Originally published on "thefix.com" on 3/20/15:

It’s simple if you’re an alcoholic needing help: there’s either the 12 Step approach through A.A., or non-12 Step approaches. There are a few 12 Step offshoots geared toward specific religions, but other than a more clearly defined version of a Higher Power, they are pretty much identical to A.A.

If you are a compulsive eater, anorexic or bulimic however, there are a number of 12 Step programs from which you have to choose. They include:

• Overeaters Anonymous (OA)
• Compulsive Eaters Anonymous - HOW (CEA-HOW)
• Food Addicts in Recovery Anonymous (FA)
• Food Addicts Anonymous (FAA)
• Grey Sheeters Anonymous (GSA)

Believe it or not, there are additional, smaller fellowships as well. There are also more specialized 12 Step organizations such as Anorexics and Bulimics Anonymous (ABA), which specialize in those specific food disorders.

Why are there so many 12 Step programs for the eater? The answer lies mainly in the nature of the disease – which depends on finding a way to temper the disease, rather than arrest it totally. Imagine if in the early days of A.A., people had differing ideas of how sobriety was defined. This probably would have led to its fractionalization very quickly. Such is the case with the food programs.

A quick glance comparison of the programs for compulsive eaters shows only one main difference: all of the programs other than O.A. have some kind of a food plan as a requirement for certain things in their program. All of the programs are based on the 12 Steps and 12 Traditions, so the
only actual requirement for membership is still some derivation of “a desire to stop eating compulsively.”

The founder of Overeaters Anonymous, Rozanne S. spoke of how a schism appeared almost from the beginning of O.A. in 1960. It was a controversy that had grown up out of the definition of abstinence (the food programs’ version of “sobriety”). One side of the divide became known as “moderate mealers,” and worked on the belief that abstinence meant having three moderate meals a day – often using calorie counting as a way of determining how a “moderate meal” was defined.

Another group began to look at certain foods – refined carbohydrates, mostly – and they saw them as “trigger foods” for most compulsive eaters.  Most of this group had come to believe – through the empirical evidence of their own behavior – that curbing compulsive overeating became much easier when these foods were totally removed from their diets. Coincidentally, those feelings were reinforced in an article by friend of A.A. Father Edward Dowling. In his “Grapevine” article for the 25th anniversary of A.A. in March of 1960, he spoke of his own “gluttony” and needing to stay away from “starch, butter, salt, and sugar.” This article led to the low carbohydrate food plan that became forever known as the “Grey Sheet.” (The name came from the fact that it was printed on grey paper – donated by a member’s printer husband.)

O.A. dropped the “Grey Sheet” as its recommended food plan in the early 1980s in favor of a series of food plans. All of these plans O.A. termed “suggested” food plans, not required ones.

As O.A. grew, a number of sub-groups with slightly different approaches began to form. These groups, including the original Grey Sheeters, H.O.W. (Honesty, Open-mindedness, Willingness), and “90-Day groups” had begun to evolve. All had various additional requirements for food plan adherence and/or tying a member’s ability to share at meetings to days of abstinence.

For years to come, these sub-groups existed within the rooms of O.A. Adopting a “peaceful coexistence” approach, O.A. as an organization gave its meetings a wide latitude in how they worked their program – as long as they followed the 12 Steps and 12 Traditions.

In 1996, the O.A. World Service Conference voted to discontinue the printing of food plans for fear of legal liability. Shortly afterwards, it also forbade meetings from having specific abstinence requirements for sharing. Meetings could have “suggested” requirements concerning food plans and ability to share, just not hard and fast rules for it.

This began the fractionalization that exists to this day. Some of these sub-groups chose to modify their meeting formats to “suggest” what had formerly been required. Others, however, decided there was a need for strict adherence to these requirements and thus broke away from O.A. (There is some contention among the parties as to whether many of these groups that left O.A. left of their own volition or were asked to leave.)

The result was that a number of 12 Step food fellowships were formed in the 1990s. These were “Compulsive Eaters Anonymous – HOW” (CEA-HOW), “Food Addicts in Recovery” (FA), and “Grey Sheeters Anonymous” (GSA). All of these organizations have varying levels of requirements concerning food plans as well as abstinence requirements to share at meetings. Another group, “Food Addicts Anonymous” (FAA), developed independently of O.A., evolving from an eating disorder rehab facility in southern Florida.

The main focus of almost all of the 12 Step groups with food plan requirements is what was seen as the core of the “Grey Sheet:” elimination of sugar and flour from their members’ diets. The belief is that in trying to equate food programs with programs such as A.A. and N.A., there needs to be some solid line from which one could be determined to be “sober” or not. It was also felt that these specific foods led their members to the “phenomenon of craving” spoken of in the Big Book. These groups also have specific portion sizes for the various parts of each meal – at least until hitting a goal weight.

There are differences among these programs, too many to enumerate, but here are a few: in addition to no sugar and flour, FAA equates no calorie sweeteners as sugar, so they’re out as well. FAA also requires an evening snack called a “metabolic adjustment,” which it feels is necessary for members to “get through the night.” Grey Sheeters Anonymous requires members to weigh and measure all meals – even when dining in restaurants. FA has no set food plan (but forbids sugar and flour), but has strict requirements for their meetings, down to how the chairs must be positioned at their meetings. FA also does not allow phone meetings, which are staples of the other programs. CEA-HOW, the offshoot with the closest ties to O.A., seems to find a middle ground with weighing and measuring foods, but without some of the extra requirements of the other programs.

In terms of program size, O.A. dwarfs the others, with over 6,000 meetings worldwide. FA comes in second with about 570 meetings. CEA-HOW is third with about 420, while FAA and Grey Sheeters trail with about 150 meetings each.

How sound and scientifically valid are these food plans? The elimination of sugar and carbohydrates are not usually problematic. However, the weights for food portions (until reaching “goal weight”) in these programs are shown to be relatively static, no matter what the member’s size, body frame, or daily caloric needs. A 6’ 5” college football player in training is allowed the same amount of food as a 4’ 11” secretary who sits at a computer all day. (FAA does allow men one to two more ounces of protein per meal – but without regard to anything other than gender.)

Lynn Elliott-Harding, RN, has worked with food addicts professionally for 30 years. She is deeply knowledgeable about 12 Step recovery and her take is that prescribing food plans should not be the purview of recovery groups. “Twelve step groups acknowledge the need for outside professional help to aid people's recovery. This is the perfect place for it! No one can reasonably expect a sponsor to understand, address, and treat the complex physiologic needs of the food addict.”

Lynn refers clients to nutritionists and nutritionally-oriented physicians who are expert in testing for and treating the myriad biochemical issues of food addicts. “These professionals must also be knowledgeable about 12 Step programs and have a deep appreciation of what these programs provide that nutritional medicine cannot.” Her point is that everyone is enriched by this collaboration. “Sponsors have very successfully supported people on medically prescribed food plans.”

While most food programs have the proviso that potential members should visit such doctors, this fine print is sometimes hard to find on their websites. Some of the program spokespeople with whom I conversed said it was also within a sponsor’s discretion to vary the amounts of their sponsee’s portions based on their needs. When asked if most members knew about this flexibility, they admitted most probably did not.

Interestingly, in the years since the “Grey Sheet” was published, there has been more scientific proof that such a low-carb diet (the Atkins diet, for example) has been seen to cause fewer cravings in some people. Simple carbohydrates have been found to increase serotonin levels, which in turn leads to feeling better (and full) temporarily. The downside is that the increase in blood sugar levels is followed by a later drop in those levels, which can cause cravings later. The cycle is then often repeated.

There are also other types of eating disorders such as anorexia and bulimia that sometimes require a different approach altogether. In some cases, anorexics left some of these food programs in worse shape, because a highly structured food plan allowed them to validate their restricting.

In the end, comparisons as to the pros and cons of these programs are so complex as to be almost impossible to do without a spreadsheet and a few reams of paper. The reality is that all comparisons will also be subjective. Moreover, unlike alcoholism, food addiction has varying layers of severity. A phrase sometimes said in A.A. as a snarky comment is a reality in food programs: “Some are sicker than others.”

As someone who has been in both types of programs, one with a food plan and one without, I can say that I have observed good recovery in both programs, as well as not so good recovery. Of course, this is true of all 12 Step programs, but is more noticeable in a program where one often “wears their recovery.”

With each of these programs having their pros and cons, it behooves a food addict to keep an open mind and try more than one program to see which one works best for them. The key is being honest with oneself about a program’s efficacy rather than how comfortable it might seem. Sometimes the program that “feels” best is the one that works the worst in practice.

For a time in my recovery, I needed the structure of the program with a specific food plan. It helped me pull out of a severe relapse that attendance in the other “non-food plan” program had not been able to help. At a later point, however, that program and its food plan became an oppressive authority figure against which this oppositional defiant personality rebelled. Having later gained a steadier footing in recovery, I was able to return to the earlier, less restrictive program. Twenty years later, this food addict is still abstinent.