Family Meals Focus

The Ellyn Satter Institute Newsletter

sDOR.2-6y validation transforms nutrition intervention

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

For a PDF of this newsletter, click here.

Nutritionists, health, and mental health professionals have long depended on the Satter Division of Responsibility in Feeding (sDOR) as a practical and common-sense way to help parents be successful with feeding and raise children who eat well.1-4 Although experience has shown that sDOR works, it is only we now have a questionnaire, sDOR.2-6yTM, that can prove that it works. After a decade of rigorous testing, the last link in the chain of evidence gives parents and professionals an achievable way to address their biggest feeding worry: that children are doing well nutritionally.5

Following sDOR is associated with lower child nutritional risk

As indicated by coded video observation, parents who score high on sDOR.2-6y actually do feed in a way that is consistent with sDOR: They do the what, when, and where of feeding and let their child do the how much and whether of eating.6 They also use less restriction and pressure to eat.5 Moreover, and this is the really big news, parents who score high on sDOR.2-6y have children who show lower nutritional risk.5, 7 That means parents can do their feeding jobs and relax, even when children show typically maddening eating behaviors like eating a lot one day and hardly anything the next, eating fruits and vegetables one time and shunning them another, and taking weeks, months, and even years to investigate new food.

Relaxing about children’s eating means a lot! Validation results support what parents say: When feeding goes well, they and their children feel better all day. Parents who feed well—who score high on sDOR.2-6y–report better quality of life indicators that go beyond mealtime. Their stress level is lower, their sleep quality is better, and they are less likely to show uncontrolled or emotional eating. Those who have meals about the same times every day indicate a lower incidence of mood and anxiety disorders.5 They see their children as doing better overall,5, 7 and they are more likely to describe their children as “good eaters.”8

Children’s nutritional well-being can be secured through sDOR and parents’ Eating Competence.

ecSatter is the path to nutritional excellence

sDOR.2-6y validation results put a whole new spin on supporting children nutritionally. Validation work combined with earlier evidence relative to the Satter Eating Competence Model (ecSatter) suggests that children’s nutritional well-being can be secured through parents’ Eating Competence. Adults who are Eating Competent (EC), who score high on the validated Satter Eating Competence Inventory (ecSI 2.0), have more nutritious, higher-quality diets,9, 10 show numerous positive health indicators,9, 11, 12 and do better with respect to food management.13, 14 EC parents score high on sDOR.2-6y. Children of parents who score high on ecSI 2.0 have lower nutritional risk.5, 7

The implications? Instead of telling parents what and/or how much to eat and feed their child, teach parents to follow sDOR and support their Eating Competence. Trust the process. Parents who feel secure and comfortable with getting enough to eat learn and grow in their ability to manage food and achieve dietary variety.15 And they are able to trust their children to eat well.

 EC-consistent questions support parent leadership with feeding

  • How do you see to it that you get fed? How do you go about feeding your family? What would you like to be different?
  • Find out about structure: Do they have regular meals and snacks?
  • What they eat will emerge, but don’t stop at that. Find out how they feel about what they eat and feed their family. Are they ashamed of their food?

EC-consistent interventions support parents’ trust in children’s autonomy with eating

  • Give parents strong permission to eat what they eat. Reassure them of their food’s nutritional value.
  • Encourage them to be faithful about feeding themselves and their family. Discuss organizing the food they currently eat into regular meals and sit-down snacks.
  • Give practical suggestions that support internal regulation: Wait to eat at regular meals and snacks. Go to meals hungry and eat until satisfied. Do it again the next time, and the next.

Support children’s autonomy with eating

In the next issue of Family Meals Focus we will discuss doing parent education and conducting clinical practice in ways that are compatible with giving children autonomy with their eating. Here is a sneak peek at common interfering practices:

  • Insisting family meals be “healthy.”
  • Trying to get children to eat certain foods.
  • Trying to get children to eat less.
  • Identifying children as being incapable with eating and growth.

New directions in research

The validation research is only the beginning. Consider the research questions that can now be answered:

  • Is parents’ ecSI 2.0 and sDOR.2-6y associated with child growth patterns and other physiological parameters?
  • Is parents’ ecSI 2.0 and sDOR.2-6y associated with parents’ executive functioning skills related to organization and strategic planning?
  • How would these questions be answered for families with children who have serious medical conditions?


  1. Satter EM. The feeding relationship. J Am Diet Assoc. 1986;86:352-356.
  2. Satter EM. The feeding relationship: problems and interventions. The Journal of pediatrics. 1990;117:S181-S189. Computer.
  3. Satter EM. Internal regulation and the evolution of normal growth as the basis for prevention of obesity in childhood. J Am Diet Assoc. 1996;96:860-864.
  4. Davies WH, Satter E, Berlin KS, et al. Reconceptualizing feeding and feeding disorders in interpersonal context: The case for a relational disorder. J Fam Psychol. 2006;20:409-417. Computer.
  5. Lohse B, Mitchell DC. Valid and reliable measure of adherence to Satter Division of Responsibility in Feeding. Journal of Nutrition Education and Behavior. 2021:1-12.
  6. Lohse B, Satter E. Use of an observational comparative strategy demonstrated construct validity of a measure to assess adherence to the Satter Division of Responsibility in Feeding. JAND. 2020
  7. Lohse B, Mitchell DC. Valid and reliable measure of adherence to Satter Division of Responsibility in Feeding. JNEB. 2020;(November 12, 2020)
  8. Lohse B, Satter E, Arnold K. Development of a tool to assess adherence to a model of the division of responsibility in feeding young children: using response mapping to capacitate validation measures. Child Obes. Apr 2014;10(2):153-68. doi:10.1089/chi.2013.0085
  9. Lohse B, Psota T, Estruch R, et al. Eating competence of elderly Spanish adults is associated with a healthy diet and a favorable cardiovascular disease risk profile. J Nutr. 2010;140:1322-1327. doi:10.3945/jn.109.120188
  10. Lohse B, Bailey RL, Krall JS, Wall DE, Mitchell DC. Diet quality is related to eating competence in cross-sectional sample of low-income females surveyed in Pennsylvania. Appetite. 2012;58:645-650. doi:10.1016/j.appet.2011.11.022
  11. Psota TL, Lohse B, West SG. Associations between eating competence and cardiovascular disease biomarkers. J Nutr Educ Behav. Sep-Oct 2007;39(5 Suppl):S171-178. doi:10.1016/j.jneb.2007.05.004
  12. Tilles-Tirkkonen T, Aittola K, Männikkö R, et al. Eating Competence Is associated with lower prevalence of obesity and better insulin sensitivity in Finnish adults with increased risk for type 2 diabetes: The StopDia Study. Nutrients. Dec 30 2019;12
  13. Krall JS, Lohse B. Cognitive testing with female nutrition and education assistance program participants informs validity of the Satter eating competence inventory. J Nutr Educ Behav. Jul-Aug 2010;42(4):277-83. doi:10.1016/j.jneb.2009.08.003
  14. Lohse B, Satter E, Horacek T, Gebreselassie T, Oakland MJ. Measuring eating competence: psychometric properties and validity of the ecSatter Inventory. J Nutr Educ Behav. Sep-Oct 2007;39:S154-66. doi:10.1016/j.jneb.2007.04.371
  15. Satter E. Hierarchy of food needs. J Nutr Educ Behav. 2007;39 (5 suppl):S187-188.



Ellyn Satter’s Secrets of Feeding a Healthy Family says the secret of raising a healthy eater is to love good food, enjoy eating, and share that love and enjoyment with your child. When the joy goes out of eating, nutrition suffers. 

Family Meals Focus ~ No. 19


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