 'fidgetting'.
In terms of treatment denial is as high if not higher for overeaters than for alcoholics. An interesting Calgary study enrolled a sample of obese people and set up a cafe where they ate 3 nutritious meals a day while their work and home were monitored for no food or snacks. It was so highly successful that it was yet more proof of the addiction paradigm. Just as alcoholics lied and hid bottles, food addicts lie and hide food. As Alcoholics Anonymous, Overeaters Anonymous states that honesty is the cornerstone of success. Being honest with oneself follows being honest with one's peers .The problems of addiction in therapeutic settings is the intrinsic anti authority aspects of addiction in which the addict naturally won't 'tell mommy or daddy' and yet in a group of fellows they will eventually become honest and address shame and find acceptance.
Not ironically where the alcoholic is comfortable in a bar but says they don't 'like' AA meetings, so the obese person comfortable in restaurants says they don't 'like" over eater anonymous meetings. They don't like the gym even more. Yet as with all addictions they're effectively killing themselves slowly and their personality disorders, neurosis, depressions and attitude problems including perfectionism and controlling are harming those around them. Untreated food addiction is psychosocially as disturbing as untreated alcoholism and costs are exhorbitant though rarely are they acknowledged.
Thanks to a friend in Over eater's Anonymous I am becoming more aware of how ubiquitous food is in social interactions in the same way as alcohol. Recently at a hotsprings I watched the parents drinking and stuffing their children with chocolate bars and cookies in this setting where food was rather incongrous. Going to a library in Mexico City I noted that there was no food on the desks whereas at another library in Canada it seemed the desk was more of a picnic area than a place of study.
Fat is a Family Affair is an excellent book looking into all aspects of the disease of food addiction. Knowing as I do that anger and resentment are so central to the disease I am interested to see so much obesity in the Christian churches which 'overtly' claim to be 'forgiving'. According to the 12 step program, forgiving, and trusting God is central to the cure for addiction and evidenced in the abstinence from alcohol and drugs and restoration of healthy weight and belt size. I was shocked this summer to be in a meeting with a gorgeous 5'6" black female psychiatrist who said that that she'd been 350 lbs only a couple of years back. If ever there was a poster child for OA she was it. Over eaters anonymous is best considered the treatment of choice for Obesity as alcoholics anonymous is the treatment of choice for alcoholism.

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