Practicing nutritional judo

by Ellyn Satter, MW, MSSW, Dietitian and Family Therapist

What most of us really want with eating is to eat enough of food we genuinely enjoy. Research with the Satter Eating Competence Model indicates that going with that energy, rather than fighting against it, makes us healthier. People who are Eating Competent people do better nutritionally, medically, psychosocially, and with respect to parenting with food and their lifestyle habits are more positive. Here is what to consider when you support your patients in moving themselves along based on ecSatter and the Satter Hierarchy of Food needs.

Prescribed diets overrule food longings

Since the 1970s, nutrition policy has said to eat a lot of fruits and vegetables, lean meat, low-fat dairy products, high-fiber food and less high-fat, high-sugar foods, “empty” calories, and calories, overall in pursuit of disease resistance and recommended weight. It hasn’t worked: Average Healthy Eating Index score, a measure of adherence to the Dietary Guidelines, has remained around 60% during that time. It is difficult to change diet, but not nearly as difficult to learn to feel bad about what we eat. When asked a typical motivational intiewing question, “If you were to change, what would it be like?” we are likely to say, “eat more fruits and vegetables . . . eat less fast food . . . eat less sweets . . . don’t eat so much fast food.” But is that what we really want, or is that what we want to want—or what somebody else wants us to want?

 What we really want

As I observed my patients’ inability to follow prescribed diets during my decades of clinical practice, I discovered that deep in their heart of hearts (or in their taste buds and stomachs), what most people really want is eating as much as they want of food they genuinely enjoy. So why not, I reasoned, practice nutritional judo? Why not go with the energy to eat enough of food they enjoy rather than fighting against it? So my patients and I did just that, and it was a revelation—and a revolution!  People did far better without eat-this-don’t-eat-that guidelines. They had meals, ate a variety of food, and stopped trying to force their weight down only to have it rebound to a higher level. The Satter Eating Competence Model ³ and the Satter Eating Competence Inventory (ecSI)⁴ grew out of that clinical judo work. The rapidly accumulating ecSatter research shows that, like my patients, people who are Eating Competent, those who respect their food wishes and regularly provide themselves with food they enjoy, do better.  

Trust your energy to learn and grow

Nutritional judo works because we are born with the energy to learn and grow. According to Abraham Maslow,⁵ growth occurs on its own, in its own time, in a sequence that addresses our basic needs. From the foundation through the apex on Maslow’s pyramid-shaped hierarchy of growth, those needs are:

1. Physiological needs: air, water, food, shelter, sleep, sex
2. Safety, security, order
3. Social affection: love, belonging
4. Esteem, status; self-esteem and esteem by others
5. Self-actualization: being all the individual can be.

Maslow translates to food needs

The JNEB article, Hierarchy of Food Needs, applies Maslow’s hierarchy to natural adult maturation with food acceptance. It is based on the ecSatter principles of making time to eat, being comfortable with eating as much is wanted of personally enjoyable food, and trusting the body to weigh what is right for it. Judging from the fact that it is the most-often-requested JNEB reprint, the Hierarchy of Food Needs is a concept that has captured the imagination of nutrition professionals.

The same is in Maslow’s hierarchy, as needs at each level of maturation are satisifed, growth unfolds at a subsequent level. Both Maslow and the Satter Food Hierachy say to trust the process. Start at the bottom and take the weeks, months, or years needed to grow through the levels. 

• Take good care of yourself with food. Consider the food that is readily available. Figure out practical and enjoyable ways of providing yourself with three meals a day and sit-down snacks if you need them.
• Eat what you are eating now. Just have it at regular meal- and snack-times.
• Trust yourself to learn and grow. You will move up on the hierarchy when you are ready. Don’t try to push yourself beyond what feels genuinely comfortable to you. You will slow your growth, not speed it up.

Here is what to consider with your patient as they move from the base to the apex of the food hierarchy.

The energy to eat enough

Do you have enough to eat? If you are food insecure, on a weight-reduction diet, or on an airplane with no food stash, your major concern is getting something to eat. The hungrier you are, the more you find high-calorie foods appealing. It is food that quickly fills you up and drives away that compelling and frightening hunger.

If your income is low, you are wise to avoid good-food-bad-food thinking and, instead, follow Eating Competent-consistent strategies that ensure your getting enough to eat: choose whole milk, fry, use butter or margarine on vegetables and on the table, and buy fruit canned in heavy syrup. And do it with a glad heart, without shame or recrimination. All the nutrients are still there, it just has more staying power.

The energy to eat “acceptable” food 

Do you have food you can stomach? Hand in hand with getting enough to eat is having access to food you consider “acceptable.” This is in large part experience-based. We learn from little on which foods are safe and desirable. Midwestern families rarely eat rice and consdier meal without potatoes as lacking. For families of Asian descent it is the opposite. People who have to scrounge for food discover what they can tolerate. One person finds using food stamps or going to food pantries acceptable, another doesn’t.

The energy to have reliable, ongoing access to food

Once today’s needs are satisfied, you can and will naturally begin to consider feeding yourself the next meal and the next day. You can and will do at least some cursory planning for subsequent meals, accumulate a food stash, and save up for food purchases. Having reliable access to enough acceptable food, not just today but also tomorrow and into the indefinite future, gives you food security.

The energy to have good-tasting food

Having achieved food security, your appetite will become more prominent. Most people prioritize taste in food selection, but that is only when they know they will get enough to eat. When you are starving, almost anything tastes good and you settle for “acceptable.” Now that you aren’t starving any more, you get pickier. Honor your appetite. You are entitled. This too, will pass.

The energy to seek novel food

After you have had plenty of time to eat as much as you want of food you enjoy, you will find yourself tiring of even your favorite foods. You will begin taking more interest in new foods or perhaps in familiar foods prepared in novel ways. You will begin to experiment. You will gradually increase the variety in your diet, which will improve its nutritional quality. Better nutrition is a nice side benefit, but don’t make it the primary benefit or you will revert to fighting against, rather than going with, your basic food-seeking energy. Once you have naturally grown to this level on the food hierarchy, you are in good shape nutritionally. Your energy to seek novel food will stay with you, and you will learn and grow nutritionally throughout your life. You will, that is, unless you pervert seeking novel food into a should rather than a want.

The energy to seek instrumental food

This is the level addressed in the item on ecSI 2.0, “I consider what is good for me when I eat.” When you have grown solidly through all of the other parts of the hierarchy, this is a both-and, not an either-or, consideration. You will eat food you enjoy and that you consider is good for you. If you have been traumatized by trying to force yourself to eat by the rules, it will take a long time before you can comfortably consider what is good for you when you eat. This is not to say that you will do poorly nutritionally if you don’t get to this level. Having grown and developed to point of seeking novel food or, before that, seeking good-tasting food, your nutritional status is likely to be just fine.

In skipping over all the other levels of the food hierarchy and concentrating on instrumental food, the Dietary Guidelines traumatizes us. It condemns our natural energy to eat enough of food we genuinely enjoy and create the expectation that we will do the opposite.

When your patient is stuck

Learning and growing through the Food Hierachy depends on permission and positive discipline: Permission from you, and permission from themselves. Your patient may not be able to give themselves permission. They may have struggled for years trying to lose weight or be caught in a whirlwind of what-to-eat-and-not-eat in the name of health or disease management. When they tune in on their eating, especially when they eat food they enjoy, they are hit wiht painful memories, shame, and/or self-cricitism. To avoid those feelings, they may “eat without eating”–eat fast, impulsively, put themselves on automatic pilot, or distract themselves while they eat. 

The How to Eat method taught in the Treating the Dieting Casualty workshop teaches sophisticated psychosocial techniques to help patients resolve their conflict and anxiety about eating. Treating the Dieting Casualty also teaches health professionals to use those techniques without crossing the line into psychotherapy. After three or four sessions the conflict and anxiety subside and the chaos morphs into order. After a few more sessions, the patient discovers their stopping place. It is profoundly moving and joyful. Then, they can trust themselves eat enough, and they can continue the natural processes of learning and growing as described in the Food Hierachy.