Family Meals Focus
The Ellyn Satter Institute Newsletter
Counseling with the Satter Eating Competence Model (ecSatter)
by Ellyn Satter, MS, MSSW, Dietitian and Family Therapist
Conventional nutrition education is head learning: what and how much to eat, correct portion sizes, prepare it this way, avoid this and that. In contrast, you learn Eating Competence with your body. To become Eating Competent, you need new ways of experiencing food so you can respond to it in different and more positive ways. Most of all, you need permission to eat as much as you want of food you enjoy and to share pleasant eating times with others.1
Move away from discussing food and weight
You learn Eating Competence with your body, by experiencing food in new ways so you can respond to it positively.
Because that is what we have taught them, most people come to nutrition counseling wanting advice about keeping their weight and/or doing good-food-bad-food thinking. For years, growing out of nutrition policy, we have been saying, essentially, don’t eat so much, eat this and you will be healthy, don’t eat that or you will be sick. People can’t ask questions about Eating Competence because they don’t know what it is. It is your job to move the discussion from food and weight to Eating Competence, by addressing the experience of eating.
- How do you see to it that you get fed? This addresses eating management overall and emphasizes the bottom line of Eating Competence: being reliable about feeding themselves.
- How do you feel about eating that way? For instance, does your grazing and 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 Eating Competence 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, resolving wants/shoulds conflict with food selection.
Coming out of this general discussion, continue to focus the discussion on eating attitudes and behaviors rather than on food selection. Do they have regular meals? Do they plan for feeding themselves? Are they comfortable with their enjoyment of food and eating? Are they interested in new food, and can they experiment with it? Do they trust themselves to eat enough for them?
Use and interpret ecSI 2.0TM
Along with your interview, giving and scoring ecSI 2.0TM can give you some clues to where your client or audience is having particular difficulties. (But don’t go over the questionnaire with them. That spoils its utility for after-intervention testing.) A score of 32 or above on ecSI 2.0TM gives an indication that they are doing well with eating: they feed themselves reliably, are comfortable with enjoying eating, seek out new food, and are tuned in to their hunger, appetite and satiety. To a score below 32, you could make an observations such as, “it seems you are missing out on enjoyment from your eating.” Often, the problem is their attitude: Maybe they just need to get out from under their draconian rules about food selection or weight, or maybe they need you to give their food your blessings. On the other hand, a score in the teens, combined with interview evidence of serious conflict and anxiety about eating, is likely to mean this person requires treatment, not education.
Perhaps the issue is food acceptance. Gaps in ecSI 2.0TM factors could be precipitated by their thinking they should have more home-cooked meals, eat more vegetables, avoid sweets, or make fewer fast-food jaunts. Your job is to get the “shoulds” out. “If eating that way worked for you, you would have done it already. You can guilt-trip yourself into doing those things, but it won’t last.” With people who want such general help with eating management, most change can revolve around building family meals. “It seems to me that all of the things you want to change relate to meals. Shall we start by taking a look at meals?” Depending on their eating patterns, you might help them get the meal habit by putting structure around what they are currently eating, at the one extreme, or encouraging them to tone down their nutritional over-zealousness, on the other. In the process, you will discover opportunities to neutralize other areas of rigidity, such as by showing them how to matter-of-factly include “forbidden” food or encouraging them to use enough fat and salt in cooking to make their food taste good. Studying the foundational article3 about the definition and evidence for ecSatter will deepen your understanding of eating dynamics so you can address eating attitudes and behaviors. You can also learn from your clients. Once they get the idea of providing structure paired with permission to eat, they will be creative about eating – and thinking and feeling about eating.
ecSatter counseling supports the sDOR
To successfully follow the Satter Division of Responsibility in Feeding with their child, parents often need help becoming Eating Competent. Typical adult eating attitudes and behaviors are anything but Eating Competent: Most people, most of the time, try to eat less to lose or maintain weight, avoid food they think is unhealthy, and force themselves to eat food they think is healthy. Successfully following sDOR means trusting their child to eat a little or a lot, not eat food just because it is nutritious, and grow rapidly or slowly. Parents can only fully trust their child’s eating if they can trust their own ability to eat as much or as little as they want and eat nutritious food because they enjoy it, not because they are supposed to. At the same time, receptive parents can watch their child and learn about Eating Competence from their child’s natural ability to eat as much as s/he is hungry for and gradually learn to enjoy food that parents enjoy.
Some people have entrenched eating problems
Most eating problems can be addressed with primary intervention: the brief education and counseling we have been discussing.2 The person gets it, they go off and make progress on their own, they do some background reading – or not, they come back – or not. If you see them again, you go by what they are working on: you do a bit of encouraging and/or tuning up. On the other hand, an ecSI 2.0TM score in the teens, combined with interview evidence of serious conflict and anxiety about eating, is likely to mean this person requires treatment, not education. Their eating problems are pronounced, firmly established, and difficult to change. Their low ecSI 2.0TM supports your impression that they are seriously upset, the problem is long-standing, and they have tried many solutions without success. Typically, these difficult issues relate to ecSatter subcategories: to food acceptance or food regulation. They may be a chronic failed dieter, be a seriously picky eater, binge and purge, have unstable weight, and/or have pronounced body dissatisfaction. Those folks require a treatment plan and several-session, systematic follow-ups addressing their eating attitudes and behaviors. The How to Eat method has had considerable clinical success with the problems I just described.4,5 ESI teaches that method in the Treating the Dieting Casualty VISION workshop.
Addressing eating instead of teaching food selection takes re-learning
As one of my colleagues said when she was struggling to master counseling with Eating Competence, “Sometimes I would just like to go back to telling them what to eat.” You may feel the same. However, once you gain an appetite, so to speak, for the relationships and dynamics of working with Eating Competence, you won’t want to go back! Keep in mind that for many people, your giving your blessings is enough. In social work graduate school, I learned to make strategic use of myself in helping my patients. Your attitude can heal when you are accepting of your client and their relationship with food, and have the calm conviction that it is okay for them to trust themselves and experience joy from eating. At whatever your level of intervention, your regard and strategic assistance will help set them free to learn and grow on their own.
1. Satter EM; Appendix C, What Surveys Say about our Eating. Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press ; 2008.
4.Harris C, Estes P, Satter E. Feasibility of Using Satter’s How to Eat Method to Improve Eating Competence Among Previous Dieters in a Metropolitan Hospital System Employee Wellness Program. Current Developments in Nutrition. 2020;4(Supplement_2):1307-1307. doi:10.1093/cdn/nzaa059_024
5.Harris C, Crum P, Satter E. Feasibility of Satter’s How to Eat Method Using Two Delivery Modes to Improve Eating Competence Among Previous Dieters in a University Employee Wellness Program. Current Developments in Nutrition. 2020;4(Supplement_2):1306-1306. doi:10.1093/cdn/nzaa059_023
This kind, clear, and matter-of-fact booklet shows you how to eat. Discover the joy of eating and escape from struggling with eating and weight!
- Clearly understand the evidence for ecSatter, its elaboration in the Hierarchy of Food Needs, and application of ecSatter to nutrition education.
- Examine the validation process for the Satter Eating Competence Inventory, ecSI 2.0,TM and what it says about the nature of Eating Competence.
- Understand how to teach Eating Competence. Differentiate between cognitive and experiential education in teaching/acquiring Eating Competence.