The Food Fights: Food Addiction or Eating Disorder? For many years, I believed I was bulimic. The psychiatrist who examined me at the beginning of my troubles tried to capture it all: my disabling obsession around food that started from the time I woke up and dogged me until I passed out, my marathon eating (especially at night) that never ceased to amaze even me, and the mortifying purges that followed like a cloying stench after each binge. Eating Disorder, bulimic subtype, she reported clinically in her chart, using the terminology available to physicians in the 1970s. Food addiction did not even come up in her radar, though I described how I felt as out of control with food as I had with drugs and alcohol. No, I reconsidered, the food habit was worse. Much worse. The1990s was the decade of the food fights. Right from the beginning, professionals found it difficult to come to a consensual understanding of the underlying dynamic associated with chronic obesity and overeating. Was it the result of an eating disorder or an addiction to food? Was there such a thing as a normal eater who just ate too much? Doctors, therapists, and dieticians who worked with people struggling with their eating issues sided with the belief that deep social-psychological traumas led people to develop an emotional dependency on food. When confronted with the proposition that food could have a powerful chemical lure, clinicians argued that food addiction was without convincing empirical support and turned instead to the research on eating disorders to probe the dimensions and treatment of their obese patients. That attitude started in the 1970s and has carried through to the present. There are no eating disorder programs that treat food as if it were a drug as powerful as cocaine or alcohol.
Yet as early as 1960, Overeaters Anonymous produced evidence that a 12-Step program that dealt with food as an addiction, similar to alcohol, drugs or gambling, could help compulsive eaters. By identifying the behavior as addictive, getting support from others, and especially when recommending abstinence from certain foods (as if food were a drug like any other), people got better. They believed that overeating was the result of a neurochemical disease. Joining this camp were the self-declared food addicts who passionately disagreed with the established medical paradigm that disordered eating was caused by poor willpower or deep-seated problems. Noted spokespeople, such as Kay Sheppard, Anne Katharine and Joan Ifland, wrote self-help books that made the case that people who could neither diet successfully nor control their eating were actually addicted to food. So a disagreement had developed through time: was abnormal eating the result of an addiction, an eating disorder or just plain gluttony? For decades, at the annual conference of the International Association of Eating Disorder Professionals, panels of experts debated the topic: Is There Food Addiction? Pro or Con? True believers debated the issue at length, with neither side successful at convincing their opponents. We even found a similar debate within Overeaters Anonymous. A central theme of each OA World Service Business Conference for more than a decade has been whether compulsive overeating is the result of psycho-social-emotional disturbance that has lead to an addiction to eating behaviour or due to the chemical nature of particular foods, rather than the actual disordered eating. As the fellowship s founder, Rozanne S., describes in her history, Beyond Our Wildest Dreams: A History of Overeaters Anonymous As Seen By a Cofounder, a strong faction of members saw compulsive overeating as the result of psychosocial problems;
they believed that the central platform of the 12-step program was to redress the emotional problems that were fueling the need to overeat. Another group within OA, many of whom were recovered alcoholics from AA, viewed the root of compulsive overeating as a simple physical craving for food. They maintained that a chemical dependency could occur with food, just as it did with alcohol or other drugs. They felt that complete abstinence from addictive foods was the first priority and if abstinence was accomplished, the overeating would stop. The 12 Steps would create the psychic change in one s personality that was necessary to ensure long-term recovery but abstinence got the recovery process started in the first place. Those who claim recovery without abstaining from their trigger food, this second group claimed, are in denial about the true nature of their disease. Meanwhile, the psychosocial-emotional group contended that too much focus on physical abstinence turned the OA program into a mere diet. Looking at these historical controversies within the mutual support fellowships and amongst professionals, we can now see that they were probably both right. They were behaving similarly to the blind men attempting to describe an elephant. One man feels the trunk and believes the elephant is snake-like; another feels the leg and imagines the elephant to be as big as a tree. After running into the sleeping elephant s large body, the third claims the creature is actually some type of large rock. Each bases his conclusion on only part of the whole. How does this analogy work here? Those OA members who were helped by therapists or the 12 step program to resolve underlying trauma tended to see everyone as having similar emotional problems. After all, a survey of OA members showed that over 80 percent of the members report prior psychic, emotional or sexual abuse, or some combination of the three.
Those people, who found that working a therapeutic12 step approach did not help their compulsive eating, found themselves criticized for not having yet resolved their core issues. Those in the food-as-chemical group who found recovery (by completely eliminating sugar or wheat or other trigger foods) alternatively assumed that the fat members who were claiming to be in recovery were actually expressing the denial so typical of addicts. They were not seeking food sobriety so much as fat serenity. They did not believe that it was possible to treat overeating with an inside-out approach of addressing internal issues and only then becoming abstinent from trigger foods. Instead, they argued, an outside-in approach was necessary, where people had to become abstinent first and then address internal issues to maintain food sobriety and serenity. And they pointed to themselves as examples: one study of 162 OA members found that those with the most success at taming their overeating were following an abstinence-based food plan. These members were also more likely to report that they had never or rarely relapsed. Among a smaller sample of 30 stable OA members (defined as those with five to twenty years of recovery and weight loss), 91% reported abstaining from sugar, 67% weighed and measured their food and 74% had eliminated flour, wheat or all grains. Small wonder that concept of food as an addiction persists as a controversial issue. What seems intuitively obvious at the outset has baffled both clinicians and fellow sufferers when they have tried to nail it down to help each other. What is this primitive urge to overeat, and how to harness its voracious lure? I soon came to realize that I had to find what worked best for me, regardless of what others postulated: abstinence of sugar, wheat, flours. These are the drugs that derail my better nature. We are at the frontier of this last most insidious addiction, still grasping in the dark for a solution that will work for everyone. But at least, at last, we are no longer alone.