Counseling With The Satter Eating Competence Model (ecSatter)

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

Professionals who embrace ecSatter have changed their thinking and practice, but the public is still caught in the nutritional black-and-white thinking of the past 50 years. Folks come into counseling or class asking for advice about what to eat and how to get themselves to eat it. Even though they are caught in the rules, what they really want is to eat enough of food they enjoy and to share rewarding eating times with others.¹ How do you refocus the discussion onto eating competence (EatC) so they replace eating negativity with joy, delight, and peace?

Becoming EatC is experiential

You learn eating competence with your body. To become eating competent, you need new ways of experiencing food so you can respond to it positively.

Conventional nutrition education is head learning: what to eat, correct portion sizes, prepare it this way not that way. Because ecSatter is a biopsychosocial model, becoming EatC is a corrective experience. Focus from the beginning on the experience of eating. The Satter Eating Competence Inventory (ecSI 2.0)² supports that focus. Of the 16 items in ecSI 2.0, only one addresses food selection, and then obliquely: “I consider what is good for me when I eat.” Begin by asking eating-attitude-and-behavior-focused questions:

• How do you see to it that you get fed? This emphasizes the bottom line of EatC: being reliable about feeding themselves.
• How do you feel about eating that way? For instance, does eating in a hit-or-miss fashion work for you?
• What would you like to be different? Don’t settle for food selection answers. Keep asking until you get EatC answers: feeling better about food and weight, being less picky, not being so troubled about how much to eat or how much to weigh, having more enjoyable family meals.

Consider capabilities – or gaps

The individual might already do well with eating: They feed themselves reliably, enjoy eating, seek out new food, are tuned in to their hunger, appetite and satiety, and let their body weigh what it wants to weigh. It could be they just need to get out from under their self-criticism: Feeling they “should” have more home-cooked meals, eat more vegetables, fewer sweets, or make fewer fast-food jaunts. Your job is to get the “shoulds” out. Nutritionitsas—those who devotedly follow the nutrition rules—are the most challenging. (Yes, I made up that word. Do you like it?) They are low in EatC and may not consider change until their nutritional overzealousness causes pain, often to their children and other family members.

Combine positive permimssion and discipline

For an article outlining the content of EatC-focused nutrition education, look here.³ For process, remember that ecSatter is built around the productive tension between positive discipline and unsparing permission. In the words of Becoming Eating Competent (sBEC): “Feed yourself faithfully and give yourself permission to eat.” Get help from my self-help publications.^{4, 5} Help the unstructured eater or family get the meal habit by putting together meals made up of what they currently eat, reassuring them that food doesn’t have to be home-cooked and “healthy” to be worthy of sitting down together, paying attention, and sharing it. In fact, that is the ecSatter definition of a family meal. ESI faculty member Jennifer Harris said it best: “No meal is perfect; eat together anyway.”⁶ You might encourage the nutritionitsa to tone down their nutritional preoccupation, and they might even listen. Deepen your understanding of ecSatter so you can address eating-attitude-and-behavior-related issues as they emerge.^{7, 8} Learn from the people you teach. Once they get a taste of the joy and reward of pairing feeding themselves faithfully with giving themselves permission to eat, they will be creative.

Some have established eating problems

Most eating problems can be addressed with brief intervention. The person gets it, they make progress in session or two or on their own, they do some background reading—or not—they come back—or not. If you see them again, you do a bit of eating attitude-and-behavior-focused encouraging and/or tuning up. Only offer food selection advice if they ask for it, and then always from the point of view of encouraging them to eat what they enjoy. As I said in Secrets of Feeding a Healthy Family, “when the joy goes out of eating, nutrition suffers.” As they gain EatC, their dietary variety and nutritional quality will grow by itself—without any prompting from you.⁹

Some need secondary intervention: Assessment and treatment. The individual’s ecSI 2.0 score may be well below the 32 cutoff, they are seriously rigid and upset about their eating and weight, the problem is long-standing, and they have tried many solutions. Their established issues could be repeat dieting, extreme pickiness and even avoidant/restrictive food intake disorder (ARFID), overeating or binge eating, unstable body weight, or very low physical self-esteem. Those folks can be helped with the “How to Eat” intervention, taught in The Treating the Dieting Casualty Master Course.¹⁰ However, they have to be ready. Most folks have to be so beaten up by failed repeated weight loss attempts or attempts at dietary perfection that they are willing set those impossible goals aside and focus on developing a positive and rewarding relationship with food. Unfortunately, semaglutide drugs have prolonged the time until that happens.

Addressing eating attitudes and behaviors takes relearning

You may feel, as one of my colleagues did when she was struggling to master counseling with EatC, “sometimes I would just like to tell them what to eat.” However, once you gain an appetite, so to speak, for the humanity and dignity of working with EatC, you won’t want to go back. In social work school, I learned to make strategic use of myself in helping my patients. You do the same with your own joy, delight, and peace with eating and your desire for your students to experience the same.