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By Matthew Rees

Food and Health Fact #173:

In the fight against fat, what can we learn from AA?

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On Wednesday, the Biden Administration sponsored a day-long conference on hunger, nutrition, and health – the first such federal government gathering since Richard Nixon held one in 1969. This forum received high-level attention – President Biden spoke – which suggests the administration just might focus on the role food plays in undermining the nation’s health.

Underscoring the need for high-level attention was the CDC’s release of a study on Tuesday showing that 19 states now have an obesity rate above 35 percent – more than double the number meeting that threshold just four years ago.

It’s tempting to dissect the Biden Administration’s strategy, and all the different dimensions of the Wednesday event (which was billed as a “White House” conference despite having been held a few blocks away from 1600 Pennsylvania Avenue). But only time will tell whether the administration is serious about tackling the issue and whether Congress, which gets big money from the food and beverage industry, will support any meaningful reforms.

In the meantime, it’s worth considering one approach to addressing obesity that wasn’t part of the White House conference, nor is it part of the mainstream discussion about how to help people get their weight under control. But it draws on a therapeutic practice pioneered by a group with a remarkable record of effectiveness: Alcoholics Anonymous

Founded in 1935, AA has achieved renown since then, and global membership has been at about 2 million people for more than 20 years. But for most people outside AA, there’s a limited understanding of the group’s unorthodox approach to treatment and the 12 steps members navigate through on their path to recovery.

(I come to this topic with the benefit of having seen friends and family members get sober, and remain sober, thanks to the healing power of AA.)

Something else is not well understood about the group: precisely why it works. The simplest answer is a concept (and a word) that’s weaved into almost everything at AA: fellowship. Members of AA go to meetings with other members, and these meetings frequently involve people discussing how their drinking affected them and those around them, as well as explanations of what they did to stop drinking.

The candor at the meetings, which is enabled by everyone having a cloak of anonymity, gives rise to a support system among the members. And new members have “sponsors,” who are fellow members serving as something resembling mentors on the journey to sobriety. When challenges arise – it could be temptation to drink, resuming drinking, or something else – members are expected to contact their sponsors. The sponsor-member relationship is fundamental to the fellowship within AA.

Keith Humphreys, a professor at Stanford University’s School of Medicine, speaks to the value of this: “If you want to change your behavior, find some other people who are trying to make the same change.”

In March 2020, he published a study that involved evaluating 35 other studies of AA, involving more than 10,000 participants. He concluded that AA was almost always more effective than psychotherapy in getting people to stop drinking. (A Harvard study published in 2011 reached a similar conclusion.)

There’s another reason AA works. There are no dues or fees to attend (though donations are accepted) and meetings are led by AA members, not medical professionals. This is a sharp break with America’s hyper-medicalized society, where the default remedy for every problem is a pill or a procedure.

Can AA’s principles be a guide for those struggling with their weight? There are obvious differences between food and alcohol, starting with the fact that one is necessary for survival and the other is not.

But alcohol is nearly as ubiquitous as food in much of American life. And the principles that guide people who are trying to abstain from alcohol are broadly applicable to other behaviors. Thus the existence of a food-focused version of AA, Overeaters Anonymous, which holds AA-style meetings in the United States and throughout the world.

The fellowship at the heart of AA can also counter the way in which obesity is contagious among family and friends. We know from a study conducted by Yale’s Nicholas Christakis that if your spouse is obese, you are 37 percent more likely to become obese. If you are male, and one of your male friends is obese, the likelihood of becoming obese rises 100 percent.

Applying AA principles to obesity would surely encounter resistance – not least from medical professionals, who can believe their training gives them a monopoly on solutions. Humphreys, at Stanford, has admitted to having been skeptical about AA, thinking, “How dare these people do things that I have all these degrees to do?”

There is not going to be a single measure that will reduce America’s obesity rate, and we can only hope that some of the reforms being advanced by the Biden Administration will bear fruit. But there’s clearly room to experiment with potential remedies, like the AA principles.

The battle against obesity has been underway for several decades and obesity is winning, in a landslide. And it will continue to do so if there are no changes to the country’s public policy environment, the thinking about prevention and treatment, and our obesogenic culture.