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Overeaters anonymous: Who goes and

who succeeds?
a a
Vernon K. Westphal & Jane Ellen Smith
a
University of New Mexico grants both from the Office of
Graduate Studies Research
Published online: 13 Jun 2007.

To cite this article: Vernon K. Westphal & Jane Ellen Smith (1996) Overeaters anonymous: Who
goes and who succeeds?, Eating Disorders: The Journal of Treatment & Prevention, 4:2, 160-170,
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 Overeaters Anonvmous:
Who Goes and Who-Succeeds?

VERNON K. WESTPHAL
JANE ELLEN SMITH
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Overeaters Anonymous (OA) participants completed a survey that

examined characteristics of members who attend and succeed and
also participated in a diagnostic interview. Results indicated that
these predominantly white, female respondents had been in OA
an average of 5.7 years. A sizable number appeared to have met
diagnostic criteria for eating disorders in the past, but only 8.8%
were currently diagnosable. The average member entered OA at a
moderate level of obesity and was currently at a low level. A multi-
ple regression analysis predicting the self-mting of success from
ratings of the importance of abstinence and spirituality was stat&
tically signijicant. In a post hoc analysis, only the longest period
of abstinence correlated strongly with an objective wekht-loss cri-
terion.

Overeaters Anonymous (OA) is a program modeled after the 12 steps of

Alcoholics Anonymous. It is composed of members who view themselves as
LL
compulsive overeaters”; people who are powerless over food. Little re-
search has been conducted on OA over the 35 years since it was founded.
Since OA claims to have had 100,000 members as of 1980 (OA, 1980),
this represents a substantial gap in the eating disorder literature.

Vernon K. Westphal is a doctoral student in clinical psychology. This research was funded
in part by University of New Mexico grants both from the Office of Graduate Studies Research,
Project, and Travel and from the Graduate Student Association Student Research Allocations
Committee (SRAC). Address correspondence to Jane Ellen Smith, Ph.D., Director of Clinical
Training, University of New Mexico, Department of Psychology, Logan Hall,Albuquerque,
NM 87131.

Eating Disorders, Volume 4 , Number 2, Summer 1996 0 BrunnedMazel, Inc.

160
 Overeaters Anonymous 161

Efforts to draw a diagnostic profile of the typical OA member have been

inconclusive due to probable sampling biases (Malenbaum, et al., 1988;
Spitzer et al., 1992) and the use of psychometrically untested instruments
(Yager et al., 1989). So although studies have shown that individuals with
anorexia nervosa (Yager et al., 1989), bulimia nervosa (Malenbaum et al.,
1988; Yager et al., 1989), and binge eating disorder (Spitzer et al., 1992)
sample at least one OA meeting, it is uncertain whether such people attend
OA regularly. The current study administered a diagnostic interview, the
Structured Clinical Interview for DSM-111-R (SCID-Ill-R) (Spitzer et al.,
1990) to determine the degree to which these groups are represented in the
OA membership. This study also addressed the confusion over OA partici-
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pants’ weight status by calculating subjects’ body mass index (BMI).

Bray’s (1989) obesity classifications were used: BMI under 25 = nonobese,
BMI of 25-30 = mildly obese, BMI of 30-35 = moderate level of obesity,
BMI of 35-40 = high level of obesity. and BMI over 40 = very high level
of obesity. Eating patterns were explored through the Revised Restraint
Scale (Herman & Polivy, 1980). and by having subjects clarify the meaning
and importance of abstinence.
OA is available to anyone regardless of their eating behavior or weight
problem. and yet it is unlikely that the program is equally effective for
all. Consequently, correlations between program success and other variables
were examined. But defining success^' in OA is not an easy task. Pretreat-
ment characteristics vary tremendously-particularly weight status. Addi-
tionally, the goals of OA are different from most eating disorder treatments,
since abstinence and spirituality are emphasized instead of weight loss.
Furthermore, OA members have idiosyncratic interpretations of their
goals. For example. “abstinence” may be defined as avoiding binge foods
(Malenbaum et al., 1988: OA, 1980: Yeary, 1987),eating only three meals
per day (Malenbaum et al., 1988), or weighing one’s food (Yeary, 1987).
And since OA members are encouraged to attend indefinitely, they have been
involved an average of 4.3 years (OA, 1992).
The current study explored program “success” in several ways. The aver-
age weight loss and the current reduction Quotient (CRQ)(Black & Sherba,
1983, cited in Snow, 1988) were the objective outcome measures. The CRQ
is calculated as follows: CRQ = (Current wt. - Initial wt.) / (Initial wt. -
Ideal wt.). A desirable weight based on mortality risk studies was used for
the ideal weight. This study employed ideal BMIs of 22.6 for men and 21.1
for women (Garrison & Kannel, 1993). A reasonable subjective outcome
measure was a rating of how successful participants felt they were in the
OA program. This mirrored measures utilized by other OA studies (Mara,
1988: OA, 1992).
In summary, one purpose of the study was to examine the eating disorder
diagnoses represented among OA members. Analyses would also deter-
mine whether certain types of individuals appeared to benetit more from
 1 62 Eating Disorders, YoL. 4, No. 2, Summer 1996

the program, either subjectively or objectively. Another purpose was to see

whether members’ subjective rating of their program success would corre-
late positively with their view of the importance of OA meetings, abstinence,
sponsors, and spirituality. The rating for the importance of weight was also
included to explore whether OA members were not, in fact, concerned
about losing weight.
Given the paucity of studies on OA, other variables were included to
permit post hoc analyses. These focused on the objective outcome measure
called the CRQ. We planned to examine the relationship of certain variables,
such as length of membership in OA, to weight loss. In order to test these
hypotheses, OA members in the Albuquerque area were recruited to com-
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plete questionnaires. Subjects who returned completed questionnaires

were interviewed when consent was obtained.

METHOD
Participants
Subject recruitment involved a variety of procedures, beginning with
posting flyers (n=2).The local OA Intergroup was contacted to request per-
mission to present the study at OA meetings. Instead they opted to announce
the study to meeting representatives. A total of 14 questionnaires were mailed
out as a result: of which seven were completed. Next, subjects were obtained
through word of mouth ( n = l ) and by screening psychology classes (n=2).
Thirty-four potential subjects were referred by previous participants, of
whom 22 returned the questionnaire. In summary, a total of 53 question-
naires were distributed to potential subjects, of which 45 (64.2%) were
returned. Since the local membership of OA was estimated to be 300 people,
a sample of roughly 10% was obtained.
Subjects ranged in age from 23 to 76 years, with a mean of 42.9 years
(SD = 11.7 years). Thirty-two of the subjects were female (94.1%). Thirty
of the subjects were white (88.2%),two were Hispanic, one was Native
American, and one described himself as Spanish-Irish. The majority were
married (52.9%),23.5% were single, 20.6% were separated or divorced,
and 3.0% were widowed. Nearly half the subjects (48.5%) reported being
raised in a Protestant household, 21.2% Catholic, 15.2% “none,” 9.1%
Jewish, and 6.1% other. The average number of years of education com-
pleted was 16.2 (SD = 2.6).According to the Hollingshead job categories
(Hollingshead, 1975),types of employment were described primarily as
“lesser professionals” such as nurses or teachers (26.5%),managers or
small-business owners (20.6%),and clerks or technicians (20.6%). The
average number of hours worked per week was 34.1 (SD= 16.5).
Twenty-seven subjects, or 79.4% of those who returned the survey, took
part in the follow-up interview. The demographics of the subsample were
not significantly different from those of the full sample.
 Overeaters Anonymous 163

Materials
The questionnaire sections included demographics, DSM-IV criteria for
bulimia nervosa and binge eating disorder (Spitzer et al., 1992), treatment
history, OA as a treatment organization, meeting attendance, abstinence,
exercise, body weight, sponsors, spirituality, and the Revised Restraint
Scale (Herman & Polivy, 1980).* The interview was composed primarily
of the eating disorder section of the SCID-111-R (Spitzer et al., 1990).**

Procedure
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Subjects recruited on campus were called by a female research assistant

to arrange an appointment in the psychology department. The session
began with the 3040-minute questionnaire, and continued with the 40-60-
minute interview if consent was obtained. Potential subjects who were off-
campus had the questionnaire mailed to them (n=48) along with a stamped
return envelope. When no response was received within three weeks, re-
minder letters were mailed. Twenty-two such letters were sent; three addi-
tional questionnaires were subsequently returned. If the questionnaire was
returned and the subject wished to be interviewed, the research assistant
arranged a convenient time and place. Subjects were interviewed at their
homes (51.9%),in restaurants (22.2./,), at the psychology department
(18.5%),at work (3.7%), or by telephone (3.7%). Nineteen of the 27
interview subjects agreed to have the interview taped for a reliability check.

RESULTS

Except where noted, there were 34 respondents for the questionnaire and
27 for the interview. Missing questionnaire data could not be queried when
subjects refused the interview.

Diagnoses
Although nine subjects stated on the Binge Eating Disorder questionnaire
(Spitzer et al., 1992) that they had been binge eating during the last six
months, only two reported the minimum required frequency of 2-3 binge

*Cronbach's alpha for the 19 completed Revised Restraint Scales (alpha = .7) was below
the criterion value for reliability (+ha = .8), so these results will not be explored in this
paper. They can, however, be obtained from the authors. Space limitations necessitate an
abbreviated presentation of the weight findings and the elimination of results about OA spon-
sors. These also may be obtained from the authors.
**Copies of the questionnaire and interview forms employed in this study can be obtained
from the authors.
 164 Eating Disorders, Vol. 4, No. 2, Summer 1996

TABLE 1
Means for Female Subjects Obese Upon Entering OA on Selected
Variables Used in Hypothesis Testing and Post Hoc Analysis
(n=24)
n M SD n ObesitvLevel
Weight Entering OA 24 202.96 42.06 9 low; 8 moderate
BMI Entering OA 24 33.82 8.46 4 h&, 3 very lugh
Current Weight 24 181.21 42.96 1 underweight; 4 normal
Current BMI 24 30.13 7.85 9 low; 7 moderate; 1 high;
2 very high
Weight Lost in OA 24 21.75 36.04
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Exercise (midweek) 26 183.39 173.85

Longest Period of Abstinence 25 34.32 31.70
(months)
Importance of Abstinence 26 6.15 1.26
Restraint Score 20 18.20 5.44
CRQ 24 0.26 0.56
Self-Rated Success 25 5.44 1.33

days a week. One of these subjects was diagnosed with binge eating disorder,
and as noted below, the other currently met criteria for bulimia nervosa-
purging subtype.
According to the SCID-111-R interview, four women (14.8%)met criteria
for a past diagnosis of anorexia nervosa, one of whom also satisfied the criteria
for a current diagnosis. Four other subjects (7.4%) had anorectic traits.
Eleven subjects (40.7%of those interviewed) met all criteria for a diagnosis
of bulimia nervosa in the past, but only one met the criteria currently. A
reliability check on taped interviews resulted in adding one subject to the
past bulimia nervosa category.

Weight
Weight data reflect the 32 subjects who provided complete information.
Upon entering OA, the average subject had a BMI of 32.6 (SD = 10.3). At
the time the questionnaire was answered, the average BMI was 29.1 (SD=
8.2).The difference between the subjects’ weight on entering OA (M = 196.7,
SD = 54.0) and current weight (M = 178.9, SD = 53.0) was calculated.
Average weight loss was 17.8 pounds (SD = 36.9). The high variance
reflects the fact that some subjects gained weight in OA. The mean rating
for the importance of reaching or maintaining a certain body weight was 4.8
(SD = 1.7) on the Likert scale (7 = very important).
The average weight loss for the female subjects who were obese when
they joined OA was 21.8 pounds (SD = 36.0; range: -115 to +42 pounds)
(n = 24) (Table 1 ) . Another way of examining changes in weight is to note
 Ouereaters Anonymous 165

movement across weight categories (Bray. 1989) for members of this sub-
group. Accordingly, 45.8%lost sufficient weight to move to a lower cate-
gory, 4S.8% remained in the same category, and 8.4% gained sufficient
weight to move to a higher category. The CRQ result (M = 0.3; SD = 0.6)
indicated that the average member of this subsample had lost roughly 30%
of the difference between her initial and ideal weights.

OA Program
OA members most commonly reported going to their first OA meeting as
a result of involvement in another 12-step program (29.4%). Multiple re-
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sponses were offered for the question about what first attracted them to OA
(M = 1.5; SD = 0.8). Answers included: to lose weight (58.8%):to stop
binge eating (38.2%): and to get group support (29.4%).The question
about the most useful aspects of the OA program received an average of
2.5 responses (SD= 1.9) and included the 12 steps (55.9%), OA meetings
(44.1%), and abstinence (38.2%). When asked to indicate the least useful
aspect of OA, 38.2% did not answer. The most frequent reply among re-
spondents was sponsoring (20.6%). Subjects reported being OA members
from 2 to 233 months (M = 68.4, SD = 47.0) and attending an average
of 2.1 weekly meetings (SD = 0.9). The importance of meetings rating
averaged 5.7 (SD = 1.6) (7 = very important).
Subjects offered an average of 2.6 definitions of abstinence (SD = 1.3)
(see Table 2). Three meals a day was endorsed by 61.8% and slightly
fewer (58.8%)included not binge eating. Subjects’ longest period of absti-
nence ranged from 1 to 126 months (M = 38.8: SD = 34.6). Participants
endorsed an average of 4.2 answers (SD= 2.2) to the question about behav-
ior that promoted abstinence, with the most popular response (91.NO) being
daily prayer or meditation. The importance of abstinence was rated an
average of 6.2 (SD = 1.2) (7 = very important).
When asked, “What does Higher Power mean to you in the OA pro-
gram?”, 48.4% of the 31 respondents said their Higher Power was a
nontraditional god, goddess, or spirit. Some referred to the Higher Power
as being a power within themselves (25.8%), and still fewer suggested that
their Higher Power was a traditional religious god (18.6%). The average
number of responses to the question about how the Higher Power helps the
OA member was 4.1 (SD = 1.1). The majority endorsed the statements
that the Higher Power acts through other people (88.2%), that they sur-
render their will to their Higher Power (82.4%), that the Higher Power
offers them guidance (76.5%), that they have had a spiritual experience
(73.5%), and that their Higher Power is there to listen (61.8%). Subjects
rated the importance of spirituality as 6.4 on average (SD = 1.1) (7 =
very important).
 166 Eating Disorders, Vol. 4, No. 2, Summer 1996

TABLE 2
Responses to Questions About Abstinence
N %
How do ym currently de&e abstinence?
Three meals a day 21 61.8
Not binge eating 20 58.8
No snacks between meals 11 32.4
Other (write-in responses)
Moderate, healthy eating 4 11.8
Eating when physically hungry 4 11.8
Not eating to avoid emotions 3 8.8
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Restricting sugar intake 3 8.8

Eating without guilt 3 8.8
Not compulsive eating 3 8.8
(Remaining uncommon responses) 16 47.1
m a t do p u do on a daily basis to try to stay abstinent?
I engage in prayer or meditation 31 91.2
I contact other OA members 24 70.6
I read OA literature 21 61.8
I go to OA meetings 21 61.8
I contact my sponsor 14 41.2
I plan my meals 11 32.4
I practice the 12 steps 7 20.9
Other (write-in responses)
I write in a journal 3 8.8
I do OA service work 3 8.8
(Remaining uncommon responses) 9 26.5

Treatment Outcome Predictors

Prior to testing treatment outcome predictors, eight subjects were
dropped. These included both male subjects, due to gender differences in
outcome predictors (Forster & Jeffery, 1986; Wing, 1992), and one subject
who no longer regularly attended OA meetings. Additionally, the five subjects
who were not obese when they started OA were eliminated, since their goals
probably were different from those of other members.
A subjective rating of success in the OA program was used as one outcome
measure. The average self-rating was 5.4 (SD = 1.4) (7 = very successful).
A multiple regression analysis using the ratings of the importance of meet-
ings, abstinence, weight, sponsors, and spirituality as outcome predictors
was significant 0, = .0003). Using this information, a simplified equation
was developed using integer weights. The equation Success = Abstinence
+ Spirituality correlated with the full equation at a Pearson 1 value of .6,
making it significant at a fully post hoc level of p = .001. In other words,
people who rated themselves as very successful in OA also tended to rate
abstinence and spirituality very highly.
 Overeaters Anonymous 167

An attempt to predict the objective outcome measure, the CRQ, from

variables such as the longest period of abstinence and the amount of
weekly exercise did not yield significant results. The small sample size also
necessitated dropping several planned comparisons to conserve power, so the
correlations between the variables were examined post hoc instead. The
most interesting correlation meeting the Bonferroni-corrected post hoc
criterion (s = .10/105) was that of 0.7 between self-rated success in OA
and the rating of the importance of abstinence. Also of interest was the
relatively strong correlation (0.6)between the subjective measure of out-
come (the self-rating) and the objective measure of outcome (the CRQ).
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DISCUSSION

Who Goes to OA?

Consistent with three previous OA surveys (Mara et al., 1988; OA, 1992;
Spitzer et al., 1992), the typical OA member was a middle-aged, college-
educated, white female. In terms of eating disorders, only three subjects
(8.8%)were currently diagnosable: one met criteria for binge eating disorder.
one for bulimia nervosa, and one for anorexia nervosa. However, past diag-
noses were identified for bulimia nervosa (40.7%)and anorexia nervosa
(14.8%).In contrasting the low rate of currently diagnosable subjects found
in this study with rates of earlier studies (Spitzer et al., 1992; Yager et
al., 1989), one should consider that this study used a diagnostic interview
with a reliability check, and that this sample likely overrepresents the more
successful, long-term OA participants. Nevertheless, this study does support
the spirit of previous studies, namely, that the OA program attracts not
only obese individuals but those with diagnoses of anorexia nervosa and
bulimia nervosa as well.
For the subsample of women who entered OA obese, the rating of the
importance of reaching or maintaining a certain weight did not correlate
signiikantly with any of the predictor or outcome variables. However, this
was inconsistent with the high correlation between self-rated satisfaction and
the CRQ, which suggested that weight loss W Q S important. This contradic-
tion may reflect a reluctance to admit to the importance of weight reduc-
tion, since it is not technically part of the OA program. This inference is
also supported by the fact that the most popular reason for first attending
OA was to lose weight (58.8%).Interestingly, female members who were
obese when they joined OA lost an average of 21.8 pounds over the course
of their membership. At the same time, the average participant still fell in
the low obesity category.
Although “abstinence” used to imply avoiding sugar and white flour, in
this study it was described by the majority as eating only three meals a
 168 Eating Disorders, Vol. 4, No. 2, Summer 1996

day (61.8%) and refraining from binge eating (58.8%). Nevertheless, many
idiosyncratic definitions were offered as well, including “not eating to
avoid emotions,” “not obsessing about food,” and “not purging.” Conse-
quently, the utility of “abstinence” as a weight loss technique is unclear,
in part due to its many definitions. Also, the common use of prayer or
meditation to achieve or maintain abstinence (91.2%) might make this
approach unappealing to less spiritual consumers.
Spirituality was rated the most important program component. Aid from
the Higher Power could be encountered socially or in isolation, and partici-
pation in formal, structured religion was not required. The rating of the
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importance of spirituality, hke that of abstinence, correlated positively and

significantly with self-rated success. Unlike abstinence, however, spirituality
showed very little correlation with the CRQ. Perhaps spirituality was essential
to the OA members, but had no direct connection to weight control.

Success in OA
As found previously (Mara, 1988; OA, 1992), females who had begun
the OA program overweight generally considered themselves quite success-
ful. They tended to rate their success highly if they agreed with the program
on the importance of abstinence and spirituality, and, it is of interest, if they
lost weight.
In terms of objective measures of treatment outcome, it is impossible to
compare directly the results of this study with weight loss programs, since
OA members essentially had access to a free ongoing maintenance plan.
With this caveat in mind, Garner and Wooley (1991) reported that the aver-
age weight loss for controlled behavioral treatment was 15.4 pounds, but
that the majority of subjects regained most of the weight lost after 4-5
years. For women in the current study who entered OA obese, the average
loss was 21.8 pounds-an average body weight percentage loss of 9.7% (SD
= 16.9%). Research suggests that a loss of this magnitude may lead to
health benefits in the form of improved heart and respiratory function
and reduced blood pressure (Blackburn & Kanders, 1987; Brownell and
Rodin, 1994; Goldstein, 1992; Hypertension Prevention Trial Research
Group, 1990). For the last objective measure of treatment success, the CRQ,
only the longest period of abstinence showed a strong correlation. This sug-
gests that prolonged abstinence may lead to weight loss.

Limitations of the Study

Certainly the most serious limitations of the current study were sample
size and representativeness. Subject recruitment was difficult, due to the
emphasis on anonymity in OA. The resultant small sample size restricted
the number of a priori hypothesis tests that could be conducted, and so
 Ooereaters Anonymous 169

limited much of the data analysis to description. Furthermore, missing data

were inevitable, since only those subjects who were intervjewed could be
contacted and questioned about blanks. Generalization of findings are lim-
ited, given that this sample was composed primarily of long-term OA mem-
bers. A more representative sample of OA members might be obtained by
focusing on one specific OA group, and trying to contact all people who attend
the meeting even once over a period of months. The direct assistance of OA
administrators would be necessary to accomplish this. Another limitation
of the study was its reliance upon a questionnaire with multiple-choice
options that were largely specific to the OA program philosophy. Although
this provided useful information regarding how subjects utilized various
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components of OA, it likely failed to reveal the full spectrum of coping

behaviors that CA members employed. Future research might examine the
full range of eating- and weight-control behaviors reported by OA members.

Summary
The average OA member in this study was a middle-aged, college-edu-
cated, white female who had been in OA for 5.7 years. A significant minority
(32.4%)of the total sample had a past history of anorexia or bulimia, but
only 8.8%had a current eating disorder diagnosis. Most (87.5%)of the
women who entered OA overweight wanted to lose weight or stop bingeing.
The majority (54.2%) currently reported a lower weight, little or no bingeing,
and being abstinent. More than half of the subsample made progress toward
their goals, primarily relying upon the OA program concepts of spirituality
and abstinence.

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