Ideas

Ideas | Kelly Kasulis

When calories consume you

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It happened 44 years ago, when a boy from out of town asked her to senior prom.

“I always dreamed of going to a prom,” she said, reflecting back on the year before, when she had stayed home. She was awkward and fat junior year, she explained, and those were the days when no date meant no reason to go. But senior year was different. She got her first boyfriend, and, on May 19, 1972, her wish came true — he asked her to the dance.

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Now the memory makes her weep.

“He told me that he’d go to prom with me if I lost 20 pounds,” she said through tears. She’s now in her 60s, gathered in a circle inside a Cambridge church. This is where she’s been going for more than 30 years — and yet, every May, she still remembers that anniversary.

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“I didn’t say f– you. I just went ahead and lost the 20 pounds,” she said, her petite frame shrinking further into the tall, Victorian-style armchair. She fumbled with her glasses and slid them on and off her head as she talked about her relationship with food — something she says leaves her powerless.

She was 12 years old when she started her first diet. As a teenager, her passion for sports was always overshadowed by uncontrollable binges and the desire to cover her body. In college, she’d book her dates with men two weeks ahead of time, starving off weight before seeing them again.

“When I had a boyfriend, I had a reason not to eat,” she says. “Other times, I was up to my eyeballs with food. I didn’t know I was an addict.”

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The woman, a math teacher and former swimming instructor, is just one of 54,000 people worldwide who subscribe to Overeaters Anonymous, a 12-step program for food addiction that’s modeled after Alcoholics Anonymous. In Massachusetts, more than 100 OA meetings are held in church basements, community centers, hospitals, and classrooms each week, according to the organization’s website.

At some meetings, participants take turns reading aloud from the Big Book of Alcoholics Anonymous. The book was first published in 1939 and is dated by its various iterations of the same businessman who chooses a swig of whiskey over his “charming wife and family.” At OA, they replace the word “drink” with “food.” In other meetings, they talk about body image or gender-specific issues. The topic at each session is different, but the pace is generally the same — somber, yet supportive.

As with substance abuse, the science on how best to treat eating disorders can be murky. Talk therapy and peer support groups have long been thought of as effective options. But unlike with alcoholism or narcotics addiction, there is no consensus that addictive overeating is a true medical condition. That can often leave those who struggle with it especially isolated.

Heroin addicts can die in an instant. The United States lost 10,500 lives to the drug in 2014, according to the Centers for Disease Control. But obesity is arguably more fatal — a 2013 study in the American Journal of Public Health linked it to 1 in 5 deaths, while a 2004 study in the Journal of the American Medical Association estimated that 300,000 Americans die annually from obesity-related disease.

“If you have to die of an overdose to have an addiction, then marijuana and cigarettes are not addictive,” Ashley Gearhardt, an assistant professor of clinical science and addiction at the University of Michigan, said. Gearhardt isn’t sure if food is addictive but does recognize its power over some people.

“I get frustrated when someone can’t see what these people are going through. They’re hard-working, and they’re completely devastated by their relationship with food. It’s wreaked havoc on their lives.”

The woman spent years yo-yo dieting and dropping thousands of dollars on weight loss retreats with no success. When her 30th birthday approached in 1984, she joined OA and got a sponsor.

“I was ready to kill myself because I had never been thin, and I had never been married,” she said.

She’s now abstinent — a loose term defined as working toward a healthy body weight and no compulsive overeating; for many, it means cutting out flour and sugar products all together, though OA doesn’t provide a diet plan. She no longer feels “powerless over bags and boxes” nor does she drive great lengths to stuff her face in the middle of the night. But sometimes she still prays to God in the grocery store, begging him to stop her from going down the junk food aisle.

“I was putting myself in danger — hating myself — using people and food to fill my core,” she said. And although she’s convinced that her compulsive overeating is a legitimate addiction like with alcohol or heroin, the medical community remains divided.

“There’s no substance in food that you can point to like ethanol in alcohol,” said Jennifer Thomas, a doctor and the codirector of Massachusetts General Hospital’s Eating Disorders and Clinical Research Program. Thomas argues that Binge Eating Disorder, the closest thing to a food addiction in the DSM-5 manual, can evoke behaviors similar to substance addiction. People with the condition often experience a loss of control, cravings, and continued use despite the consequences — but even these are superficial similarities, she said. Others disagree.

“It’s an addiction in the sense that, if you look at any kind of compulsive behavior, it’s coming from the same place in the brain — the brain’s reward system,” said Thulani DeMarsay, an addiction specialist at Lotus Recovery, a women-focused holistic recovery center in Norwell. “Refined sugar has similar properties as heroin in terms of how it reacts in the brain and body. Sugar is absolutely addictive.”

DeMarsay is a recovering food addict herself, though she thinks OA is only a small piece of a greater treatment plan. The biggest downfall of 12-step programs is the abstinence-based model, which she said sets overeaters “biochemically up to be more vulnerable to crashing.” Her alternative is a combination of supplements, support, and therapy.

“These people are malnourished. If we do not support that person in nourishing their bodies properly, they’re going to continue to perpetuate the same addictive cycle,” DeMarsay said.

But even though DeMarsay claims her program has an overwhelming success rate, Thomas doesn’t believe that sugar is as addictive as cocaine or heroin — a common claim made among addiction-believers. “No one is going to rob you at gunpoint for a Twinkie,” she said.

Maybe not, but even food cravings and long binges have moved everyday people to crime. With money in his wallet, a 24-year-old math teacher was arrested for stealing junk food from a store. Long before then, he stole regularly from roommates and market shelves. He says it goes as far back as childhood, when his mother would stomp down the stairs in the morning and ask what happened to the pantry. He never admitted it, but he’d empty it out overnight.

“There were fights and problems in my family because of it,” he said. “I’d experience tension because people would want me to just stop hurting myself.”

He’s tall, slender, and handsome, wearing a navy dry-fit T-shirt and gym shorts as he hit his temple and talked about all the “noise around food” in his head. He started putting on weight at age 7, slowly creeping up to 200 pounds on a 5-foot-8-inch frame by age 13. Desperate to stop the cruel comments from his classmates, he cut his weight. By age 14 — just a year later — he was 130 pounds and 5 feet 11 inches tall.

“I sort of felt like I really found the thing that was going to make me happy — being thin and looking good,” he said. “In a way, I even got addicted to the attention. I could talk to girls, and people were complimenting me.”

When he became too thin, others started urging him to eat. He obliged somewhat and binged behind closed doors. By age 15, he started eating as much as 10,000 calories daily while purging in the bathroom five times a day.

For seven years, he walked through every doorway looking for the closest bathroom, left parties early to eat in solitude, and pretended to listen to conversations at restaurants while his mind begged for the willpower to eat just one — only one — slice of cheesecake. After restricting himself all day, he would go home to binge, purge, and binge again — sometimes digging up food from trash cans. At his worst, he hardly slept.

“I was an active addict,” he said. “The shame, the self-loathing, the hiding — honestly, it was just humiliating.”

It’s been a year and a half since he last purged and even longer since he had a drink. Also in AA, he spends several hours a week across various 12-step programs. It’s essential to his recovery, he said. His definition of abstinence is more spiritual — he avoids obsessive behavior and does not follow a food plan or count calories.

Seven people sat in a room in a Brookline church. It was reminiscent of a hospital, with blank white walls, fluorescent lighting, and linoleum floors. Addiction pamphlets were passed around the table.

As in every meeting, one person shared a story for 15 minutes. A woman, in her 50s, apologized because she forgot to bring in two old pairs of pants — sizes 22 and 3. Instead, she handed out a leather-bound album with photos starting from kindergarten and sticky note captions. She pointed out where her weight gain started in an elementary school photo, where she hunched over the edge of a pool diving board. It looked like baby weight, but the pages showed a slow progression of ups and downs on the scale.

“Obsessed with Oreos while in paradise,” she wrote next to a photo of her on a beach. It was her honeymoon.

She now wears a size 6 in jeans and steers away from sugar and flour. For her, abstinence is more than just restricting certain foods — she’s also a recovering alcoholic.

“When it wasn’t alcohol, it was eating. When it wasn’t eating, it was credit card debt,” she said, letting out a small laugh. “My whole life, I was constantly thinking about food. It’s not just about weight. It’s about the peace of mind.”

Fifteen minutes passed, and the alarm sounded. A woman across the table with red cat-eye glasses and short, gray hair styled into a bob smiled and raised her hand. She asked when the speaker knew she hit her rock bottom.

“For me, that rock bottom is invisible — like it’s just endless,” the woman in the red glasses told her.

“Some people never hit rock bottom. My father died before he made it there,” the other woman answered. Seven years ago, she got the phone call while she was on a weekend retreat with other overeaters. Her father had been hospitalized after his aorta tore, and he died a week later.

The death almost pushed her to relapse, but she went through the 12 steps instead, and friends comforted her by bringing “abstinent food” to her house.

Even now, her routine to stay “sober” is exhaustive. She reads an inspirational e-mail every morning before exercising, and she spends an hour preparing the next day’s food every night. Twice a week, she takes a call from another OA member at 5:45 a.m. — and she talks to her own sponsor just as much. She also meditates, prays, sends out lists of things she’s grateful for in an e-mail chain, and jots down goals and glitches in her journal.

“I will never stop working the steps,” she said. “I am not in charge of what I eat.”

A few moments passed, and the woman with the red glasses raised her hand again. This time, it was her own story.

“I’m still not being honest with myself about what I’m doing with food,” she told everyone.

She has diabetes. In the last few years, the only time she stayed abstinent was when she was bedridden in the hospital, where meals were served to her on a tray. Now, she is struggling with overeating again.

“It goes without saying that this disease will kill you,” she said.

Three months ago, doctors saved her life with a triple bypass heart surgery.

Kelly Kasulis is the deputy digital editor at The GroundTruth Project.
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