Is Overeaters Anonymous an alternative to bariatric surgery?

Editor's note: The author is a Star Tribune employee and member of Overeaters Anonymous. He is writing the article with no byline because a basic tenet of OA is that members maintain anonymity in the media.

Dr. Guilford Hartley, an obesity expert at Hennepin County Medical Center (HCMC), was skeptical when I told him I'd found a solution to my binge-eating problem.

"Come back and talk to me in five years," he told me. That was 13 years ago. Last month I talked to Hartley again. I've maintained an 83-pound weight loss since joining Overeaters Anonymous in 2002, and have not overeaten since.

"It is gratifying you ... have made such a success of this," he told me. But he still thinks I'm an anomaly because I did it through OA HOW, a 12-step program with meetings across the Twin Cities. "I think your experience continues to be very characteristic of a very small fraction of people who have a problem with overweight and obesity," he said.

"The general rule of thumb of people has been that 5 percent can get [weight] under good control for the long haul with some approach of behavior modification. Clearly the program you're describing is a form of behavior modification."

Hartley says the best solution is bariatric surgery. He himself had the surgery in 2010.

My success as an OA member is an "anecdote," Hartley insists. More important, he says, is the scientific evidence that shows what really works.

While he says "surgery has not worked for everybody," he points to statistics that indicate the average person who has gastric bypass surgery loses and keeps off 60 percent of their excess weight over the long term. He's unaware of data validating OA as a solution.

I re-interviewed Dr. Charles Billington, a professor of medicine at the University of Minnesota, whom I spoke with 13 years ago. He is an expert on weight management and chief of the endocrinology section at the Department of Veterans Affairs Hospital. Back then, he believed OA could be helpful, and he still thinks so today.

"I don't think what you have done is an anecdote," he said recently. "I do recommend to some patients that they pursue the OA option. I don't know that is the only option for these people." The success rate of individuals following OA or programs is higher than 5 percent, he says. New medications also help, he says.

"I think it's fair to say bariatric surgery is the strongest tool we have available," he says. But he says about 30 percent who have bariatric surgery never lose the weight or lose the weight and regain most of it.

"My view, based on my experience, is that those who don't get a good result of the surgery have a problem with food addiction."

Connie Stapleton, an Augusta, Ga., psychologist, has counseled about 5,000 bariatric surgery patients and estimates at least half are food addicts. She wrote a book titled "Weight Loss Surgery Does Not Treat Food Addiction."

"I am a very big proponent of weight loss surgery for those people who have severe medical conditions related to their obesity," she says. But she says many need to deal with their food addiction afterward.

As many as 100,000 people belong to 12 step groups like OA that focus on overeating, estimates Phil Werdell, a food addiction expert at Acorn Food Dependency Recovery Services in Sarasota, Fla. Some 50 percent of OA members report they no longer eat compulsively, according to a 1991 survey analyzed by the Gallup organization, he says.

In the OA program I do, we eat no sugar and weigh and measure all our food. Dr. Vera Tarman, medical director of Renascent in Toronto, a treatment program for drugs, alcohol and food addiction, explains the science behind it.

"In the food addiction paradigm," she said, compulsive overeaters "cannot rely on self-control." Eating sugar "fires up the addictive pathways," triggering the same impulses to overeat as alcohol does for alcoholics. It requires total abstinence from sugar. Volume eaters need to follow a strict food plan, commit it to someone else, and weigh and measure all food and attend support meetings, she said.

Werdell, author of the book "Bariatric Surgery and Food Addiction," urges people mulling surgery to ask themselves if they may be a food addict. OA has a 15-question survey.

Some bariatric surgery patients rave about its value.

Susan S., a friend, weighed 300 pounds, had the surgery and said "it saved my life." After food cravings returned, she joined OA HOW and is now near her desired weight.

"I no longer have the insatiable cravings for sugar or food," she said, but does not regret the surgery. Still, "if I had a choice of the surgery and altering my body or going to a meeting, I would have gone to a meeting."

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The author is at: anonymous@startribune.com