A Disease of the Mind

Several years ago, as a psychiatrist working in drug abuse and alcoholism programs, I was led, through the experience of a staff member, to examine compulsive overeating as a disease process identical to alcoholism. We started to apply, in a limited fashion, the same principles to the problem of compulsive overeating that we were using in our alcoholism treatment program and found them to be very successful. The more closely I examined the phenomenon, the clearer it became that compulsive overeating is a disease.

Overeaters Anonymous is a system of people who are trying to help each other, and as such it is tremendously successful.

In medical school, we doctors are never taught about overeating, certainly not as a disease. So we are prejudiced against it. Overeaters Anonymous is very successful with cases that haven’t responded to conventional kinds of treatment. This success is often threatening to the professionals because it’s difficult for us to see how someone who hasn’t had years of study and experience could be more successful with people we’ve been trying to treat, unsuccessfully, for so long.

The remarkable thing about OA’s success is that the program gets people to function far better than they ever have in their lives. With any other disease, you’re lucky to get back to where you were. If you have a heart attack, for example, you’re fortunate to get your heart to function as well as it did before the attack.

With the compulsive overeater, not only do you get back to a normal weight, but more importantly, your life is changed, and in a sense, you’re ahead of where you were before you became a compulsive overeater. Now you have tools of feeling, touching, caring, loving, sharing, being honest with your family, and looking at life in an understanding way and not fighting it but going along with it. Once you treat the illness, you have the potential to be a more “together” person than you were. Therefore, it’s exciting for physicians and others, who have been ignoring the problem or expressing deep pessimism about it, to think of compulsive overeating as a disease and to realize that it can be treated so successfully.

One of the prejudices about compulsive overeating is society’s view of a compulsive overeater as someone who is obese. Yet the overeater can be one pound (0.4 kg) overweight or even underweight, as in anorexia nervosa, and still be a compulsive overeater. The illness has nothing to do with weight. That’s why it’s so silly to go on diets or to weigh all the time.

The problem is with the control of food. Is one preoccupied with controlling food intake to the point that it’s interfering with one’s life? Just as being an alcoholic is not related to the amount one drinks, being a compulsive overeater is not related to the amount one weighs.

The overeater’s problem is not being able to control eating behavior the way other people can, and the need is for a system to control that behavior. Of course, the most effective one is a support system like that of Overeaters Anonymous. What the overeater has to do is turn over the control to a Higher Power. Once it is turned over, the behavior is under control.

A major confusion we in medicine have is the erroneous belief that compulsive overeating is a result of physiologic, psychologic, and environmental problems. We try to treat compulsive overeaters psychiatrically or physically with medicine or structures in their lives, and it doesn’t work. The reason it fails is because we are doing it in reverse. What has to be dealt with is the compulsive overeating. When it is, the physiologic and psychiatric problems seem to take care of themselves.

There are some people, about the same percentage as in the general population, who after getting the food back in its proper place, find themselves needing traditional psychiatric care because they do have a problem, which they had pushed down with food. But that is the exception. What is probably true in most cases is that the individual develops the compulsive overeating mechanism for dealing with life at an early age and then starts to push problems down with the food. Once people become compulsive overeaters, every aspect of their lives is affected. Now they get into the psychological, physical, and environmental problems and start changing their lives, their friends, and their social structures. All these changes are really caused by the compulsive overeating. Most compulsive overeaters, through a program like OA’s, will lose all these syndromes and not need to have any kind of traditional psychiatric care.

We in the medical community must take responsibility for failing to understand the real problem. Compulsive overeating is a serious disease, and it is devastating this country. It is the basic cause of disorders that medicine views as primary illnesses, such as hypertension and diabetes. But physicians don’t look at compulsive overeating, they look at the secondary disease process that comes from compulsive overeating. They ignore the overeating and rigorously work on the symptoms and the secondary diseases.

Obviously, that is not the way to treat it. If a patient has pneumonia, the doctor doesn’t treat the fever and then send the patient home after the temperature is normal, saying, “Your fever is down; now watch that pneumonia.” But we certainly do this with the overeater. We take care of the symptoms of the secondary disease, and we tell that patient, “Your weight (or blood pressure or blood sugar) is normal; now watch that overeating.”

It is the responsibility of the medical community to understand what compulsive overeating really means and to recognize that Overeaters Anonymous has been dealing successfully with the disease. We need to work closely with OA, to have OA as the base or structure, and only then should we offer what we as professionals are able to contribute. The doctor should have the patient go to OA, and then serve as OA’s support system for that patient. Overeaters Anonymous should be the treatment, and the professional should be the adjunct, not the other way around. This is very difficult for a physician or mental health professional to accept.

As long as Overeaters Anonymous continues to keep the Principles it has now, it will be our most valuable means of treatment of the disease of compulsive overeating. OA’s Principles ensure that no individual has power. In essence, it is a leaderless organization, making the process much stronger than any one member or group.

Overeaters Anonymous is a system of people who are trying to help each other, and as such it is tremendously successful.

— William Rader, M.D., 1980

Dr. William Rader is a psychiatrist engaged in clinical work with alcoholism, drug addiction, and compulsive overeating. Winner of the 1977 Appreciation Award of Overeaters Anonymous, he
has carried the OA message in his treatment programs.

Overeaters Anonymous, Third Edition pp. 195–198. © 1980, 2001, 2014 by Overeaters Anonymous, Inc. All rights reserved.